COPD Flashcards
What is COPD?
A disease characterised by progressive airflow limitation that is not fully reversible.
What does COPD include?
Chronic bronchitis
Emphysema
What can COPD lead to?
Pulmonary hypertension
Cynosis
Hypoxia
Right heat failure
How is chronic bronchitis diagnosed?
Clinical diagnosis- daily productive cough for 3 months or more in at least 2 consecutive years
How is emphysema diagnosed?
Pathological diagnosis- permanent enlargement and destruction of airspaces distal to the terminal bronchiole
What are the typical characteristics of someone with chronic bronchitis?
Overweight and cyanotic.
Elevated haemoglobin.
Peripheral edema.
Rhonchi and wheezing
What are the typical characteristics of someone with emphysema?
Older and thin.
Severe dyspnea.
Quiet chest.
X-ray hyperinfiltration with flattened diaphragms
What is the UK prevalence of COPD?
1.5%
What are the risk factors to COPD?
Tobacco smoke. Urban pollution. Industrial pollution. Textile dust. Biomass fuels.
What is found in the sputum of i) COPD patients ii) Asthma patients?
COPD-Neutrophil
Asthma-eosinophil
Does COPD have limited or marked hyper-responsiveness?
Limited
What are the mechanisms of airflow reduction in COPD?
Occlusion of airway by mucus.
Thickened airway wall.
Loss of elasticity due to emphysema.
What cells form mucus?
Mucous glands
Goblet cells
What is mucus production controlled by?
Neuronal input and inflammatory mediators
What is there an increased production of in COPD?
Inflammatory cells
Oxidative stress
Viral infection
Bacterial infection
What is there a decreased elimination of in COPD?
Poor ciliary clearance
Airway occlusion
Reduced PEF
Resp muscle weakness
What is mucus secretion regulated by?
Sensory nerve (inhaled irritants-NK1)
Cholinergic nerve-M3
Adrenergic nerve-NA-adrenal gland
Are neutrophil numbers elevated or lowered in COPD during infection?
Elevated
What is the consequence of epithelial damage?
Decrease ciliary cell function.
Increase mucus secretion from goblet cells.
Mucus cell hyperplasia,
Increased bronchial permeability.
What is a cough?
Motor reflex in response to sensing chemicals, particulates and airway excessive mucus.
What are effective at suppressing a cough?
High dose opioids
What is emphysema?
Permanent enlargement of airspaces distal to the terminal bronchiole-destruction of alveolar walls
What has been associated with emphysema?
Decreased serum a1 proteins
What are lung elastases derived from?
Neutrophils and macrophages
What do lung elastases degrade?
Elastin, basement membrane and connective tissue
What cytokines are increased in COPD sputum?
TNF and IL-8
What does TNF do ?
Increases mucin secretion from epithelium and induces elastase production
What do macrophages and neutrophils release in COPD?
Proteases
Reactive oxidant species
What do proteases do in COPD?
Break down connective tissue.
Stimulate mucus hypersecretion
What do reactive oxidant species do?
Damage epithelium
Activate inflammatory genes
What are TGFb and EGF?
Fibroblast growth factors
