COPD Flashcards
1 cause of COPD
cigarette smoking
A heredity deficiency of _____ may result in early onset and severe COPD.
alpha-1 antitrypsin
polymorphisms
genes that code for TNF, surfactant, proteases and antiproteases
- airway inflammation and obstruction of the major and small airways
- chronic productive cough for at least 3 consecutive months over 2 consecutive years
chronic bronchitis
Loss of lung elasticity & abnormal enlargement of the airspaces distal to the terminal bronchioles with destruction of the alveolar walls & capillary beds
emphysema
- permanent dilation of the bronchi and bronchioles
- caused by destruction of the muscle and elastic supporting tissue due to vicious cycles of infection & inflammation
bronchiectasis
onset of COPD
occurs midlife
clinical features of COPD
persistent or worsening dyspnea, chronic cough
pathologic changes in COPD
squamous metaplasia of epithelium, parenchymal destruction, mucus gland metaplasia & enlargement
a respiratory disorder largely caused by smoking, characterized by progressive, partially reversible airway obstruction and lung hyperinflation, systemic manifestations, and increasing frequency and severity of exacerbations.
COPD
occurs with emphysema due to protease mediated degradation of connective tissue elements in the lungs.
loss of lung elastic recoil
occurs due to an imbalance between the lung’s repair and defense mechanisms.
Peribronchiolar fibrosis
contributes to airway remodeling
fibrosis of the small airways
the persistent changes that occur within the structural components of the airways in response to inflammation.
airway remodeling
mucus hyperplasia and increased expression of mucin genes results in…
increased airway secretions
due to hyperactivity of the bronchi with bronchoconstriction due to persistent inflammation
increased tone in airway smooth muscle
first feature of chronic bronchitis
hypersecretion in the large airways
airway obstruction causes….
ventilation-perfusion mismatch, hypercapnia, and hypoxemia.
cor pulmonale
enlargement of the right ventricle
enzymes that digest proteins
proteases
Characterised by a breakdown of elastin in the alveolar septa and bronchial walls as well as breakdown of alveolar and bronchial wall components by proteases
emphysema
where are proteases released from?
neutrophils, alveolar macrophages and other inflammatory cells
____ contributes to air trapping.
decreased elastic recoil in bronchial walls
septal destruction in the alveoli destroys portions of the pulmonary capillary bed causing ______.
ventilation-perfusion mismatch and hypoxemia.
the action of elastin is normally inhibited by ____
alpha-1-antitrypsin
the most serious a1-antitrypsin deficiency is caused by ___
PIZ variant which is found in 5% of the population
what is the most common form of emphysema?
Centriacinar emphysema
- the destruction is confined to the terminal and respiratory bronchioles.
- upper parts of the lung
centriacinar emphysema
- there is involvement of the peripheral alveoli and later the more central bronchioles.
- lower parts of the lung
panacinar emphysema
this form of emphysema is more common in individuals with inherited a1-antitrypsin deficiency
panacinar emphysema
appearance of barrel chest is due to
air trapping
expanded thorax results in
decreased tidal volume, hypoventilation and hypercapnia
____ is a central feature of COPD
inflammation
leads to damage & remodeling of the lung parenchyma -> airflow limtiation
inflammation
___ immunity activated at all stages of COPD
innate
____ immunity activated in more severe disease
adaptive
____ mediate both types of immunity
cytolines
___ likely link innate and adaptive immunity in COPD
dendritic cells
what are the most important inflammatory cells in COPD?
neutrophils, macrophages and CD8+ T lymphocytes
what are the most important proteases involved in emphysema?
Elastases, cathepsins and matrix metalloproteinases
secrete inflammatory mediators that active neutrophils and CD8+ T lymphocytes.
macrophages
secrete inflammatory mediators that active neutrophils and CD8+ T lymphocytes.
TNF-a
activates macrophages to secrete inflammatory cytokines, chemokines and matrix metalloproteinase.
IL-B
s a link between innate and acquired immunity and stimulates C-reactive protein release from the liver.
IL-6
is newly described pro-inflammatory cytokine and is correlated with disease severity.
IL-32
- belongs to the IL-7 family
- plays a role in dendritic cell programming by stimulating specific chemokines which then attract T helper lymphocytes and cytotoxic T lymphocytes
Thymic stromal lymphopoeitin (TSLP)
induce leukocyte chemotaxis specifically promoting neutrophil activation and migration.
Chemockines, growth factors, anti-inflammatory cytokines
It plays an important role in regulating energy and is decreased in persons with COPD.
leptin
An elevated ____ during exacerbations is correlated with the severity of exacerbations
serum amyloid A
increased ____ has been linked to health and exercise capacity and appears to be a significant predictor of BMI.
CRP
may be caused by disturbances in ventilation, gas exchange or ventilation-perfusion relationships as well as increase work of breathing or diseases that damage the lung parenchyma.
dyspnea
occurs as breathing with effort depletes energy stores.
fatigue and exercise intolerance
is a reflex that is stimulated in COPD by excessive secretions and/or inhaled irritants
cough
is caused by inflammation in the airways
sputum production
occurs as air passes through narrowed airways
wheezing
often seen due to prolonged expiratory phase.
hypoventilation
may be present related to inadequate gas exchange in COPD.
hypoxemia
helps to prevent expiratory airway collapse.
pursed lip breathing
is caused by hypoxemia.
cyanosis
are caused by abnormal secretions, mucus or fluid in the airways.
crackles
usually associated with upper airway obstruction
inspiratory wheezing
usually associated with lower airway obstruction
expiratory wheezing
indicates more advanced disease
FEV1 <80%
not always reduced in early stages of COPD
FVC
confirms airflow limitation
FEV1/FVC post-bronchodilatory <0.70
main pharmacological therapy for COPD
bronchodilators
decrease bronchoconstriction by reducing muscle tone and glandular mucus.
inhaled anticholingeric
It is important to identify the _____ names and what they are prior to administering
generic
can also be used especially in patients with significant mucus hypersecretion.
mucolytics
third line treatment
methylxanthines
the only intervention shown to slow the rate of lung function decline.
smoking cessation
