COPD Flashcards
2 types of COPD
- Emphysema
- Chronic bronchitis
Simple pathology behind COPD
- Airway and/or alveolar abnormalities
- Mixture of small airway disease and parenchymal destruction
Define chronic bronchitis
Chronic productive cough for 3 months in 2 successive years - with other causes of chronic cough excluded
- Inflamed bronchi and excessive sputum production
Define emphysema
Abnormal and permanent enlargement of the airspaces distal to the terminal bronchioles
- Destruction of airspace walls, without obvious fibrosis
Subtypes of emphysema
- Proximal acinar
- Panacinar
- Distal acinar
Gender prevalence COPD
M > F
Mortality M = F
COPD is the …. leading cause of death globally
5th
Is COPD prevalence increasing/decreasing?
Increasing
Prevalence of COPD in the population
5-10%
COPD aetiology
- Tobacco smoking (40-70%)
- Air pollution
- Occupational exposure
- Alpha-1-anti trypsin deficiency
Relationship between tobacco smoking and COPD
- Inflammatory response
- Cilia dysfunction
- Oxidative injury
Alpha-1-anti trypsin deficiency and COPD
Panacinar emphysema at a younger age
With COPD, the prominant pathologic changes are seen where?
Airways (changes also seen in lung parenchyma and pulmonary vasculature)
Pathological changes seen in COPD depend on….
- Underlying disease
- Individual susceptibility
- Disease severity
Airway changes seen in COPD
- Chronic inflammation
- Increased number of goblet cells
- Mucus gland hyperplasia
- Fibrosis
- Narrowing
- Decreased number of small airways
- Airway collapse (loss of tethering caused by alveolar wall destruction in emphysema)
Cells involved in COPD inflammation
- CD8+
- T cells
- Neutrophils
- Macrophages
Cells involved in asthma inflammation
- CD4+
- Eosinophils
- Interleukins
Emphysema affects structures …. to the terminal bronchiole
Distal
What structures make up an acinus
- Alveolar ducts and sacs (with capillaries and interstitium = parenchyma)
Proximal acinar emphysema location and cause
- Centrilobar
- Smoking
- Pneumoconiosis
Panacinar emphysema location and cause
- All parts of the alveolar duct and sac
- A-1-A deficiency
- Smoking
Distal acinar emphysema location and cause
- Paraseptal
- Spontaneous pneumothorax
What happens to pulmonary vasculature in COPD
- Intimal hyperplasia
- Smooth muscle hypertrophy and hyperplasia
- Due to chronic hypoxic vasoconstriction of small pulmonary arteries
Do eosinophils play a role in COPD
No (except for acute exacerbations)
Emphysema inflammation causes what to happen
- Elastin breakdown
- Loss of alveolar integrity
Chronic bronchitis inflammation causes what to happen
- Ciliary dysfunction
- Increase goblet cell size and number
COPD and hyperinflation
- Increased airway resistance
- Expiratory flow limitation
- Hyperinflation
COPD and hypoxia
- Vascular smooth muscle thickening
- Leads to pulmonary hypertension
- Worsens hypoxia
3 main symptoms of COPD
- Dyspnoea
- Chronic cough
- Sputum production
Other symptoms of COPD
- Wheeze
- Course crackles
- Chest tightness
- Cough syncope
- Weigh loss of gain
- Use of accessory muscles
- Intercostal retraction
- Barrel chest
- Hyperresonance
- Quiet/absent breath sounds
- Asterixis (hypercapnia)
COPD comorbid diseases
- Lung cancer
- Bronchiectasis
- CVD
- Osteoporosis
- Metabolic syndrome
- Skeletal muscle weakness
- Anxiety
- Depression
COPD investigations
- Spirometry
- CXR
- Pulse oximetry
- FBC
- ECG
- ABG
- Sputum culture
- Chest CT
- Exercise study
Findings on spirometry with COPD
- Decreased FEV1
- Decreased FEV1/FVC (<0.7)
Risk factors for COPD
- Cigarette smoking
- Advanced age
- Genetic factors
- White ancestry
- Exposure to pollution
- Developmentally abnormal lungs
- Male
- Low SES
Main goals of treatment of COPD
- Prevent and control symptoms
- Reduce severity and number of exacerbations
- Improve respiratory capacity
- Reduce mortality
What is the GOLD criteria for COPD
- Global initiative for chronic obstructive lung disease
- Assess different stages of COPD
- > 18 years old and already diagnosed via spirometry
- Guides treatment
- Group A-D
Treating an acute exacerbation of COPD
- Short acting bronchodilator (salbutamol)
- Systemic corticosteroid
- Inhaled corticosteroid
- Supplemental O2
Add antibiotics if an infectious exacerbation
Ongoing/long term treatment for COPD
- Short and long acting bronchodilator
- Education
- Vaccination - influenza and pneumococcal
What is the CODEX index for COPD
- Cormorbidities, obstruction, dyspnoea, previous severe exacerbations
Complications of COPD
- Cor pulmonale
- Recurrent pneumonia
- Depression
- Pneumothorax
- Respiratory failure
- Anaemia (25% of COPD patients are anaemic)
- Polycythaemia
