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INTERNAL MED 3+ conditions > COPD > Flashcards

COPD Flashcards

1
Q

2 types of COPD

A
  • Emphysema

- Chronic bronchitis

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2
Q

Simple pathology behind COPD

A
  • Airway and/or alveolar abnormalities

- Mixture of small airway disease and parenchymal destruction

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3
Q

Define chronic bronchitis

A

Chronic productive cough for 3 months in 2 successive years - with other causes of chronic cough excluded
- Inflamed bronchi and excessive sputum production

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4
Q

Define emphysema

A

Abnormal and permanent enlargement of the airspaces distal to the terminal bronchioles
- Destruction of airspace walls, without obvious fibrosis

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5
Q

Subtypes of emphysema

A
  • Proximal acinar
  • Panacinar
  • Distal acinar
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6
Q

Gender prevalence COPD

A

M > F

Mortality M = F

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7
Q

COPD is the …. leading cause of death globally

A

5th

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8
Q

Is COPD prevalence increasing/decreasing?

A

Increasing

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9
Q

Prevalence of COPD in the population

A

5-10%

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10
Q

COPD aetiology

A
  • Tobacco smoking (40-70%)
  • Air pollution
  • Occupational exposure
  • Alpha-1-anti trypsin deficiency
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11
Q

Relationship between tobacco smoking and COPD

A
  • Inflammatory response
  • Cilia dysfunction
  • Oxidative injury
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12
Q

Alpha-1-anti trypsin deficiency and COPD

A

Panacinar emphysema at a younger age

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13
Q

With COPD, the prominant pathologic changes are seen where?

A

Airways (changes also seen in lung parenchyma and pulmonary vasculature)

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14
Q

Pathological changes seen in COPD depend on….

A
  • Underlying disease
  • Individual susceptibility
  • Disease severity
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15
Q

Airway changes seen in COPD

A
  • 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)
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16
Q

Cells involved in COPD inflammation

A
  • CD8+
  • T cells
  • Neutrophils
  • Macrophages
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17
Q

Cells involved in asthma inflammation

A
  • CD4+
  • Eosinophils
  • Interleukins
18
Q

Emphysema affects structures …. to the terminal bronchiole

A

Distal

19
Q

What structures make up an acinus

A
  • Alveolar ducts and sacs (with capillaries and interstitium = parenchyma)
20
Q

Proximal acinar emphysema location and cause

A
  • Centrilobar
  • Smoking
  • Pneumoconiosis
21
Q

Panacinar emphysema location and cause

A
  • All parts of the alveolar duct and sac
  • A-1-A deficiency
  • Smoking
22
Q

Distal acinar emphysema location and cause

A
  • Paraseptal

- Spontaneous pneumothorax

23
Q

What happens to pulmonary vasculature in COPD

A
  • Intimal hyperplasia
  • Smooth muscle hypertrophy and hyperplasia
  • Due to chronic hypoxic vasoconstriction of small pulmonary arteries
24
Q

Do eosinophils play a role in COPD

A

No (except for acute exacerbations)

25
Q

Emphysema inflammation causes what to happen

A
  • Elastin breakdown

- Loss of alveolar integrity

26
Q

Chronic bronchitis inflammation causes what to happen

A
  • Ciliary dysfunction

- Increase goblet cell size and number

27
Q

COPD and hyperinflation

A
  • Increased airway resistance
  • Expiratory flow limitation
  • Hyperinflation
28
Q

COPD and hypoxia

A
  • Vascular smooth muscle thickening
  • Leads to pulmonary hypertension
  • Worsens hypoxia
29
Q

3 main symptoms of COPD

A
  • Dyspnoea
  • Chronic cough
  • Sputum production
30
Q

Other symptoms of COPD

A
  • 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)
31
Q

COPD comorbid diseases

A
  • Lung cancer
  • Bronchiectasis
  • CVD
  • Osteoporosis
  • Metabolic syndrome
  • Skeletal muscle weakness
  • Anxiety
  • Depression
32
Q

COPD investigations

A
  • Spirometry
  • CXR
  • Pulse oximetry
  • FBC
  • ECG
  • ABG
  • Sputum culture
  • Chest CT
  • Exercise study
33
Q

Findings on spirometry with COPD

A
  • Decreased FEV1

- Decreased FEV1/FVC (<0.7)

34
Q

Risk factors for COPD

A
  • Cigarette smoking
  • Advanced age
  • Genetic factors
  • White ancestry
  • Exposure to pollution
  • Developmentally abnormal lungs
  • Male
  • Low SES
35
Q

Main goals of treatment of COPD

A
  • Prevent and control symptoms
  • Reduce severity and number of exacerbations
  • Improve respiratory capacity
  • Reduce mortality
36
Q

What is the GOLD criteria for COPD

A
  • 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
37
Q

Treating an acute exacerbation of COPD

A
  1. Short acting bronchodilator (salbutamol)
  2. Systemic corticosteroid
  3. Inhaled corticosteroid
  4. Supplemental O2

Add antibiotics if an infectious exacerbation

38
Q

Ongoing/long term treatment for COPD

A
  1. Short and long acting bronchodilator
  2. Education
  3. Vaccination - influenza and pneumococcal
39
Q

What is the CODEX index for COPD

A
  • Cormorbidities, obstruction, dyspnoea, previous severe exacerbations
40
Q

Complications of COPD

A
  • Cor pulmonale
  • Recurrent pneumonia
  • Depression
  • Pneumothorax
  • Respiratory failure
  • Anaemia (25% of COPD patients are anaemic)
  • Polycythaemia

INTERNAL MED 3+ conditions (18 decks)

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