COPD Flashcards
What is the main cause/risk factor for COPD?
smoking
Which is the only leading cause of death that is increasing in prevalence?
COPD
Which diseases is only partially reversible: COPD or asthma?
CoPD
What are the 3 mechanisms of COPD that lead to airflow obstruction?
- loss of tethering
- small airway remodeling
- increased mucus secretion
Which alpha-1 antitrypsin deficiency is linked with COPD: PiZZ, PiMZ alone, PiSZ?
PiZZ - linked
PiMZ - requires smoking as well
What is the normal alpha 1 antitrypsin phenotype?
PiMM
Who should get screened for AIATD?
ALL patients diagnosed with COPD (1% of them will have it)
In addition to COPD, what 2 conditions are associated with AIATD?
cirrhosis and lung cancer
Is COPD a neutrophilic or eosinophilic disease?
neutrophilic
Is COPD driven by a TH2 response or a macrophage response?
alveolar macrophage
What do neutrophils release to cause damage in COPD?
elastase
cathepsins
MMPs
what are the 3 hallmarks of tissue damage in COPD?
- obstructive bronchiolitis
- emphysema
- mucus hypersecretion
Are CD8+ cells common to asthma or COPD?
COPD
is LTB4 associated with asthma or COPD? which cells release it?
COPD, macrophages
Which IL attracts neutrophils in COPD?
IL 8
What defines chronic bronchitis?
Chronic bronchitis is a set of symptoms defined as the presence of a productive cough for three months in each of two successive years (that does not have another explanation)
What finding is associated with worse outcomes in COPD?
CD8+ elevation
What effect does CD8+ inflammation in COPD have on the course of the disease?
worsens it by increasing susceptibility to infection
Is basement membrane thickening found in asthma or COPD?
asthma
Is smooth muscle hypertrophy found in asthma or COPD?
asthma
Is mucus gland hyperplasia seen in asthma or COPD?
both
Inflammatory exudate in the lumen, disrupted alveolar attachments, and thickened walls with inflammatory cells in small airways are indicative of which pathologic change in COPD?
peribronchial fibrosis
On CXR, what are two findings associated with COPD?
barrel chesting, flattened diaphragm, and retrosternal clear space
What is the cause of decreased FEV1 in COPD?
PEl is reduced by emphysema and resistance is increased by peribronchial fibrosis and mucus plugging
Among what group is COPD frequently misdiagnosed?
women
FEV1 and quality of life correlated well in COPD, true or false
false.
FEV1 and exercise capacity correlate well in COPD, true or false?
false
In COPD, is inspiratory capacity increased or lowered on exercise? why?
decreased, due to increased end expiratory lung capacity/FRC from dynamic hyperinflation
What effect does a lower IC have on ventilation in COPD?
increased minute ventilation occurs with a small tidal volume, leading to decreased alveolar ventilation and dyspnea on exertion .
All caused by dynamic hyperinflation
In spirometry, what is the minimum requirement for grading COPD on the GOLD standards?
FEV1/FVC < 70%
What grade is considered significant in the mMRC grading of COPD?
grade 2 (slower walking than age or have to stop for breath when walking on level)
In the COPD assessment test (CAT), what is the cut off for significant COPD?
> 10
Why are COPD flare ups (i.e. from infection) a problem?
COPD has ups and downs in lung function that are typically defined by episodes, and irreversible.
What is the D group in COPD severity?
lots of symptoms/flare ups and hospitalizations
What is the C group in COPD severity?
not a lot of symtpoms, but frequent hospitalizations
What is the B group in COPD severity?
lots of symptoms and few hospitalizations. common to have a lot of comorbidities
What is the least severe group in COPD?
A
What is the number one treatment for COPD?
bronchodilators (LAMA or LABA)
If bronchodilators are not sufficient to manage COPD, what do you do?
add inhaled corticosteroids (i.e. its the OPPOSITE from asthma)
What is an important part of the management cycle of COPD?
patients need to increase physical activity to see if the meds are doing anything
What is the 1 year mortality following a COPD exacerbation?
20%
Oxygen, inhaled bronchodilators, systemic CS, antibiotics and ventilatory support are all part of what management in COPD?
exacerbation
what group of cells is commonly affected in both the COPD and asthma processes?
epithelial cells
How is COPD diagnosed?
FEV1/FVC < .70 and nonreversible
What can cause hypoxemia in a COPD exacerbation?
V/Q mismatch and diffusion limitation
A 53 year-old woman with a 40 pack-year history of smoking presents with dyspnea and wheeze. The most likely finding on her PFTs are:
a) Decreased FEV1, decreased FVC and increased FEV1/FVC
b) Normal values for FEV1 and FVC after albuterol
c) Decreased FEV1 and a normal FVC
d) Increased diffusing capacity
c - decreased FEV1 and NORMAL FVC. most likely CoPD.
might also have a decreased DLCO in setting of emphysema
Which of the following best characterizes lung inflammation in COPD?
a) neutrophils, macrophages and CD8 lymphocytes
b) eosinophils and TH2 lymphocytes
c) non caseating granulomas
d) fibroblastic foci
a - CoPD ***
b- asthma
c - sarcoid
d - IPF
Which of the following is true regarding smoking-related COPD?
a) it is not a bronchodilator responsive disease
b) the majority of smokers develop COPD
c) it is invariable progressive after smoking cessation
d) it causes hypoxemia by v/q mismatch (low v/q) and diffusion limitation
d - the two mechanisms for hypoxemia in COPD are low V/q and diffusion limitation
a- can be somewhat responsive, depending on the person, but not fully reversible by bronchodilators
b- not all smokers will get COPD
c - smoking cessation tends to prevent COPD
