COPD Flashcards
What is the definition of COPD?
COPD is defined as “progressive airway obstruction which does not change markedly over several months”
It is characterised by persistent airflow obstruction which is poorly reversible and usually progressive, The obstructive elements of the disease is important; it is the obstruction to airflow which causes the disabling symptoms of breathlessness and impairs quality of life.
What is the definition of COPD?
COPD is defined as “progressive airway obstruction which does not change markedly over several months”
It is characterised by persistent airflow obstruction which is poorly reversible and usually progressive, The obstructive elements of the disease is important; it is the obstruction to airflow which causes the disabling symptoms of breathlessness and impairs quality of life.
What is the definition of COPD?
COPD is defined as “progressive airway obstruction which does not change markedly over several months”
It is characterised by persistent airflow obstruction which is poorly reversible and usually progressive, The obstructive elements of the disease is important; it is the obstruction to airflow which causes the disabling symptoms of breathlessness and impairs quality of life.
What is the definition of COPD?
COPD is defined as “progressive airway obstruction which does not change markedly over several months”
It is characterised by persistent airflow obstruction which is poorly reversible and usually progressive, The obstructive elements of the disease is important; it is the obstruction to airflow which causes the disabling symptoms of breathlessness and impairs quality of life.
What is the definition of COPD?
COPD is defined as “progressive airway obstruction which does not change markedly over several months”
It is characterised by persistent airflow obstruction which is poorly reversible and usually progressive, The obstructive elements of the disease is important; it is the obstruction to airflow which causes the disabling symptoms of breathlessness and impairs quality of life.
What is the definition of COPD?
COPD is defined as “progressive airway obstruction which does not change markedly over several months”
It is characterised by persistent airflow obstruction which is poorly reversible and usually progressive, The obstructive elements of the disease is important; it is the obstruction to airflow which causes the disabling symptoms of breathlessness and impairs quality of life.
What is the definition of COPD?
COPD is defined as “progressive airway obstruction which does not change markedly over several months”
It is characterised by persistent airflow obstruction which is poorly reversible and usually progressive, The obstructive elements of the disease is important; it is the obstruction to airflow which causes the disabling symptoms of breathlessness and impairs quality of life.
What is the definition of COPD?
COPD is defined as “progressive airway obstruction which does not change markedly over several months”
It is characterised by persistent airflow obstruction which is poorly reversible and usually progressive, The obstructive elements of the disease is important; it is the obstruction to airflow which causes the disabling symptoms of breathlessness and impairs quality of life.
What is the definition of COPD?
COPD is defined as “progressive airway obstruction which does not change markedly over several months”
It is characterised by persistent airflow obstruction which is poorly reversible and usually progressive, The obstructive elements of the disease is important; it is the obstruction to airflow which causes the disabling symptoms of breathlessness and impairs quality of life.
What is the definition of COPD?
COPD is defined as “progressive airway obstruction which does not change markedly over several months”
It is characterised by persistent airflow obstruction which is poorly reversible and usually progressive, The obstructive elements of the disease is important; it is the obstruction to airflow which causes the disabling symptoms of breathlessness and impairs quality of life.
What is the definition of COPD?
COPD is defined as “progressive airway obstruction which does not change markedly over several months”
It is characterised by persistent airflow obstruction which is poorly reversible and usually progressive, The obstructive elements of the disease is important; it is the obstruction to airflow which causes the disabling symptoms of breathlessness and impairs quality of life.
What is the definition of COPD?
COPD is defined as “progressive airway obstruction which does not change markedly over several months”
It is characterised by persistent airflow obstruction which is poorly reversible and usually progressive, The obstructive elements of the disease is important; it is the obstruction to airflow which causes the disabling symptoms of breathlessness and impairs quality of life.
What is the definition of COPD?
COPD is defined as “progressive airway obstruction which does not change markedly over several months”
It is characterised by persistent airflow obstruction which is poorly reversible and usually progressive, The obstructive elements of the disease is important; it is the obstruction to airflow which causes the disabling symptoms of breathlessness and impairs quality of life.
What is the definition of COPD?
COPD is defined as “progressive airway obstruction which does not change markedly over several months”
It is characterised by persistent airflow obstruction which is poorly reversible and usually progressive, The obstructive elements of the disease is important; it is the obstruction to airflow which causes the disabling symptoms of breathlessness and impairs quality of life.
What is the definition of COPD?
COPD is defined as “progressive airway obstruction which does not change markedly over several months”
It is characterised by persistent airflow obstruction which is poorly reversible and usually progressive, The obstructive elements of the disease is important; it is the obstruction to airflow which causes the disabling symptoms of breathlessness and impairs quality of life.
What is the definition of COPD?
COPD is defined as “progressive airway obstruction which does not change markedly over several months”
It is characterised by persistent airflow obstruction which is poorly reversible and usually progressive, The obstructive elements of the disease is important; it is the obstruction to airflow which causes the disabling symptoms of breathlessness and impairs quality of life.
What is the definition of COPD?
COPD is defined as “progressive airway obstruction which does not change markedly over several months”
It is characterised by persistent airflow obstruction which is poorly reversible and usually progressive, The obstructive elements of the disease is important; it is the obstruction to airflow which causes the disabling symptoms of breathlessness and impairs quality of life.
Define chronic bronchitis
‘cough productive of sputum for 3 consecutive months for 2 consecutive years which cannot be attributed to other cardiac or pulmonary disease’.
Define Emphysema
‘permanent dilatation of the airways distal to the terminal bronchiole’. It is an ‘apparent’ dilatation of airspaces but is, in fact, due to destruction of alveolar walls.
What is the most common cause of COPD?
tobacco smoking
Define chronic bronchitis
‘cough productive of sputum for 3 consecutive months for 2 consecutive years which cannot be attributed to other cardiac or pulmonary disease’.
Define Emphysema
‘permanent dilatation of the airways distal to the terminal bronchiole’. It is an ‘apparent’ dilatation of airspaces but is, in fact, due to destruction of alveolar walls.
What is the most common cause of COPD?
Tobacco smoking. Other factors include occupation (especially those associated with dust e.g. mining) and anti-trypsin deficiency.
Define chronic bronchitis
‘cough productive of sputum for 3 consecutive months for 2 consecutive years which cannot be attributed to other cardiac or pulmonary disease’.
Define Emphysema
‘permanent dilatation of the airways distal to the terminal bronchiole’. It is an ‘apparent’ dilatation of airspaces but is, in fact, due to destruction of alveolar walls.
What is the most common cause of COPD?
Tobacco smoking. Other factors include occupation (especially those associated with dust e.g. mining) and anti-trypsin deficiency.
Define chronic bronchitis
‘cough productive of sputum for 3 consecutive months for 2 consecutive years which cannot be attributed to other cardiac or pulmonary disease’.
Define Emphysema
‘permanent dilatation of the airways distal to the terminal bronchiole’. It is an ‘apparent’ dilatation of airspaces but is, in fact, due to destruction of alveolar walls.
What is the most common cause of COPD?
Tobacco smoking. Other factors include occupation (especially those associated with dust e.g. mining) and anti-trypsin deficiency.
In COPD what causes the airflow obstruction?
The airflow obstruction is the result of damage to both small conducting airways and alveoli.
Define chronic bronchitis
‘cough productive of sputum for 3 consecutive months for 2 consecutive years which cannot be attributed to other cardiac or pulmonary disease’.
Define Emphysema
‘permanent dilatation of the airways distal to the terminal bronchiole’. It is an ‘apparent’ dilatation of airspaces but is, in fact, due to destruction of alveolar walls.
What is the most common cause of COPD?
Tobacco smoking. Other factors include occupation (especially those associated with dust e.g. mining) and anti-trypsin deficiency.
In COPD what causes the airflow obstruction?
The airflow obstruction is the result of damage to both small conducting airways and alveoli.
What are the different levels of the airway that are affected by smoking?
Bronchi
Small airways
Respiratory bronchioles
How does smoking effect the bronchi in COPD?
Hyperplasia of mucus-producing glands in the submucosa and hyperplasia of goblet cells on the surface epithelium → increased sputum production.
How does smoking effect the small airways in COPD?
Chronic inflammation → healing by fibrosis → stenosis of airways.
How does smoking effect the respiratory bronchioles in COPD?
Destruction of the walls with loss of the elastic tissue but without significant fibrosis → airway dilatation → emphysema.
What 2 major effects does destruction of the lungs by smoking have?
- Loss of pulmonary surface area for gas exchange → hypoxia.
- Loss of the elastic tissue of the terminal airways results in loss of the natural recoil of the lungs → this contributes to the reduction in airflow on expiration ie. airflow obstruction.
Remember: In normal lungs, the elastic recoil acts to collapse the lung and is opposed by negative intrapleural pressure which maintains lung expansion.
What is the protease/antiprotease hypothesis?
The protease/antiprotease hypothesis may account for the lung destruction in emphysema. Smoking causes increased number of activated neutrophils in the lung where they release protease enzymes such as elastase. In addition, smoking inhibits the lung’s natural protease inhibitor enzymes e.g. a1-antitrypsin.
Therefore, large amounts of active elastase can enter the lung interstitium, bind to and degrade elastin, which results in destruction and enlargement of the distal airspaces.
Define chronic bronchitis
‘cough productive of sputum for 3 consecutive months for 2 consecutive years which cannot be attributed to other cardiac or pulmonary disease’.
Define Emphysema
‘permanent dilatation of the airways distal to the terminal bronchiole’. It is an ‘apparent’ dilatation of airspaces but is, in fact, due to destruction of alveolar walls.
What is the most common cause of COPD?
Tobacco smoking. Other factors include occupation (especially those associated with dust e.g. mining) and anti-trypsin deficiency.
In COPD what causes the airflow obstruction?
The airflow obstruction is the result of damage to both small conducting airways and alveoli.
What are the different levels of the airway that are affected by smoking?
Bronchi
Small airways
Respiratory bronchioles
How does smoking effect the bronchi in COPD?
Hyperplasia of mucus-producing glands in the submucosa and hyperplasia of goblet cells on the surface epithelium → increased sputum production.
How does smoking effect the small airways in COPD?
Chronic inflammation → healing by fibrosis → stenosis of airways.
How does smoking effect the respiratory bronchioles in COPD?
Destruction of the walls with loss of the elastic tissue but without significant fibrosis → airway dilatation → emphysema.
What 2 major effects does destruction of the lungs by smoking have?
- Loss of pulmonary surface area for gas exchange → hypoxia.
- Loss of the elastic tissue of the terminal airways results in loss of the natural recoil of the lungs → this contributes to the reduction in airflow on expiration ie. airflow obstruction.
Remember: In normal lungs, the elastic recoil acts to collapse the lung and is opposed by negative intrapleural pressure which maintains lung expansion.
What is the protease/antiprotease hypothesis?
The protease/antiprotease hypothesis may account for the lung destruction in emphysema. Smoking causes increased number of activated neutrophils in the lung where they release protease enzymes such as elastase. In addition, smoking inhibits the lung’s natural protease inhibitor enzymes e.g. a1-antitrypsin.
Therefore, large amounts of active elastase can enter the lung interstitium, bind to and degrade elastin, which results in destruction and enlargement of the distal airspaces.
What is a1-antitrypsin deficiency?
It is an inherited deficiency of a1-antitrypsin leading to the premature onset of COPD due to widespread emphysematous change in the lungs. Affected patients may also develop liver cirrhosis.
Define chronic bronchitis
‘cough productive of sputum for 3 consecutive months for 2 consecutive years which cannot be attributed to other cardiac or pulmonary disease’.
Define Emphysema
‘permanent dilatation of the airways distal to the terminal bronchiole’. It is an ‘apparent’ dilatation of airspaces but is, in fact, due to destruction of alveolar walls.
What is the most common cause of COPD?
Tobacco smoking. Other factors include occupation (especially those associated with dust e.g. mining) and anti-trypsin deficiency.
In COPD what causes the airflow obstruction?
The airflow obstruction is the result of damage to both small conducting airways and alveoli.
What are the different levels of the airway that are affected by smoking?
Bronchi
Small airways
Respiratory bronchioles
How does smoking effect the bronchi in COPD?
Hyperplasia of mucus-producing glands in the submucosa and hyperplasia of goblet cells on the surface epithelium → increased sputum production.
How does smoking effect the small airways in COPD?
Chronic inflammation → healing by fibrosis → stenosis of airways.
How does smoking effect the respiratory bronchioles in COPD?
Destruction of the walls with loss of the elastic tissue but without significant fibrosis → airway dilatation → emphysema.
What 2 major effects does destruction of the lungs by smoking have?
- Loss of pulmonary surface area for gas exchange → hypoxia.
- Loss of the elastic tissue of the terminal airways results in loss of the natural recoil of the lungs → this contributes to the reduction in airflow on expiration ie. airflow obstruction.
Remember: In normal lungs, the elastic recoil acts to collapse the lung and is opposed by negative intrapleural pressure which maintains lung expansion.
What is the protease/antiprotease hypothesis?
The protease/antiprotease hypothesis may account for the lung destruction in emphysema. Smoking causes increased number of activated neutrophils in the lung where they release protease enzymes such as elastase. In addition, smoking inhibits the lung’s natural protease inhibitor enzymes e.g. a1-antitrypsin.
Therefore, large amounts of active elastase can enter the lung interstitium, bind to and degrade elastin, which results in destruction and enlargement of the distal airspaces.
What is a1-antitrypsin deficiency?
It is an inherited deficiency of a1-antitrypsin leading to the premature onset of COPD due to widespread emphysematous change in the lungs. Affected patients may also develop liver cirrhosis.
Clinical presentation of COPD
The earliest symptom in the natural history of COPD is usually cough and sputum production – reflecting involvement of larger airways.
If susceptible individuals continue to smoke, their small airways become increasingly obstructed until eventually the patient suddenly develops breathlessness on exertion.
With advanced disease, breathlessness occurs upon minimal exertion and then at rest. Death in COPD is usually from bronchopneumonia, respiratory or heart failure.
Role of spirometry in the diagnosis of COPD
Spirometry confirms the diagnosis of COPD by demonstrating airflow obstruction.
Cause of acute exacerbation in COPD?
Infection (either bacterial or viral) is the most common cause of an acute exacerbation of COPD. Other less common causes include pneumothorax, PE, LVF and lung carcinoma.
Difference between infection in COPD and infection in pneumonia?
The airways are the focus of infection in an infective exacerbation of COPD - CXR shows clear lung fields - Most common organisms = H. influenzae, M Catarrhalis, S. pneumonia and viruses.
This is different from pneumonia, where the infection is centred on the alveoli - CXR shows consolidation - Most common organisms = S. pneumoniae, H influenzae, viruses, atypical organisms.
Long term complications of COPD
COPD is the most common cause of cor pulmonale (right heart failure due to lung disease). COPD causes changes in the pulmonary circulation:
• emphysema causes loss of pulmonary arterioles and capillaries.
• chronic hypoxia causes pulmonary arterial vasoconstriction.
• chronic hypoxia causes increased erythropoietin production by the kidney resulting in increased RBC production (erythrocytosis) and consequently increased blood viscosity.
All these changes contribute to the gradual development of pulmonary hypertension.
Define chronic bronchitis
‘cough productive of sputum for 3 consecutive months for 2 consecutive years which cannot be attributed to other cardiac or pulmonary disease’.
Define Emphysema
‘permanent dilatation of the airways distal to the terminal bronchiole’. It is an ‘apparent’ dilatation of airspaces but is, in fact, due to destruction of alveolar walls.
What is the most common cause of COPD?
Tobacco smoking. Other factors include occupation (especially those associated with dust e.g. mining) and anti-trypsin deficiency.
In COPD what causes the airflow obstruction?
The airflow obstruction is the result of damage to both small conducting airways and alveoli.
What are the different levels of the airway that are affected by smoking?
Bronchi
Small airways
Respiratory bronchioles
How does smoking effect the bronchi in COPD?
Hyperplasia of mucus-producing glands in the submucosa and hyperplasia of goblet cells on the surface epithelium → increased sputum production.
How does smoking effect the small airways in COPD?
Chronic inflammation → healing by fibrosis → stenosis of airways.
How does smoking effect the respiratory bronchioles in COPD?
Destruction of the walls with loss of the elastic tissue but without significant fibrosis → airway dilatation → emphysema.
What 2 major effects does destruction of the lungs by smoking have?
- Loss of pulmonary surface area for gas exchange → hypoxia.
- Loss of the elastic tissue of the terminal airways results in loss of the natural recoil of the lungs → this contributes to the reduction in airflow on expiration ie. airflow obstruction.
Remember: In normal lungs, the elastic recoil acts to collapse the lung and is opposed by negative intrapleural pressure which maintains lung expansion.
What is the protease/antiprotease hypothesis?
The protease/antiprotease hypothesis may account for the lung destruction in emphysema. Smoking causes increased number of activated neutrophils in the lung where they release protease enzymes such as elastase. In addition, smoking inhibits the lung’s natural protease inhibitor enzymes e.g. a1-antitrypsin.
Therefore, large amounts of active elastase can enter the lung interstitium, bind to and degrade elastin, which results in destruction and enlargement of the distal airspaces.
What is a1-antitrypsin deficiency?
It is an inherited deficiency of a1-antitrypsin leading to the premature onset of COPD due to widespread emphysematous change in the lungs. Affected patients may also develop liver cirrhosis.
Clinical presentation of COPD
The earliest symptom in the natural history of COPD is usually cough and sputum production – reflecting involvement of larger airways.
If susceptible individuals continue to smoke, their small airways become increasingly obstructed until eventually the patient suddenly develops breathlessness on exertion.
With advanced disease, breathlessness occurs upon minimal exertion and then at rest. Death in COPD is usually from bronchopneumonia, respiratory or heart failure.
Role of spirometry in the diagnosis of COPD
Spirometry confirms the diagnosis of COPD by demonstrating airflow obstruction.
Cause of acute exacerbation in COPD?
Infection (either bacterial or viral) is the most common cause of an acute exacerbation of COPD. Other less common causes include pneumothorax, PE, LVF and lung carcinoma.
Difference between infection in COPD and infection in pneumonia?
The airways are the focus of infection in an infective exacerbation of COPD - CXR shows clear lung fields - Most common organisms = H. influenzae, M Catarrhalis, S. pneumonia and viruses.
This is different from pneumonia, where the infection is centred on the alveoli - CXR shows consolidation - Most common organisms = S. pneumoniae, H influenzae, viruses, atypical organisms.
Long term complications of COPD
COPD is the most common cause of cor pulmonale (right heart failure due to lung disease). COPD causes changes in the pulmonary circulation:
• emphysema causes loss of pulmonary arterioles and capillaries.
• chronic hypoxia causes pulmonary arterial vasoconstriction.
• chronic hypoxia causes increased erythropoietin production by the kidney resulting in increased RBC production (erythrocytosis) and consequently increased blood viscosity.
All these changes contribute to the gradual development of pulmonary hypertension.
Define chronic bronchitis
‘cough productive of sputum for 3 consecutive months for 2 consecutive years which cannot be attributed to other cardiac or pulmonary disease’.
Define Emphysema
‘permanent dilatation of the airways distal to the terminal bronchiole’. It is an ‘apparent’ dilatation of airspaces but is, in fact, due to destruction of alveolar walls.
What is the most common cause of COPD?
Tobacco smoking. Other factors include occupation (especially those associated with dust e.g. mining) and anti-trypsin deficiency.
In COPD what causes the airflow obstruction?
The airflow obstruction is the result of damage to both small conducting airways and alveoli.
What are the different levels of the airway that are affected by smoking?
Bronchi
Small airways
Respiratory bronchioles
How does smoking effect the bronchi in COPD?
Hyperplasia of mucus-producing glands in the submucosa and hyperplasia of goblet cells on the surface epithelium → increased sputum production.
How does smoking effect the small airways in COPD?
Chronic inflammation → healing by fibrosis → stenosis of airways.
How does smoking effect the respiratory bronchioles in COPD?
Destruction of the walls with loss of the elastic tissue but without significant fibrosis → airway dilatation → emphysema.
