COPD Flashcards
caused by
smoking
who is more likely to get it
men working in unskilled manual occupations
complications
- cor pulmonale
- lower tract infections
- depression
what is the overarching characteristic
- airflow limitation
- destruction of lung parenchyma
associated with
- ischaemic heart disease
- hypertension
- diabetes
- heart failure
- cancer
defined by
disease state characterised by airflow limitation that is not fully reversible
what is most common pathological finding
increase number of mucus-secreting goblet cels in bronchial mucosa
pathology in advanced stages
bronchi become overly inflamed and pus is seen in lumen
what is seen microscopically
infiltration of the walls of the bronchi and bronchioles
what is the predominant lymphocytic infiltrate
CD8
what can happen to epithelial layer
can become ulcerated
what metaplasia occurs over time
squamous epithelium replaces columnar cells
when are airways affected
early
what is emphysema
loss of elastic recoil of lung with collapse of small airways
what is pan-acinar emphysema associated with
alpha-1 antitrypsin deficiency
what does inflammation and scarring cause in small airways
narrowing
what does bronchoalveolar lavage and biopsies show
increased numbers of neutrophil granulocytes
what can granulocytes release
elastase and proteases
help produce emphysema
what imbalance is shown
in protease and antiprotease
what antiprotease is inactivated by smoking
alpha1- antitrypsin
what causes mucous gland hypertrophy in larger airways
persistent irritation from inhalation of cigarette smoke
where is alpha1-antitrypsin produced
in liver
where is alpha1-antitrypsin secreted
into blood and diffuses into lung
what dose alpha1-antitrypsin inhibit
neutrophil elastase
what does neutrophil elastase destroy
alveolar wall connective tissue
symptoms
- productive cough
- clear sputum
- wheeze
- breathlessness
- frequent infective exacerbation
when are symptoms worsened
cold or damp weather
what are some systemic effects
- depress
- hypertension
- osteoporosis
- weight loss
- reduce muscle mass
what can patients develop
pulmonary hypertension (cor pulmonale)
what is diagnosis
clinical
what investigations can be done
- Lung function test
- CXR
- CT
- blood gases
- sputum exam
- ECG
- echo
what is the FEV1:FVC ratio
reduced
what is seen on CXR
- overinflation
- flattened diaphragms
- pruned blood vessels
can be normal so would do CT
what causes exacerbation
- step pneumonia
- H.influenza
ECG shows
often normal
in pulmonary hypertension
- tall p wave
- right bundle branch block
- right ventricular hypertrophy
what is the single most useful thing for treatment
smoking cessation
what drugs are used
- beta-adrenoreceptor agonist
- antimuscarinic drug
- theophyllines
example of beta agonist
salbutamol
LAMA example
tiotropium
SAMA example
ipatropium
do theophyllines work for COPD
no
PDE4 inhibitor
roflumilast
how long should prednisolone be given for
2 weeks
in an exacerbation what is oxygen given through
venturi mask
initially 24%
what is there a loss of in emphysema
distal lung parenchyma
causes of centrilobar emphysema
- smoking
- coal dust
where is centrilobar emphysema mostly
upper lobes
where is pan lobar emphysema
lower lobes
who gets pan lobar emphysema
alpha-1 antitrypsin
