COPD Flashcards
BAL in COPD shows increased number of what cell types?
Neutrophils and macrophages
Cells recruited and activated in COPD by IL-8 and Leukotriene B4
Neutrophils
Cells in COPD that correlate with severity of COPD
Neutrophils
3 Proteinases secreted by neutrophils in COPD
- Neutrophil Elastase
- Cathepsin
- Proteinase 3
Cells in COPD activated by cigarette smoke
Macrophages
CD4/CD8 shift in COPD
Shift toward CD8
Substance generated from chemical reaction with cigarette smoke and macrophages or neutrophils
Reactive oxygen species (ROS)
Substance that supresses inflammatory genes that is impaired in COPD
Histone deacetylase 2 (HDAC2)
Components of BODE index
BMI, Degree of obstruction, Dyspnea, Exercise capacity
4 Hereditary diseases that cause bullous emphysema
Fabry’s disease (glycosphingolipid accumulation)
Cutis Laxa (lack of elastin fibers in the ECM)
Ehlers-Danlos (defect in collagen)
Marfan’s (Fibrillin-1 formation of ECM)
Increased cancer risk in COPD with smoking and Bullous disease.
Smoking = 5x more risk Bullous = 32x more risk
Effect of cannabis on COPD
Acute = bronchodilator, increase FEV1 by 150-250 ml Chronic = goblet cell hyperplasia and loss of ciliated bronchial epithelium
Effect of neutrophil elastase in COPD
degrades elastin in elastic tissue like alveoli, higher amounts in emphysema
Inhibitor that prevents elastase from destroying lung matrix
Alpha-1 antitrypsin
Treatment which decreases gene expression of pro-inflammatory cytokines in those deficient
Alpha-1 antitrypsin
4 Inflammatory cytokines in pulmonary disease
IL-1b
IL-6
TNF-a
B cell activating factor (BAFF)
Threshold of alpha-1 antitrypsin deficiency in which emphysema is common
< 11
5 most common types of alpha-1 antitrypsin deficiency in order from least to most severe
MM (Normal) SS MZ SZ ZZ
Most common respiratory diagnosis in patients with alpha-1 antitrypsin deficiency prior to the diagnosis of hereditary emphysema
Asthma
7 key features of alpha-1 antitrypsin deficiency
- Early onset emphysema (< 45)
- Lower lobe disease
- Unexplained liver disease
- Necrotizing panniculitis
- C ANCA positive vasculitis
- Family history of COPD, bronchiectasis, panniculitis
- Unremitting asthma with airflow obstruction
Substance that accounts for 50% of COPD in developing countries and is present in 90% of rural households
Biomass fuel (wood, charcoal, vegetable matter, animal dung)
Occupational fumes that are known to cause emphysema
Cadmium
Which is the worse occupational exposure, dust or fumes?
Dust
Most common virus that causes COPD exacerbation
Rhinovirus (over 100 subtypes!)
How does viral infection effect COPD exacerbation
Causes longer time to recovery
Effects of pulmonary rehab in COPD
- Improves exercise capacity and health status
- Reduces readmission in the year following initiation
- Significant reduction in mortality
Minimum time for pulm rehab to be effective
6 weeks
Requirement for roflumilast use
- On max inhaler therapy
- FEV1 < 50%
- Chronic bronchitis subtype
Requirement for macrolide use in copd
Former smoker (doesn’t work in active smoking)
Initial inhaler regimen in GOLD B
LABA or LAMA, combo if fails
Initial inhaler regimen in GOLD C
LAMA, combo LAMA/LABA if fails
Treatment in overlap syndrome that reduces mortality and exacerbations in COPD
CPAP therapy
PA diameter and ratio of PA diameter to ascending aorta measured on CT that are markers of pulmonary vascular remodeling and thus suggest PAH
PA diameter > 28 mm
Ratio > 1
Ratio found on CT that is an independent marker of severe COPD exacerbations and mortality
Pulmonary artery to ascending aorta ratio > 1
4 scoring categories of FEV1 in BODE index
0 points = > 65%
1 point = 50-65%
2 points = 35-50%
3 points = < 35%
4 scoring categories of 6MWT in BODE index
0 points = > 350 m
1 point = 250-350 m
2 points = 150-250 m
3 points = < 150 m
4 scoring categories of mMRC in BODE index
0 points = 0-1
1 point = 2
2 point = 3
3 point = 4
4 year survival BODE index 0-2
80%
4 year survival BODE index 3-4
67%
4 year survival BODE index 5-6
57%
4 year survival BODE index 7-10
18%
total number of segments for calculating post op FEV1
18
Right - 3 upper, 2 middle, 5 lower
Left - 4 upper (lingula included), and 4 lower (no medial-basal on left)
Formula for predicting post op DLCO or FEV1
preoperative value (FEV1 or DLCO) x 1 - (segments to be removed/18)
number of feet in 400 m for shuttle walk
1,333 ft
number of feet in 22 m for stair climb
73 ft
number of feet in 1 flight of stairs
13 ft or 4 m
Threshold for postoperative FEV1 or DLCO to suggest low risk for lung resection
> 60%
Threshold for postoperative FEV1 or LDCO below which you need a CPET
< 30%
Test done for lung resection risk if predicted post operative FEV1 or FVC falls between 30 and 60%
shuttle walk test or stair climb
VO2 max value indicating low risk for lung resection
> 20 ml/kg/min or > 75%
VO2 max value indicating moderate risk for lung resection
10 - 20 ml/kg/min or 35 - 75%
VO2 max value indicating high risk for lung resection
< 10 ml/kg/min or < 35%
PaO2 level on high altitude test that requires in flight oxygen
< 50
2 patient’s who need high altitude test for in flight oxygen
Sats > 95% but desate to < 84% when walking
Sats 92-95% but severe exertion dyspnea
Sat level below which oxygen is required in flight
92% at rest
