COPD Flashcards
Is it true that COPD is mainly underdiagnosed?
True
What percentage of people diagnosed with COPD are smokers?
15-20%
What genes play a role in the etiology of COPD?
TNF, surfactant, proteases and antiproteases
Inherited mutation in alpha-1 _ gene leads to _ deficiency
antitrypsin; AAT
True or false: Impairment of fetal development resulting in low birthweight is a predisposing factor to COPD
True
True or false: Infants who develop bronchopulmonary dysplasia are susceptible to developing COPD
True
What are the 3 COPD phenotypes?
Chronic bronchitis, emphysema, bronchiectasis
What phenotype is characterized by airway inflammation and obstruction of the major and small airways?
chronic bronchitis
What phenotype has a productive cough for at least 3 consecutive months over 2 years to be diagnosed?
chronic bronchitis
What phenotype is characterized by loss of lung elasticity and abnormal enlargement of the airspaces distal to the terminal bronchioles with destruction of the alveolar walls and capillary beds?
Emphysema
What is bronchiectasis?
Permanent dilation of the bronchi and bronchioles due to destruction of the muscle and elastic supporting tissue
T/F: Sinitus is a commonly seen in past medical Hx of patients with COPD
False
T/F: acute eosinophilic inflammation is seen within the bronchioles in COPD
False, this type of inflammation is seen in asthma
What is the chronic obstruction of the airways due to inflammation and irreversibility characteristics of?
COPD
T/F: The pathologic changes of COPD include squamous metaplasia of epithelium, parenchymal destruction, mucus gland metaplasia and enlargement
True
T/F: The pathologic changes of COPD include fragile epithelium, thickening of basement membrane, mucus gland metaplasia and enlargement
False; this is true of asthma
What causes the loss of lung elastic recoil in COPD?
The proteases mediate degradation of connective tissue elements in the lungs
_fibrosis is caused by the imbalance of the lungs repair and defense mechanisms
Peribronchiolar
What is the key factor in developing irreversible airflow limitation seen in COPD?
Fibrosis of the small airways leading to remodeling
Inflammation and _ injury play a role in mucus hypersecretion
oxidant
Increased tone n airway SM due to _ of the bronchi with _ due to persistent _
hyperactivity, bronchoconstriction, inflammation
“blue bloaters” is a term used for_
chronic bronchitis
Which phenotype would you expect to see cyanosis and edema in the abdomen and legs?
chronic bronchitis
When would you expect to see ciliary function impaired?
chronic bronchitis
Why does the body increase RBC production in chronic bronchitis?
In hopes to try and oxygenate the blood but the blood just gets thicker increasing pulmonary pressure
What phenotype of COPD is known as “pink puffers”
Emphysema
The breakdown of _ in the alveolar septa and bronchial walls by _ is seen in _
elastin, proteases, emphysema
Alpha-1 antitrypsin deficiency is seen in _
emphysema
Proteases are released from _, alveolar macrophages and other inflammatory cells
neutrophils
_destruction destroys portions of the pulmonary capillary bed leading to ventilation and perfusion mismatch leading to hypoxemia
septal
Decreased _ in bronchial walls leads to _ that leads to hyperinflation
elastic recoil, air trapping
_ is the most common site/ type of emphysema
centriacinar
Why is barrel chest more commonly associated more with emphysema than chronic bronchitis?
Due to the air trapping
Which type of immunity is more associated with all stages of COPD?
innate
which type of immunity is mainly seen in severe cases?
adaptive
_-_increases expression of adhesion molecules on leukocytes on leukocytes and endothelial cells and upregulates other pro-inflammatory cytokines.
TNF-alpha
_-_is associated with COPD associated weight loss
TNF-alpha
- is the link between the adaptive and innate immune systems and stimulates C-reactive protein release from the liver
IL-6
- is linked with disease severity
IL-32
_ plays a key role in dendritic cell programming by stimulating specific chemokines which then attract T helper lymphocytes and cytotoxic T lymphocytes
TSLP
COPD is _ inflammatory disease in which lungs are one form of expression
systemic
Cytokines associated with _ involvement:IL-6, TNF-alpha, IL-8, IL-1Beta
muscle
Leptin is important in regulating _ and is _ in people with COPD
energy, decreased
_ is a significant predictor of BMI
CRP
An increase in _ is correlated with an increase in exacerbations
serum amyloid A
What would we expect to see in the CBC of a patient with AECOPD?
elevated leukocytes, anemia, elevated cytokines and acute phase proteins
When reviewing chest x-ray report, _ and _ is consistent with air trapping
hyperinflation and flattening of the hemidiaphragms
_ is the standard assessment tool for dx, staging and monitoring of COPD
Spirometry
FEV _ indicates more advanced disease
<80%
FCV is not always _ during early stages of COPD
decreased
FEV/FVC post-bronchodilator _ confirms airflow limitation
<0.70
In what stage and case of COPD do we administer O2 therapy to the patient
Usually in stage 4, in very severe disease with chronic respiratory therapy
Long term therapy of O2 can be used during _ or prn to relieve episodes or acute_
exercise; dyspnea
Which type of therapy for COPD improves pulmonary hypertension, increases exercise capability and lung function, improves the mental and emotional states, increases survival in persons with chronic respiratory failure
O2 therapy
_therapy is considered during severe exacerbations or in persons with chronic hypercapnia respiratory failure
NIPPV (noninvasive positive pressure ventilation)
Inhaled _ decrease bronchoconstriction by reducing muscle tone and glandular mucus
anticholinergics
Inhaled_ recommended for the long-term prevention and reductions of COPD symptoms
Beta-2 adrenergic agonists (LABAS)
_ are negligible as a monotherapy for COPD
corticosteroids
_ is used as a third line of therapy
methylxanthines
_ reduces symptoms (specifically improves dyspnea, exercise endurance), improves QoL, increase physical and emotional participation of ADLs, decreased risk of hospitalization following AECOPD
Pulmonary Rehabilitation
The goal of _ is to restore a patient to the fullest medical, emotional, social and vocational status possible
Pulmonary rehabilitation
What are the 3 components of pulmonary rehab?
- exercise training (aerobic and resistance)
- nutritional coaching
- patient education
_ is the most common cause of AECOPD
Infection
Pharmacology for COPD is aimed at _
Improving airflow
Smoking cessation for patients with COPD is the only intervention to slow the rate of _
lung function decline
