COPD Flashcards by Dania Ernst

Is it true that COPD is mainly underdiagnosed?

True

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What percentage of people diagnosed with COPD are smokers?

15-20%

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What genes play a role in the etiology of COPD?

TNF, surfactant, proteases and antiproteases

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Inherited mutation in alpha-1 _ gene leads to _ deficiency

antitrypsin; AAT

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True or false: Impairment of fetal development resulting in low birthweight is a predisposing factor to COPD

True

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True or false: Infants who develop bronchopulmonary dysplasia are susceptible to developing COPD

True

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What are the 3 COPD phenotypes?

Chronic bronchitis, emphysema, bronchiectasis

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What phenotype is characterized by airway inflammation and obstruction of the major and small airways?

chronic bronchitis

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What phenotype has a productive cough for at least 3 consecutive months over 2 years to be diagnosed?

chronic bronchitis

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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

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What is bronchiectasis?

Permanent dilation of the bronchi and bronchioles due to destruction of the muscle and elastic supporting tissue

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T/F: Sinitus is a commonly seen in past medical Hx of patients with COPD

False

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T/F: acute eosinophilic inflammation is seen within the bronchioles in COPD

False, this type of inflammation is seen in asthma

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What is the chronic obstruction of the airways due to inflammation and irreversibility characteristics of?

COPD

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T/F: The pathologic changes of COPD include squamous metaplasia of epithelium, parenchymal destruction, mucus gland metaplasia and enlargement

True

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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

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What causes the loss of lung elastic recoil in COPD?

The proteases mediate degradation of connective tissue elements in the lungs

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_fibrosis is caused by the imbalance of the lungs repair and defense mechanisms

Peribronchiolar

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What is the key factor in developing irreversible airflow limitation seen in COPD?

Fibrosis of the small airways leading to remodeling

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Inflammation and _ injury play a role in mucus hypersecretion

oxidant

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Increased tone n airway SM due to _ of the bronchi with _ due to persistent _

hyperactivity, bronchoconstriction, inflammation

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“blue bloaters” is a term used for_

chronic bronchitis

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Which phenotype would you expect to see cyanosis and edema in the abdomen and legs?

chronic bronchitis

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When would you expect to see ciliary function impaired?

chronic bronchitis

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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?

1. exercise training (aerobic and resistance) 2. nutritional coaching 3. 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