COPD and Bronchiectasis Flashcards
preventable and treatable disease, is characterized by persistent respiratory symptoms and airflow limittaion that is due to airway and/or alveolar abnormalities caused by significant exposure to noxiuos particles or gases
COPD
Most common respiratory symptoms of COPD
Dyspnea
cough
sputum production
Most important risk factor in COPD
Cigarette smoke
key cell playes in COPD
Neutrophils, macrophages and CD8
Pathogenesis of COPD
Plasma leakage, sensory nerve impairment, smooth muscle constriction
____is already present in the early stages of COPD
Inflammation
Gold stage 0
asymptomatic but smoking individual
Airway inflammation is characterized by
Increased numbers of neutrophils, macrophages and CD8 lymphocytes
Effect of COPD in bronchus
Wall thickening and inflmmation -> mucus gland hypertrophy -> increased secretions -> phlegm
Effect of COPD in bronchiole
Wall thickening->inflam_>repair->remodeling->loss of alveolar attachment
Effect of COPD in alveoli
Wall thinning ->inflammation ->elastolysis coalescence ->decreased elasticity
In asthma the basement membrane
Thicken because smooth muscles are hyper reacting
Mediators in asthma
IL-4 IL5
LTD4, histamine, ROS
Mediators in COPD
IL-8 and TNF alpha
LTB4, ROS
Effects in asthma are in the___
All airways
Effects in COPD are in the _____
Peripheral airways
Mechanisms underlying airflow imitation in COPD
Small airway disease
PArenchymal destruction
Cause of airflow limitation
Irreversible, Fibrosis and narrowing of airways
Loss of elastic recoil due to alveolar destruction
Primary site of airflow limitation:
Peripheral airways (bronchi and nronchioles <2mm)
PFT results in COPD
FRC increases
RV increases to detriment of inspiratory capacity decreases
TLC and TV stays the same
Pathophysiological Changes in COPD
Mucus hypersecretion Ciliary dysfunction Airflow limitation Pulmonary hyperinflation Gas exchange abnormalities Pulmonary hypertension cor pulmonale - leads to death
total volume of air expired after a full inspiration
Fore vital capcity
volume of air expired in the first second during maximal respiratory effort
FEV1
Goal of COPD Assessment
To determine level of airflow limitation, its impact to patient’s health status and the risk of future events to eventually guide therapy
Classification of severity of airflow limitation in COPD:
GOLD 1: mild FEV1/FV <0.70
GOLD 2: Moderate; 50%
Tools for assessment in COPD
mMRC breathlessness scale
COPD assessment Test (CAT)
Clinical COPD questionnaire