COPD and Bronchiectasis Flashcards

1
Q

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

A

COPD

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2
Q

Most common respiratory symptoms of COPD

A

Dyspnea
cough
sputum production

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3
Q

Most important risk factor in COPD

A

Cigarette smoke

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4
Q

key cell playes in COPD

A

Neutrophils, macrophages and CD8

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5
Q

Pathogenesis of COPD

A

Plasma leakage, sensory nerve impairment, smooth muscle constriction

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6
Q

____is already present in the early stages of COPD

A

Inflammation

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7
Q

Gold stage 0

A

asymptomatic but smoking individual

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8
Q

Airway inflammation is characterized by

A

Increased numbers of neutrophils, macrophages and CD8 lymphocytes

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9
Q

Effect of COPD in bronchus

A

Wall thickening and inflmmation -> mucus gland hypertrophy -> increased secretions -> phlegm

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10
Q

Effect of COPD in bronchiole

A

Wall thickening->inflam_>repair->remodeling->loss of alveolar attachment

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11
Q

Effect of COPD in alveoli

A

Wall thinning ->inflammation ->elastolysis coalescence ->decreased elasticity

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12
Q

In asthma the basement membrane

A

Thicken because smooth muscles are hyper reacting

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13
Q

Mediators in asthma

A

IL-4 IL5

LTD4, histamine, ROS

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14
Q

Mediators in COPD

A

IL-8 and TNF alpha

LTB4, ROS

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15
Q

Effects in asthma are in the___

A

All airways

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16
Q

Effects in COPD are in the _____

A

Peripheral airways

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17
Q

Mechanisms underlying airflow imitation in COPD

A

Small airway disease

PArenchymal destruction

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18
Q

Cause of airflow limitation

A

Irreversible, Fibrosis and narrowing of airways

Loss of elastic recoil due to alveolar destruction

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19
Q

Primary site of airflow limitation:

A

Peripheral airways (bronchi and nronchioles <2mm)

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20
Q

PFT results in COPD

A

FRC increases
RV increases to detriment of inspiratory capacity decreases
TLC and TV stays the same

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21
Q

Pathophysiological Changes in COPD

A
Mucus hypersecretion
Ciliary dysfunction
Airflow limitation
Pulmonary hyperinflation
Gas exchange abnormalities
Pulmonary hypertension
cor pulmonale - leads to death
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22
Q

total volume of air expired after a full inspiration

A

Fore vital capcity

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23
Q

volume of air expired in the first second during maximal respiratory effort

A

FEV1

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24
Q

Goal of COPD Assessment

A

To determine level of airflow limitation, its impact to patient’s health status and the risk of future events to eventually guide therapy

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25
Q

Classification of severity of airflow limitation in COPD:

A

GOLD 1: mild FEV1/FV <0.70

GOLD 2: Moderate; 50%

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26
Q

Tools for assessment in COPD

A

mMRC breathlessness scale
COPD assessment Test (CAT)
Clinical COPD questionnaire

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27
Q

Modified MRC Questionnaire

A

Assesses patient’s level of breathlessness or dyspnea at various activities

28
Q

COPD Assessment Test

A

8 item questionnaire
Scoring system : 0 to 40

If score is at least 10-more = symptomatic

29
Q

Assess Risk of exacerbation

A

Ask history:

> 2 in the past year
FEV1 postBD <50% predicted
1 hospitalization for COPD in the past year

30
Q

Performed when COPD develops in patient of caucasian descent >45 years or with a strong family history COPD

A

Alpha-1 Antitrypsin Deficient Screening

31
Q

Characterized by persistent airflow limitation with several features usually associated with asthma and COPD

A

Asthma-COPD Overlap syndrome

32
Q

How to manage ACOS

A

treat asthma first, then COPD

33
Q

Goals of therapy in COPD

A

Reduce symptoms
Reduce risk
Avoidance of risk factors through:

34
Q

Greatest capacity to influence the natural history of COPD

A

Smoking cessation

35
Q

Brief strategies to help the patient willing to quit smoking

A
ASK
ADVICE
ASSESS
ASSIST
ARRANGE
36
Q

Stimulate beta-2 receptors, thus relax airway smooth muscle

A

Beta-2 agonist

37
Q

Block the effect if Ach on M3 receptors and relax smooth muscle

A

Anti-cholinergics

38
Q

Exact MOA controversial; Antagonize bronchoconstriction through PDE4 inhibition in smooth muscle;

A

Methylxanthines

39
Q

Eacerbations are reduced by ______in patients with severe and very severe COPD (GOLD 3 and 4) and a history of exacerbations

A

ROFLUMILAST (PDE4) inhibitors

40
Q

Management of Group A

A

Give bronchodilator->Evaluate effect _> change if ineffective

41
Q

management of group B

A

Mandatory put in LAMA or LABA depending on patient and behavior on side effect

42
Q

management of Group C

A

LAMA, if with exacerbations, shift to LAMA +LABA

Alternatively LAMA +ICS

43
Q

management of Groupd D

A

Dual therapy (LAMA+LABA)

If with exacerbations, sequentially add:
ICS, PDE4, Macrolide, Descalation of symptoms

44
Q

Pneumococcal polysaccharide vaccine is recommended for those who are

A

65 years old and older

Younger than 65 with FEV1 <40% predicted

45
Q

Removal of hyperinflated section

A

Lung volume Reduction Surgery

46
Q

an acute event characterized by worsening of the patient’s respiratory symptoms that is beyond normal day to day variation and leads to a change in medication

A

Exacerbations

47
Q

Most common cause of COPD exacerbation

A

Viral infection

48
Q

Antonisen Criteria

A

At least two of the following cardinal symptoms:

Shortness of breath
Sputum purulence
Increase sputum volume

or any one of the above plus
URTI
Wheeze
Cough
Increased PR/RR
49
Q

Mild Exacerbations

A

Requiring more reliever medication

50
Q

Moderate Exacerbations

A

Systained worsening symptoms (2-3 days)
Need for antibiotic and or systemic CS
Unscheduled hospital visits

51
Q

Severe Exacerbations

A

Require hospitallization

52
Q

Oxygen saturation

A

88-92%

53
Q

Antibiotics should be given to patients with

A

Increased dyspnea, sputum volume, and sputum purulence

54
Q

Abnormal and permanent dilatation of the medium-sized bronchi , destruction of elastic and muscular components of their walls, primarily mediated by neutrophils

A

Bronchiectasis

55
Q

Primary criteria for bronchiectasis

A

Impairment of mucociliary drainage in one or both of the lungs.

  • Acute or chronic infection
  • Anatomic airway obstruction
  • Congenital disease that predisposes to chronic infection
56
Q

enzyme deficiency that produce non-functional cilia

A

Alpha-1 anti trypsin deficiency

57
Q

SIte of pathology in bronchiectasis

A

Medium sized bronchi

  • replaced by fibrous tissue
58
Q

Causes of bronchiectasis

A
Post infective
Mechanical obstruction
Deficient immune response
Inflammatory pneumonitis
Congenital
Excessive immune response
Abnormal mucus clearance
Fibrosis
59
Q

reed classification

A

Radiologic classification

60
Q

Reed classification (Radiologic)

A

Cylindrical Bronchiectasis -Sections of bronchi are consistently widened

Varicose Bronhiectasis - There are local constrictions and there is an irregular pattern that closely mimics that of the varicose veins

Saccular (Cystic) Bronchiectais - dilation increases towards the peripheral areas of the lung; honeycombing

61
Q

Predominant organism in sputum of bronhiectasis patient

A

gram negative

62
Q

Cystic fibrosis

A

Mucoviscoidosis
AR disorder
CFTR protein

63
Q

Cystic fibrosis Diagnosis

A

Gibson-Cooke Sweat Test
-Gold standard
-Forearm sweat stimulated with pilocarpine
(+) >60mml/L Cl

64
Q

Clinical features of Cystic fibrosis

A

Coughing, dyspnea, and expiration of foul, voluminous secretions especially prevalent in the morning

65
Q

Signet ring sign on Chest CT

A

bronchiectasis

66
Q

Only curative treatment of bronhiectasis

A

Surgical Treatment