COPD/Emphysema (Headley) Flashcards
What is a disease state that is characterized by reversible airway obstruction?
Irreversible?
asthma
COPD
What changes are happening in the airways and the lung parenchyma in COPD?
airways: inflammation, fibrosis, luminal plugs (secretions)
parenchyma: loss of alveolar attachments and decreased elastic recoil
COPD mortality is higher in (men or women)
women
What are the causes of COPD?
smoking > occupational dust and chemicals, air pollution
poorly controlled asthma can also cause it
FEV1 of ____% of normal is assc with exertional dyspnea
____% of normal is assc with disability
40 -60%
<30%
Smokers with a mean ____ pack yeat Hx develop COPD
20
At what age do pts with COPD develop URT symptoms (cough and sputum)?
40s
At what age does dyspnea develop?
50s or 60s
What is required to make the diagnosis of COPD?
spirometry with FEV1/FVC ratio < 0.7 and no improvement in post-bronchodilator therapy FEV1 >15% and > 200 ml
What are the symptoms and risk factors for COPD?
symptoms: Cough, sputum, dyspnea (exertional then at rest)
RF: smoking, occupation, indoor/outdoor pollution (mostly developing/3rd world countries)
What is the clinical definition of chronic bronchitis?
production of sputum for 3 months in 2 consecutive years
What are clinical findings assc with airway obstruction with COPD
- Wheezing (due to obst)
- prolonged forced expiration (due to obst)
What are clinical findings assc with hyperinflation with COPD?
- barrel chest
- pursed lip breathing
- low diaphragm position
- distant heart and breath sounds
What are clinical findings assc with impairment of the mechanics of breathing with COPD?
- use of accessory muscles when breathing
- retractions (in drawings of lower intercostal interspaces)
- chest/abdominal wall paradoxical movements
What CV signs can be seen with advanced COPD?
cor pulmonale
hyperinflation puts pressure on RA –> Right heart failure
-JVD, hepatomegaly, peripheral edema
How are asthma and COPD spirometry results different?
low FEV1/FVC in asthmatics will correct with bronchodilator and it will not in pts with COPD
What makes a pt with COPD “high risk” to have progressive decline in disease? *sorry for the terrible wording
2 or more exacerbations within the past year
FEV1 < 50% of predicted value
WHat is the defn of an exacerbation of COPD?
worsening of respiratory symptoms (dyspnea) that requires a change in medication
When should a pt be screened for alpha-1 anti-trypsin deficiency?
person in 30 or 40s develop COPD and have a strong family Hx of COPD
On what chromosome is the alpha-1 anti-trypsin gene found?
14
Who are the pink puffers and blue bloaters? Why are they called that?
2 sides of the COPD spectrum:
pink puffers = emphysema prominent COPD
-pink = near normal gas values, thin, intense dyspnea
blue bloaters = chronic bronchitis prominent COPD
-blue = hypoxemic and hypercapnic, obese, CHF, edema, mild dyspnea
What is the cause of the hypoxemia and hypercapnia in chronic bronchitis?
V/Q mismatch
Are blue bloaters hypo or hyperventilated? Why?
Hypoventilated:
alterations in CNS centers allows for decreased work of breaking (dec RR) but it comes at a cost of inc CO2 levels
What are the long term consequences of blue bloaters’ hypoventialtion?
chronic hypoxemia –>
- polycythemia (elevated Hct)
- Pulmonary HTN
- cor pulmonale
What is the cause of the hypoxemia in emphysema?
V/Q imbalance and diffusion abnormalities from alveolar destruction
Are pink puffers hypo or hyperventilated? Why?
hyperventialted:
they maintain thier PCO2 levels in the normal rage but it comes at the cost of high work of breathing
T or F: In emphysema O2 saturation is preserved
True (by inc MV)
COPD pts are at an increased risk to develop…
MI, angina osteoporosis respiratory infections depression DM lung cancer
What are the different inflammatory cell mediators in Asthma and COPD?
Asthma: CD4 and eosinophils
COPD: CD8, macrophages, neutrophils
What does an icreased Reid Index indicate? What does this index measure?
chronic broncitis
bronchial gland depth as a fraction of total bronchial wall thickness
Describe the cellular changes in the central airways (cartilaginous) of COPD/chronic bronchitis
bronchial gland hypertrophy goblet cell metaplasia squamous metaplasia of epithelium (loss of cillia and function) fibrosis infiltration by CD8 and neutrophils
What are the differences between centrolobular and panlobular emphysema?
centrolobular: dilation and destruction of the respiratpry bronchioles
- upper lobe predominance
- assc with smoking
panlobular: dilation and destruction of the entire acinus
- lower lobe predominance
- assc with alphs 1 anti-trypsin def
What are bullae?
emphysematous spaces > 1 cm in diameter
What is the pathophys of emphysema?
loss of alveolar attatchments –> small airway collapse during expiration
V/Q mismatch
What are the 3 irreversible changes that limit airflow in COPD?
- fibrosis and narrowing of airways
- loss of elastic recoil
- destruction of alveolar attachments
What are the 3 reversible changes that limit airflow in COPD?
- accumulation of inflammatory cells, mucus, and plasma exudate in bronchi
- smooth muscle contraction
- dynamic hyperinflation at rest and worsening at exercise –> muscles at at mechanical disadvange and have to work harder to breathe
How does COPD manifest on CXR
flattened diaphragm
hyper-inflated lungs
tear drop heart
increased vascular markingss
Describe the PFTs for pure emphysema ?
- increased TLC and RV
- increased compliance
- decreased VC
- decreased elastic recoil
- dec DLCO
What are the etiologies of COPD exacerbations?
bacterial infection, virus, unidentified
For Tx/management of COPD see sweatmen’s shit
im feeling lazy
