COPD & ILD - L11 Flashcards
Name characteristics of COPD.
- Non-fully reversible airflow limitation
- Progressive airflow limitation
- Airflow limitation is associated with abnormal inflammatory response to noxious particles or gases.
Name symptoms and risk factors of COPD.
Symptoms:
* Shortness of breath
* Chronic cough
* Sputum
Risk factors:
* Tobacco
* Occupation
* Indoor/outdoor pollution
Fill in the correct words.
Gas exchange occurs between the … (part of the lungs) and the … (part of blood circulation).
Gas exchange occurs between the alveoli and capillaries.
The blood gas barrier consists of three layers, namely…
- Alveolar epithelium
- Interstitium
- Capillary epithelium
Describe pathologies of COPD in relationship to lung anatomy (i.e. what can you see in the lungs of COPD patients).
- Hypertrophy of bronchial muscle
- Airway wall edema
- Acute bronchoconstriction of bronchioles
- Thick mucus filling airways
- Airway wall remodeling and narrow lumen
- Chronic mucus plug formation
- Thick mucous fills alveoli
COPD consists of chronic obstructive bronchitis and emphysema (and small airway disease). What is the difference between chronic obstructive bronchitis and emphysema?
Chronic bronchitis:
Inflamed bronchial tube resulting in among other hypertrophy of the bronchial muscle.
Emphysema:
Destruction of alveolar and bronchiolar walls
Blue bloater and pink puffer are two phenotypes of COPD that are linked to chronic bronchitis or emphysema. Explain which of these phenotypes belongs to bronchitis or emphysema.
Blue bloater = chronic bronchitis:
Patients with chronic bronchitis have (severe) difficulty breathing and decreased oxygen in the body. As a result, the patient’s skin and lips appear blue. They also have chronic cough and are unable to get enough oxygen even with deep breaths.
Pink puffer = emphysema:
Emphysema causes people to have difficulty catching their breath. They gasp or take short, fast breaths. As a result, this causes temporary redness or pink coloring on their cheeks and faces.
What is elastic recoil?
The deflation of lungs following inflation.
What is meant with air trapping in COPD?
The lungs of a healthy person get filled with fresh air upon inhalation and upon exhalation, this air leaves the lungs again.
Due bronchoconstriction, the lungs of a patient with COPD cannot fully exhale, leaving air trapped in the lungs.
In a healthy situation, the air pressure of oxygen is equal to 105 mm Hg and the air pressure of CO2 is equal to 40 mm Hg.
What happens when there is hypoventilation and name two ways it can occur?
Hypoventilation is breathing that is too shallow or too slow to meet the needs of the body. Hypoventilation causes an increase in CO2 and a decrease in O2.
* Airway obstruction: e.g. due to hypertrophy of the bronchiolar muscles causing airway obstruction and making it more difficult to let air enter the alveoli and bronchioli.
* Altered elasticity: e.g. in the case of emphysema where there is alveolar wall destruction, resulting in decreased elasticity.
What is pursed lip-breathing?
- COPD patients experience resistance in breathing due to narrowed airways. As a result, exhalation is difficult and airways collapse (due to loss of elasticity or increased mucus), which result in air trapping. Air trapping also decreases the amount of air inhaled, leading to hyperinflation.
- Pursed lip breathing is a breathing technique that helps breathing in COPD patients. By breathing with pursed lips, the exhalation time is extended, allowing more time for trapped air to be released from the lungs and thereby increasing the amount of air that can be inhaled. It also prevents airway collapse and stimulates a better utilization of oxygen and removal of CO2.
Chronic bronchitis and emphysema have different causes, but same clinical outcomes. Describe causes and outcomes of both diseases.
- Chronic bronchitis is caused by continual bronchial irritation and inflammation.
- Emphysema is caused by the breakdown of elasting in connective tissue of the lungs. And this can be caused by a a-1 antitrypsin deficiency, but can also be environmentally linked.
- Both diseases result in airway obstruction or air trapping, dyspnea, frequent infection, abnormal ventilation-perfusion rate, hypoxemia, and hypoventilation.
What are exacerbations in COPD?
Exacerbations are seen as a worsening of COPD symptoms caused by a bacterial, viral or pollutant trigger. Exacerbations are associated with:
* Increased inflammation (raised CRP, fibrinogen, IL-6)
* Increased risk for viral infection
* Greater bacterial colonisation
* Faster FEV1 and functional decline
* Poorer healthcare status
* More severe depression and poorer cognition
* Worsened comorbidity
* Increased cardiovascular risk
* Increased hospitalisation and mortality
Glucocorticoids is medication used for COPD to reduce inflammation. Name the effect of glucocorticoids on the following cells:
* Eosinophils
* T-lymphocytes
* Mast cells
* Macrophages
* Dendritic cell
* Epithelial cell
* Endothelial cell
* Airway smooth muscle
* Mucus gland
- Eosinophils: decreased number of eosinophils
- T-lymphocytes: decreased amount of cytokines
- Mast cells: decreased amount of numbers
- Macrophages: decreased amount of cytokines
- Dendritic cell: decreased amount of dendritic cells
- Epithelial cell: decreased production of cytokine mediators
- Endothelial cell: decreased leak
- Airway smooth muscle: increased b2-receptors
- Mucus gland: decreased mucus secretion
Describe which signaling pathway glucocorticoids use.
Glucocorticoids can pass through the cell membrane and interact with their receptor. The complex translocates to the nucleus and stimulates the transcription of mRNA that ultimately inhibit muscle atrophy gene program and muscle protein breakdown.
