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COPD PART 1 Flashcards

1
Q

What is the mucosa of the lining of the lungs made from?

A

Epithelium - Ciliated pseudostratified columnar epithelial cells
Goblet cell - makes mucus
Lamina propria

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2
Q

What are the 2 parts of the lamina propria?

A

BM
Loose connective tissue

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3
Q

What is the submucosa (found under mucosa) made from?

A

Smooth muscle
Connective tissue
Bronchial mucinous Glands

Underneath the submucosa is the cartilage (Bronchi only)

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4
Q

Definition of COPD: Chronic bronchitis

A

Bronchitis means inflammation of the bronchial tubes in the lung.

It is said to be chronic when it causes a productive cough for at least 3 months each year for 2 or more years.

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5
Q

Epidemiology of Bronchitis

A

Usually co-exists with emphysema, causing COPD.

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6
Q

RFs for Bronchitis

A
  • Smoking
  • Exposure to air pollutants e.g. sulfur and nitrogen dioxide
  • Exposure to dust and silica
  • Family history of chronic bronchitis
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7
Q

What do irritants and chemicals do to airways?

A
  • Infiltrate walls with inflammatory cells
  • epithelial layers becomes ulcerated + with time > columnar cells become squaumous epithelium
  • inflammation is followed by scarring and thickening of the walls, which narrows the small airways.
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8
Q

Whatr do irritants stimulate hypertrophy and hyperplasia in?

A

mucinous glands in the main bronchi, as well as the goblet cells in the bronchioles, which increases mucus production in both locations.

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9
Q

What happens since the bronchioles are smaller?

A

even a slight increase in mucus can lead to airway obstruction, which contributes to the majority of the air trapping.

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10
Q

What does smoking do to the cilia?

A

Makes it shorter and less mobile, making it harder to move mucus up and out of bronchioles. A cough is sometimes the only way to clear this mucus.

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11
Q

What do people people with chronic bronchitis often present with?

A

Hypoxemia + Hypercapnia

because the mucus plugs block airflow, causing high levels of CO2 and low levels of O2 in the lung so less O2 moves into blood and less CO2 moves out of blood.

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12
Q

Overall what happens in COPD bronchitis

A

airway narrowing due to hyperplasia, inflammation and oedema.

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13
Q

What happens to the FVC, FEV1, FEV1:FVC ration and TLC in COPD bronchitis?

A
  • FVC (max air exhaled in one breath): lowered
  • FEV1 (first second of air breathed out in a single breath): lowered, more than the FVC
  • FEV1:FVC ratio: lowered
  • TLC (total lung capacity): increased due to air trapping
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14
Q

Signs of COPD bronchitis

A
  • Wheeze: due to narrowing of the passageway available for air to move in and out
  • Crackles or rales: caused by the popping open of small airways
  • Cyanosis (blue bloaters): if there is buildup of CO2 in blood
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15
Q

Symptoms of COPD bronchitis

A
  • Productive cough
  • Dyspnoea
  • Signs of CO2retention
    • Drowsy
    • Asterixis
    • Confusion
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16
Q

Management of COPD Bronchitis

A
  • Smoking cessation
  • Management of associated illnesses
  • Antibiotics for infections
  • Supplemental oxygen
  • Bronchodilators
  • Inhaled steroids
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17
Q

Complications of COPD bronchitis

A
  • Cor pulmonale and right sided heart failure: vasoconstriction leads to pulmonary hypertension which affects the functioning of the right ventricle.
  • Lung infections: can develop behind the mucus plugs
18
Q

What is COPD?

A

Chronic obstructive pulmonary disease (COPD) describes progressive and irreversible obstructive airway disease.

It is a combination of emphysema and chronic bronchitis.

19
Q

Epidemiology of COPD

A
  • There are 1.2 million people with COPD living in the UK
  • COPD is the fourth leading cause of death globally
  • Usually diagnosed >45 years
  • 28,600 deaths on average
20
Q

RFs for COPD

A
  • Age:usually diagnosed after the age of 45
  • Tobacco smoking: the single greatest risk factor for COPD
  • Air pollution
  • Occupational exposure: such as dust, cadmium (in smelting), coal, cotton, cement and grain
  • Alpha-1 antitrypsin deficieny: younger patients present with features of COPD
21
Q

What is COPD a combination of?

A

Emphysema + Chronic Bronchitis

22
Q

What is emphysema?

A

involves loss of alveolar integrity due to an imbalance between proteases and protease inhibitors (e.g. alpha-1 antitrypsin) triggered by chronic inflammation, such as smoking, which causes elastin breakdown

23
Q

What is bronchitis?

A

involves increased mucus secretion secondary to ciliary dysfunction and increased goblet number and size → lung parenchymal destruction → impaired gas exchange

24
Q

In COPD what happens to the lungs?

A
  • FVC (max air exhaled in one breath): lowered
  • FEV1 (first second of air breathed out in a single breath): lowered, more than the FVC
  • FEV1:FVC ratio: lowered
  • TLC (total lung capacity): increased due to air trapping
25
What is V/Q (ventilation perfusion) mismatch due to?
- damage and mucus plugging of smaller airways from the chronic inflammation - rapid closure of smaller airways in expiration due to the loss of elastic support
26
What does V/Q mismatch lead to?
- fall in PaO2 and increased respiration. - Usually PaCO2 is unaffected until patient's are unable to maintain their respiratory efforts. - Buildup of CO2 leads to cyanosis.
27
What is the drive for respiration?
At first CO2 As patient becomes desensitised to CO2 - hypoxaemia becomes drive for respiration
28
What are exacererbations?
Worsening of patients lung function - beyond normal day to day variations leading to change in medication Often triggered by infections
29
Signs of COPD
Barrel chest Tachypnoea Cyanosis Tar staining fingers Downward displacement of liver Cor pulmonale
30
Symptoms of COPD
Dyspnoea Wheeze Productive Cough Chest tightness Weight loss
31
Primary investigations for COPD
- **Spirometry and bronchodilator reversibility (BDR)**: FEV1/FVC <0.70; bronchodilator will not reverse symptoms. - **Chest X-ray**: flattened diaphragm, hyperinflation and bullae. Should also be performed to see if there is evidence of lung cancer. - **FBC**: COPD causes chronic hypoxia which may result in secondary polycythaemia; also required to determine if eosinophilia is present. - **Calculate body mass index (BMI):** as a baseline to later assess weight loss (e.g. cancer or severe COPD) or weight gain (e.g. steroids) - **ECG** - **Sputum culture** - **ABG** - ** Inflammatory markers (calcitonin)**
32
Other investigations to consider?
ECG and Echo ABG CT chest Serum alpha 1- antitrypsin
33
What is COPD characterised by
persistent respiratory symptoms (such as breathlessness, cough, and sputum) and airflow obstruction (usually progressive and not fully reversible). Results from chronic inflammation caused by exposure to noxious particles or gases (usually tobacco smoke but also from environmental and occupational exposures).
34
Airflow obstruction numbers:
If FEV1/FVC ration < 0.7 you have airway/airflow obstruction
35
What is the inflammatory process and cell signalling drivign COPD?
factors driving inflammation (Autoimmunity, bacteria, particles) bind to cell surface receptor of immune cell (Macrophage, T cell, Neutrophil) Activates intracellular signalling (NFkBeta and STAT3 pathway leading to the activation of: Cytokines (TNFa, IL-1,IL-6) ROS Proteases - NE, MMPS
36
Gold Grades and severity of Airflow Obstruction in COPD for FEV1 ratio (With FEV1/FVC ratio <0.7)
Gold 1 (Mild) - FEV1 >_ 80% predicted Gold 2 (Moderate) - 50%<_ FEV1 < 80% predicted Gold 3 severe - 30%<_ FEV1< 50% predicted Gold 4 (V.Severe) - FEV1< 30% precited
37
Factors in decline of patient with COPD
- Dyspnoea - Depression + Anxiety - Exercise limitation - Disability - Personality and environment
38
Egs of Acute exacerbation
- Breathlessness - Sputum quantity - Sputum colour - Sputum thickness - Fever
39
Clubbing and end inspiratory crackles are suggestive of
pulmonary fibrosis
40
wheezing and hyper resonance on auscultation is suggestive of
COPD
41
Typical signs and symptoms of pulmonary oedema
Shortness of breath Pink frothy sputum Tachypnoea Decreased oxygen saturations Raised jugular venous pressure (JVP)
42
pulmonary oedema on auscultation would show ?
Reduced breath sounds and/or coarse crackles are associated with pulmonary oedema.

Respiratory (21 decks)

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