Exam 3: COPD Flashcards
Med terms: alpha-1 antitrypsin
An enzyme that regulates the breakdown of lung tissue
Med terms: gas exchange
ability to transfer oxygen and carbon dioxide across alveoli membrane that is impaired in some cases of COPD
Med term: chronic bronchitis
Chronic or recurrent excessive mucus secretion into the bronchial tree with cough that is present on most days for at least 3 months of the year for at least 2 consecutive years in a patient in whom other causes of chronic cough have been excluded
Med term: Emphesyma
Abnormal permanent enlargement of the airspaces distal to the terminal bronchioles accompanied by destruction of their walls yet without obvious fibrosis
COPD def
A common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gasses
Risk factors of COPD
Exposure to particles: tobacco, indoor/outdoor air pollution, occupational dusts/chemicals Genetic (alpha 1 antitrypsin deficiency) Age Gender Lung growth/development Socioeconomic status asthma bronchial hyper-reactivity chronic bronchitis Infections
Pathophysiology of COPD
Noxious particles and gas produce and release inflammatory mediators characteristic of COPD
Neutrophils, macrophages, CD8+T lymphocytes
Chem. Mediators: TNF-alpha, interleukins, leukotrienes
COPD Patho: Small Airway Disease
Airway inflammation, fibrosis, resistance, remodeling
COPD Patho: Parenchymal destruction
Loss of alveolar attachments
Pulmonary pressures and gas exchanges abnormalities
Decreased elastic recoil
COPD patho: Airflow limitation/trapping
Air-trapping on expiration
Results in hyperinflation and increased functional residual capacity with reduced inspiratory capacity
Results in increased dyspnea on exertion (DOE)
COPD patho: Gas exchange abnormalities
Abnormalities in alveoli
Hypoxemia, hypercapnia
reduced ventilation leading to CO2 retention
Worsens with disease progression
S/sx of COPD
Dyspnea (labored breathing) Cough Sputum prod wheezing and chest tightness Others: hypoxia, hypercapnia
Pts ≥40yo with at least one of the following should be assessed for COPD:
Dyspnea Chronic cough Chronic sputum production Recurrent lower respiratory tract infections Hx of exposure to risk factors FHx of COPD and/or childhood factors
Assessment of COPD
FEV1/FVC <70% in all pts for diagnosis
FEV1% predicted via spirometry
Imagining (CXR, CT)
Lung volumes and diffusion capacity
Oximetry and arterial blood gas
Exercise testing and assessment of physical activity
Low risk of exacerbations def
≤1/year with no hospitalization for exacerbation
High risk of exacerbations
≥2/yr or ≥1 with hospitalization
What is CAT
COPD assessment test
T/F: Asthma is neutrophilic in nature while COPD is eosinophilic
FALSE - COPD is neutrophils, asthma is eosinophils (that is why ICS is better for asthma but not COPD)
What are 3 symptom score/scale tests to assess copd
COPD assessment test (CAT) - range 0-40
Clinical COPD Questionnaire (CCQ)
Modified British Medical Research Council (mMRC) breathlessness scale
**CAT > mMRC bc CAT includes effect of life activities
COPD Goals of management
Reduce symptoms: relieve symptoms, improve exercise tolerance, improve health status
Reduce risk: prevent disease progression, prevent/treat exacerbations, reduce mortality
