Exam 3: COPD

Question 1

Med terms: alpha-1 antitrypsin

Answer 1

An enzyme that regulates the breakdown of lung tissue

Question 2

Med terms: gas exchange

Answer 2

ability to transfer oxygen and carbon dioxide across alveoli membrane that is impaired in some cases of COPD

Question 3

Med term: chronic bronchitis

Answer 3

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

Question 4

Med term: Emphesyma

Answer 4

Abnormal permanent enlargement of the airspaces distal to the terminal bronchioles accompanied by destruction of their walls yet without obvious fibrosis

Question 5

COPD def

Answer 5

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

Question 6

Risk factors of COPD

Answer 6

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

Question 7

Pathophysiology of COPD

Answer 7

Noxious particles and gas produce and release inflammatory mediators characteristic of COPD

Neutrophils, macrophages, CD8+T lymphocytes
Chem. Mediators: TNF-alpha, interleukins, leukotrienes

Question 8

COPD Patho: Small Airway Disease

Answer 8

Airway inflammation, fibrosis, resistance, remodeling

Question 9

COPD Patho: Parenchymal destruction

Answer 9

Loss of alveolar attachments
Pulmonary pressures and gas exchanges abnormalities
Decreased elastic recoil

Question 10

COPD patho: Airflow limitation/trapping

Answer 10

Air-trapping on expiration
Results in hyperinflation and increased functional residual capacity with reduced inspiratory capacity
Results in increased dyspnea on exertion (DOE)

Question 11

COPD patho: Gas exchange abnormalities

Answer 11

Abnormalities in alveoli
Hypoxemia, hypercapnia
reduced ventilation leading to CO2 retention
Worsens with disease progression

Question 12

S/sx of COPD

Answer 12

Dyspnea (labored breathing)
Cough
Sputum prod
wheezing and chest tightness
Others: hypoxia, hypercapnia

Question 13

Pts ≥40yo with at least one of the following should be assessed for COPD:

Answer 13

Dyspnea
Chronic cough
Chronic sputum production
Recurrent lower respiratory tract infections
Hx of exposure to risk factors
FHx of COPD and/or childhood factors

Question 14

Assessment of COPD

Answer 14

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

Question 15

Low risk of exacerbations def

Answer 15

≤1/year with no hospitalization for exacerbation

Question 16

High risk of exacerbations

Answer 16

≥2/yr or ≥1 with hospitalization

Question 17

What is CAT

Answer 17

COPD assessment test

Question 18

T/F: Asthma is neutrophilic in nature while COPD is eosinophilic

Answer 18

FALSE - COPD is neutrophils, asthma is eosinophils (that is why ICS is better for asthma but not COPD)

Question 19

What are 3 symptom score/scale tests to assess copd

Answer 19

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

Question 20

COPD Goals of management

Answer 20

Reduce symptoms: relieve symptoms, improve exercise tolerance, improve health status
Reduce risk: prevent disease progression, prevent/treat exacerbations, reduce mortality