EXAM3/CH19- COPD Flashcards

1
Q

COPD

A

chronic obstructive pulmonary disease

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2
Q

how is COPD defined by the American Thoracic Society

A

a disease characterized by the presence of airflow obstruction that is attributable to either chronic bronchitis or emphysema

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3
Q

why do we combine emphysema + chronic bronchitis into 1 disease

A

because they are rarely pure expressions of either disease
-in general, they overlap a lot so we treat them the same

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4
Q

chronic bronchitis

A

the presence of a productive cough most days during 3 consecutive months in each of 2 successive years

ex: chronic cough January/February/March for 2 years straight

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5
Q

emphysema

A

a pathological or anatomical diagnosis marked by…
1) permanent enlargement of the respiratory bronchioles and alveoli
AND
2) destruction of the lung parenchyma without obvious fibrosis

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6
Q

can you see bronchioles + alveoli on x-ray

A

hard to see bronchioles + alveoli by x-ray or eye but we can see them via microscopic exam or more sophisticated imaging techniques

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7
Q

parenchyma

A

bronchioles + alveoli

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8
Q

fibrosis

A

deposition of collagen + elastin

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9
Q

diaphragm

A

acts as a piston to enlarge to draw air into the lungs

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10
Q

lung damage in COPD

A

-tissue has less elastic structures, causing constriction
-bronchioles lose their shape + become clogged with mucus
-walls of alveoli are destroyed, forming fewer, larger alveoli

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11
Q

what is COPD often associated with

A

cachexia

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12
Q

cachexia

A

a substantial loss of muscle mass + strength

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13
Q

physical characteristics of COPD patients

A

-pronounced neck muscles because they have stiff chest walls + strain neck muscles to try to bring air in
-bracing arms, typical postural behavior
-pursed lip breathing; attempt to facilitate gas flow from lungs to prevent lungs from collapsing prematurely

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14
Q

disease scope of COPD

A

-estimated that 24 million people in the United States have COPD
-a major cause of morbidity + disability + a major health care cost, estimated at $50 billion annually in the US
-4th leading cause of death in the US
-projected to be the third leading cause globally by 2020

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15
Q

causes of COPD

A

-smoking
-environment
-alpha-1antitrypsin deficiency

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16
Q

is there a cure to COPD

A

NO
-irreversible

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17
Q

causes of COPD- smoking

A

85-90% of all cases are caused by smoking cigarettes

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18
Q

causes of COPD- environment

A

long-term exposure to air pollution, second-hand smoke, dust, fumes, + chemicals

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19
Q

causes of COPD- alpha-1antitrypsin deficiency

A

a small number of people have this genetic disease

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20
Q

trypsin

A

enzyme that degrades proteins in lungs

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21
Q

what inhibits trypsin

A

antitrypsin

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22
Q

if you have a genetic deficiency where you don’t make antitrypsin, what would happen

A

the trypsin in your lungs will destroy lung tissue causing emphysema
-extremely rare

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23
Q

chronic bronchitis pathophysiology

A

-excessive cough + sputum production
-bronchial enlargement
-airflow obstructed by mucus plugging, inflammation, + increased smooth muscle

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24
Q

emphysema pathophysiology

A

-alveoli lose parenchymal tethering
-loss of lung elasticity and recoil
-reduced expiratory airflow
-increased work of breathing
-lung hyperinflation
-diaphragm flattening
-barrel chest

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25
Q

COPD pathophysiology

A

-chronic bronchitis + emphysema have similar causes
-they rarely occur separately; most patients exhibit symptoms of both diseases
-this led to clinical use of COPD as a broad diagnostic category
-it encompasses the vast majority of individuals with chronic airflow obstruction

26
Q

what holds the airway open

A

alvolar attachments

27
Q

airway cross section- COPD

A

-mucus hypersecretion (luminal obstruction)
-disrupted alveolar attachments (emphysema)
-mucosal + peribronchial inflammation + fibrosis (obliterative bronchiolitis)

28
Q

spirometry in COPD

A

-clinical test of lung function
-measures airflow over time during respiratory maneuvers
-predicted normal values vary with age and sex

29
Q

spirometry values abnormal in COPD

A

-forced expiratory volume in 1 second (FEV1) is reduced; predictor of survival
-forced vital capacity (FVC) also reduced
-total lung capacity (TLC) is increased

30
Q

when is FVC the highest

A

at a young age, decreases as you age

31
Q

what value of spirometry predicts survival of COPD

A

FEV1

32
Q

common comordities in COPD

A

-hypoxemia + hypercapnia
-cardiovascular disease
-limb muscle atrophy + contractile dysfunction
-physical inactivity + deconditioning
-undernutrition or malnutrition

33
Q

hypoxemia

A

low levels of oxygen in the blood

34
Q

hypercapnia

A

high levels of CO2 in the air in the lungs

35
Q

symptoms of COPD

A

-increased cough
-purulent sputum production
-wheezing
-dyspnea
-occasional fever

36
Q

purulent

A

means pus
-pus is a collection of inflammatory cells

37
Q

pneumonia

A

infection of the lungs

38
Q

a smoking history of ____ pack-years has been reported to be suggestive of COPD

A

70+ pack-years

-means 7 packs a day for 10 years or 10 packs a day for 7 years

39
Q

common measurements to help assess the presence + severity of COPD

A

-lung volume measurements (FEV1, FVC, FEV1/FVC, TLC)
-arterial blood gases
-chest X-ray
-computed tomography (aka CT scan)

40
Q

describe chest x-ray for chronic bronchitis/emphysema patients

A

can be normal in chronic bronchitis but reveal large lungs in advanced emphysema patients

41
Q

how does exercise test responses of COPD patients vary

A

based on lung disease
-also affected by frailty, chronic inactivity, CV disease, malnutrition, motivation, etc.

42
Q

compared to healthy individuals, how will patients with moderate + severe COPD perform

A

abnormal outcomes

43
Q

COPD exercise test response- peak work rate

A

decreased

44
Q

COPD exercise test response- peak oxygen consumption

A

decreased

45
Q

COPD exercise test response- peak heart rate

A

decreased

46
Q

COPD exercise test response- peak ventilation

A

decreased

47
Q

COPD exercise test response- heart rate reserve

A

increased

48
Q

COPD exercise test response- ventilatory reserve

A

decreased

49
Q

COPD exercise test response- arterial partial pressure of oxygen

A

decreased

50
Q

COPD exercise test response- arterial oxygen saturation

A

decreased

51
Q

COPD exercise test response- lactate threshold

A

occurs at a lower work rate

52
Q

COPD exercise test response- ventilatory threshold

A

absent

53
Q

others tests of functional capacity

A

-6 minute walk test (6MWT)
-sit to stand test (STS)

-more convenient, accessible, quick, easy, affordable
-commonly used in gerontologic screening
-results have predictive value
-increasingly used in outpatient + rehab settings

54
Q

6 minute walk test

A

basically how far you can walk in 6 minutes

55
Q

sit to stand test

A

have person sit + stand as many times as they can for a period of time

56
Q

COPD treatment

A

-smoking cessation
-oxygen therapy
-pharmacological therapy
-pulmonary rehabilitation

57
Q

COPD treatment- smoking cessation

A

stops disease progression

58
Q

COPD treatment- oxygen therapy

A

-greater than 15 hr/d increases survival
-goal is arterial pO2 > 60mmHg or HgbO2 saturation > 90%

59
Q

COPD treatment- pharmacological therapy

A

reduces symptoms + complications
-goals are to reduce inflammation, bronchoconstriction, + respiratory infections

60
Q

COPD treatment- pulmonary rehabilitation

A

decreases functional impairment, improves quality of life, + prolongs survival
-goals linked to multidisciplinary interventions