L 50. COPD

Question 1

What is COPD?

Answer 1

An inflammatory disease of the airways in response to an exposure to a particle or gas.

Question 2

Is airflow obstruction reversible in COPD?

Answer 2

It is a progressive disease, so some can be reversed but not all.

Question 3

2 main components of the COPD disease

Answer 3

1. Chronic bronchitis (mucus producing cough most days for 2 years or more)
2. Emphysema (damage and destruction of alveolar cells causing shortness of breath)

Question 4

How is COPD gotten? (lol)

Answer 4

Genetics + environment

Question 5

What environ factors help to get COPD?

Answer 5

Smoking and pollution (e.g air particulates)

Question 6

In lower income countries, … factors had a greater impact than … factors

Answer 6

In lower income countries, environmental factors had a greater impact than behavioural factors.
(e.g bad air is worse than smoking)

Question 7

COPD risk factors

Answer 7

Environment: occupational (farming, textiles, industry) and pollution (inside and outside home)

Question 8

What is the trend with NZ smoking rates?

Answer 8

Trending downwards (less people smoking)

Question 9

Risk factors for smoking x6

Answer 9

Media, social influences, friends/parents who smoke, low self esteem, taking part in risk activities, access and affordability.

Question 10

What is the overall prevalence of COPD?

Answer 10

0.95%

Question 11

COPD epidemiology x4

Answer 11

• Prevalence increases with age
• Rates higher for women <65 and men >65
• Higher mortality rates for elderly men
• Hospitalisation and mortality rates increase with increasing deprivation.
• Highest hospitalisation in māori and pacifika

Question 12

Barriers identified for COPD management

Answer 12

• Access to care
• Inattention to culturally accepted practises
• Sporadic/poor quality care
• Inadequate provision of health care ifnormation

Question 13

How to address inequities for COPD care

Answer 13

• Audits of care providing
• Systematic approach to health literacy and COPD education for whānau
• Providers need to support staff to develop Cultural safety skills to engage with māori and their whānau (about COPD)
• Assess patients using a māori model of health

Question 14

Pathogenesis of COPD

Answer 14

Production of inflammatory mediators and oxidants by airway epithelium and macrophages
Accumulation of immune cells (more macrophages, neutrophils, CD4 and CD8 cells)

Question 15

What type of CD4 cells are involved in COPD pathogenesis?

Answer 15

Th1 cells

Question 16

What role do macrophages play in COPD pathogenesis? x3

Answer 16

Macrophages release:

• Proteases (cause tissue destruction, mucus hypersecretion)
• TGF beta (fibroblasts to release CTGF - connective tissue growth factor)
• Oxidants (goblet cell hyperplasia, decrease in HDAC2 gene causing steroid resistance)

Question 17

What role do neutrophils play in COPD pathogenesis? x2

Answer 17

• An increase in number of neutrophils correlates with a decline in airway function
• Neutrophils also release proteases

Question 18

What role do CD8 cells play in COPD pathogenesis?

Answer 18

They kill alveolar cells (directly or by inducing apotosis)

Question 19

What role do Th1 and Th17 cells play in COPD pathogenesis?

Answer 19

Th1 and Th17 are pro-inflammatory.

Question 20

Requirements to get COPD

Answer 20

An inappropriate inflammatory response to noxious airway irritants in genetically susceptible individuals.

Question 21

Define noxious

Answer 21

Toxic, harmful

Question 22

How does smoking impact COPD pathogenesis?

Answer 22

Cigarette smoking impairs innate immune responses, therefore increasing susceptibility to infection (along with other methods of damaging health)

Question 23

What is the deal with eosinophils and COPD pathogenesis

Answer 23

15-40% of cases are based on Th2 biased eosinophilic inflammation.
COPD is usually more neutrophils and Th1 based, but there is a small subset that is Th2

Question 24

Exacerbations of COPD can be triggered by…

Answer 24

Symptoms of exacerbations
Triggers: infection, pollutants
Symptoms: worsening symptoms overall, often increased airway inflammation

Question 25

Features of COPD x4

Answer 25

• Early changes in airways (fibrosis and vascular smooth muscle proliferation)
• Air trapping, dyspnoea, FEV1 decline, irreversible destruction.
• Enhanced parasympathetic activity causing hyperresponsiveness to irritants. (DRUG TARGET)
• Gas exchange abnormalities, pulmonary hypertension.

Question 26

What is fibrosis?

Answer 26

Formation/thickening of scar tissue, usually as a result of injury.

Question 27

What is dyspnoea?

Answer 27

Breathlessness

Question 28

What are some other impacts of COPD?

Answer 28

Accelerated ageing, Cachexia, increased CVD risk, osteoporosis, depression and anxiety

Question 29

Define cachexia?

Answer 29

Weakness and wasting of the body due to severe chronic illness

Question 30

What % of COPD patients have comorbidities?

Answer 30

94% have at least 1 comorbidity.

Question 31

How is COPD diagnosed? x3

Answer 31

Symptoms (cough, sputum or dyspnoea)
Pulmonary function testing
Imaging (e.g chest x-ray)

Question 32

Management of COPD … x5

Answer 32

Smoking cessation
Pharmacological options
Nutrition and exercise
Pulmonary rehabilitation!!!! (physio)
Surgery

Question 33

Asthma vs COPD

Answer 33

There may be differences, it can also be considered as a continuum. Stupid 2 slides.