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Pathophysiology - Midterm > Lecture 10: COPD > Flashcards

Lecture 10: COPD Flashcards

1
Q

What structures of the body are involved in ventilating the lungs?

A
  • Chest wall
  • Respiratory muscles (diaphragm)
  • Brain areas/neuronal connections that control breathing muscles
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2
Q

What is the normal resting breath of a healthy human?

A

12-15 times per minute

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3
Q

How much air is inspired/exhaled per breath?

A

About 500 mL

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4
Q

How many alveoli are in a healthy adult?

A

About 300 million

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5
Q

What is the function of alveolar surfactant?

A

Maintains surface tension and help alveoli hold shape which improves gas exchange

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6
Q

What are 4 symptoms of COPD?

A

1) Chronic cough
2) Increased mucous production
3) Inflamed airways
4) Dyspnea (difficult breathing)

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7
Q

What does dyspnea cause?

A
  • Impaired exercise tolerance

- Contributes to anxiety and depression (because unable to do anything)

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8
Q

True or false: COPD is preventable and treatable

A

False, COPD is preventable and manageable

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9
Q

What are the 2 stages of COPD?

A

1) Chronic bronchitis

2) Emphysema

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10
Q

What occurs in chronic bronchitis?

A
  • Inflamed bronchi produce excess mucous

- Leads to cough and difficulty getting air in and out

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11
Q

What is the most common cause of chronic bronchitis?

A

Cigarette smoking

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12
Q

How often does a cough occur in chronic bronchitis?

A

Most days for at least 3 months of the year for at least 2 consecutive years

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13
Q

What happens in emphysema?

A
  • Alveoli become larger and decrease in number leading to decreased amount of oxygen transferred by lungs to bloodstream
  • Air is trapped in “dead space” at terminals
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14
Q

True or false: chronic bronchitis and emphysema are diagnosed as separate entities because most people experience one or the other

A

False, most people present symptoms of both so they are no longer diagnosed as separate entities

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15
Q

What gender has COPD increased in?

A

Women

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16
Q

What are 5 questions that are signs someone should see their doctor?

A
  • Do you cough regularly?
  • Do you cough up phlegm regularly?
  • Do simple chores make you short of breath?
  • Do you wheeze when you exert yourself, or at night?
  • Do you get frequent and persistent colds?
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17
Q

What are the 2 types of risk factors for COPD?

A

Exposures and host factors

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18
Q

What are examples of exposure risk factors for COPD?

A

Tobacco smoke, occupational dusts and chemicals, indoor or outdoor air pollution

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19
Q

What are examples of host factor risks for COPD?

A

Genetic predisposition, impaired lung growth

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20
Q

What is the cause of 90% of COPD cases?

A

Smoking

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21
Q

What is the main genetic factor of COPD and what percent of COPD cases does it account for?

A
  • Alpha 1-anti-trypsin deficiency

- About 1%

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22
Q

What is involved in an AAT deficiency?

A
  • Congenital lack of lung anti-protease AAT

- Increased protease-mediated tissue destruction and emphysema in adults

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23
Q

What is the disease hallmark of COPD?

A

Accelerated decline in lung function

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24
Q

True or false: COPD begins decades before any symptoms become obvious

A

True

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25
Q

What causes the airflow limitation in COPD?

A

Small airway disease (obstructive bronchiolitis) and parenchymal destruction (emphysema)

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26
Q

What stimulates inflammation of the airways in COPD?

A

Exposure to noxious particles and gases

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27
Q

What do inflammatory cells cause in COPD?

A
  • Structural changes and narrowing of small airways because walls of airways become thick and inflamed
  • Increased mucous production in airways
  • Airways and alveoli lose elasticity
  • Walls between alveoli are destroyed
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28
Q

What is the main difference between asthma and COPD?

A
  • In asthma there is inflammation resulting in narrowing of airways with pronounced mucous production
  • In COPD this occurs too, as well as structural damage to parenchyma that results in permanent non-recoverable damage
29
Q

COPD vs. Asthma – key cells

A
  • COPD – neutrophils and macrophages

- Asthma – eosinophils, mast cells, and TH2 lymphocytes

30
Q

COPD vs. Asthma – glucocorticoid response

A
  • COPD – variable response

- Asthma – inhibited inflammation

31
Q

Why does cigarette smoke contribute to inflammation of the airways?

A

Cause increase in oxidants (hydrogen peroxide and nitric oxide) which promote inflammation and increase protease activity

32
Q

What are the 5 main physiologic outcomes of COPD?

A

1) Mucous hypersecretion and ciliary abnormality
2) Airflow limitation and hyperinflation
3) Gas exchange abnormalities
4) Pulmonary hypertension
5) Muscle wasting

33
Q

What is the main cause of airflow limitation and hyperinflation?

A

Remodeling (fibrosis and narrowing)

34
Q

When do gas exchange abnormalities occur?

A

Later on in course of disease

35
Q

What characterizes gas exchange abnormalities?

A

Hypoxemia (low blood oxygen) and/or hypercapnia (high blood carbon dioxide)

36
Q

What causes gas exchange abnormalities?

A

Bronchitis and emphysema

37
Q

What is pulmonary hypertension?

A

Increased pressure in the right pulmonary artery

38
Q

What is pulmonary hypertension secondary to?

A

Gas exchange abnormalities

39
Q

What can pulmonary hypertension result in?

A

Right ventricular hypertrophy and ultimately right-sided heart failure

40
Q

Who is spirometry recommended for?

A
  • Adults over 40 who are current or ex-smokers

- Patients with “nagging” cough, lots of mucous, or dyspnea with regular activity

41
Q

What should you be looking for in a physical exam of someone who may have COPD?

A
  • Cyanosis (bluing) of the lips and extremities
  • Barrel chest
  • Increased resting respiratory rate
  • Shallow breathing
  • Pursed lips during expiration
42
Q

What are the 2 most useful non-pharmacologic treatments for COPD?

A

1) Quit smoking

2) Pulmonary rehabilitation

43
Q

What can exercise do to patients with COPD?

A

Decrease dyspnea and fatigue

44
Q

What are the 4 most useful pharmacological treatments for COPD?

A

1) Bronchodilators
2) Inhaled corticosteroids
3) Inhaled corticosteroids and long-acting beta-agonists combination therapy
4) Vaccinations

45
Q

What are examples of bronchodilators used for COPD treatment?

A
  • Anticholinergics
  • Beta-agonists (short and long acting)
  • Theophylline
46
Q

What is the main pharmacological therapy for controlling symptoms and increasing exercise capacity?

A

Bronchodilators

47
Q

True or false: bronchodilators can reverse COPD

A

False, treatment of COPD has no effect on the actual course of the disease

48
Q

What is the main function of bronchodilators?

A

Decrease airway smooth muscle tone to improve expiratory flow and lung emptying

49
Q

What is the main function of inhaled corticosteroids?

A

Decrease inflammation in airways

50
Q

Are inhaled corticosteroids more effective in asthma or COPD and why?

A

Asthma because of it’s varying inflammatory mechanism from COPD

51
Q

What does combination therapy of inhaled corticosteroids and long-acting beta-agonists do?

A
  • Decreases risk of moderate COPD exacerbations

- Increases lung function

52
Q

Why should COPD patients get vaccinations?

A

Can decrease complications and death

53
Q

What 2 vaccinations should COPD patients get?

A
  • Seasonal flu every year

- Pneumococcal vaccine

54
Q

What are AECOPDs?

A

Sustained worsening of symptoms that leads to increased use of medications

55
Q

How often does the average COPD patient have exacerbations?

A

Twice per year

56
Q

What cause the majority of COPD exacerbations?

A

Infections

57
Q

What are other triggers besides infections of COPD exacerbations?

A

Congestive heart failure, exposure to allergens/irritants, and pulmonary embolism

58
Q

What are the 4 steps of a therapeutic plan for a COPD patient?

A

1) Intensify bronchodilator therapy
2) Short course oral steroids to suppress acute inflammation
3) Antibiotics if pussy, coloured mucous
4) Oxygen therapy

59
Q

COPD vs. Asthma – age of onset

A
  • Asthma – usually younger than 40

- COPD – usually older than 40

60
Q

COPD vs. Asthma – smoking history

A
  • Asthma – not casual

- COPD – usually more than 10 pack-years

61
Q

COPD vs. Asthma – primary symptoms

A
  • Asthma – cough, dyspnea, chest tightness, and wheezing

- COPD – cough, dyspnea, mucous production, wheezing

62
Q

COPD vs. Asthma – sputum production

A
  • Asthma – infrequent (only in acute attacks)

- COPD – often

63
Q

COPD vs. Asthma – reversible with beta-agonists?

A
  • Asthma – yes

- COPD – little

64
Q

COPD vs. Asthma – allergies?

A
  • Asthma – often

- COPD – infrequent

65
Q

COPD vs. Asthma – inflammation?

A
  • Asthma – yes (eosinophils, mast cells)

- COPD – yes (neutrophils)

66
Q

COPD vs. Asthma – disease course

A
  • Asthma – stable (with exacerbations)

- COPD – progressive worsening

67
Q

COPD vs. Asthma – spirometry results

A
  • Asthma – often normalizes

- COPD – may improve but never normalizes

68
Q

COPD vs. Asthma – clinical symptoms

A
  • Asthma – intermittent and variable

- COPD – persistent

Pathophysiology - Midterm (11 decks)

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