Lecture 6 - pathology of copd Flashcards
what is COPD?
COPD is a complex and heterogeneous disease and its pathophysiology implicates varying degrees of airway remodelling, inflammation and tissue destruction
what are pathological features of COPD?
- glandular hypertrophy, reduced number of cilia
- goblet-cell metaplasia; smooth muscle hypertrophy; fibrosis
- loss of alveolar fine structure
what are physiological consequences of copd pathology
- increased cough with or without sputum
- increased mucous production, increased expiratory flow resistance
- loss of lung recoil, reduced gas exchange
what does dysanapsis refer to ?
dysanapis refers to the disproportionate scaling of airway dimension to lung volume or a mismatch of airway tree caliber to lung size
what are. 4 symptoms of copd?
symptoms include cough, sputum, dyspnea, and wheeze
patients who have chronic cough and sputum production with a history of exposure to risk factors should be tested for airflow limitation, even if they do not have dyspnea
what are diagnostic features of copd? x6
history of heavy smoking for many years
cough and sputum production for many years
cough often present only on waking first; later cough occurs through the day
sputum usually mucoid - become purulent with exacerbation of disease but not excessive
cough and sputum often worse in winter due to infection
insidious onset of breathlessness on exertion with wheezing or tightness of chest
describe the features of emphysema and chronic bronchitis copd
chronic bronchitis :
- clinical diagnosis daily productive cough for three moths or more in at least two consecutive years. overweight, elevated haemoglobin, peripheral edema, and wheezing
emphysema
- pathologic diagnosis, permanent enlargement and destruction of airspaces distal to the terminal bronchiole. older and Thin, severe dyspnea, quite chest, x-ray hyperinflation;ation with flattened diaphragms
what are the 3 bronchiole types in chronic bronchitis?
- simple mucoid bronchitis
- mucopurulent pus bronchitis
- chronic obstructive bronchitis
overproduction and hyper secretion of msucus by goblet cells
what are the clinical manifestations of chronic bronchitis? x6
excessive muss production
bronchospam, dyspnea and wheezing
hypoxia and hypercapnia - elevated co2 blue in colour
productive cough
increase body weight
clinically defined as persistent productive cough for at least 3 consecutive months in at least two consecutive years
what happens in emphysema?
an abnormal permanent enlargement of air spaces distal to the terminal bronchioles, accompanied by destruction of their walls
what symptoms do patients experience with emphysema?
severe difficulty breathing
chronic respiratory failure, evidenced by low oxygen levels, elevated levels of carbon dioxide
what is the diagnosis of copd?
spirometry forms the foundation of diagnosis of COPD
what is the BODE index?
measures disease severity in copd and incorporates
- BMI
- Degree of airflow obstruction assessed by fev1
- Dyspnea scale
- Exercise capacity by 6min walking test
what is an example of a protease inhibitor and what does it do?
alpha -1 anti-trypsin is a protease inhibitor
it balances the activity of elastin and other destructive enzyme proteases produced during an infection/ immune challenge
what does deletion of a1-AT cause?
higher possibility of emphysema
