Lecture 7 - COPD

Question 1

Emphysema is classified as abnormal permanent enlargement of the air spaces distal to the ______ _______. This in conjunction with Chronic Bronchitis, which is defined as chronic productive cough for ___ months or more in ____ successive years when other causes have been ruled out, is classified as ______.

Answer 1

Terminal Bronchioles

3 months

2 years

COPD

Question 2

The leading genetic risk factor for developing COPD is a deficiency in ____ __ ________.

Answer 2

Alpha1 Antitrypsin

Question 3

In smokers, eating an abundance of which foods lowers the prevalence of COPD? Does this hold true for non-smokers?

Answer 3

Fruits and vegetables

No, this does NOT hold true for non-smokers.

Question 4

Smoking increases the number of ____ cells in the airways and also destroys the _____ on airway cells. Overall, this increases the amount of _____ and decreases its clearance.

Answer 4

Goblet cells

Cilia

Mucous

Question 5

The inflammation pathway caused by cigarette smoking differs from that caused by asthma in that one is mediated by a Th1 T-cell response and the other is Th2 T-cell mediated. Which is which?

Answer 5

Cigarette smoking – Th1 T-cells

Question 6

Nicotine and ROS from cigarette smoke causes the production of cytokines that induce extravasation of _____ from the vasculature. They secrete _____, as do activated Macrophages, which reduces alveolar recoil. Keep in mind this is similar to ___ __ ______ deficiency, which is normally responsible for breaking down ______, thus maintaining recoil.

Answer 6

Neutrophils

Elastase

Alph1 Antitrypsin

Elastase

Question 7

Diffusing capacity is decreased in patients with ______ but not in patients with _____, which should make sense bc in the former, the alveoli are destroyed (less surface area) and some of the capillaries are as well.

Answer 7

Emphysema

Chronic Bronchitis

Question 8

Obstructive lung disease is defined by FEV1/FRC ratio < ____.

Answer 8

0.7

Question 9

Patients can become hyperinflated with chronic obstruction. How does this affect RV and IRV?

Answer 9

RV goes up as patients become hyperinflated (“air trapping”), which makes it more difficult for them to take a deep breath in. Thus, IRV is decreased.

Question 10

_______ is an antidepressant commonly used in pharmacotherapy for smoking cessation, and ______ is a partial nicotine agonist that helps with cravings.

Answer 10

Bupropion

Varenicline

Question 11

All patients with COPD should have a short-acting ______. Additionally, therapy should include reduction of risk factors, including IMMUNIZATIONS.

Answer 11

Bronchodilator (inhaler)

Question 12

SABA stands for Short Acting Beta Agonist; the most common one used in inhalers is ______.

______ is a Short Acting Muscarinic Antagonist (SAMA), and it basically does the same thing: bronchodilation.

Answer 12

Albuterol

Ipratropium

Question 13

Salmeterol and Formoterol are both ______, while Indacaterol is an _____-_____.

Tiotropium and Aclidinium are both _______.

Answer 13

LABA

Ultra-LABA

LAMA

Question 14

Which groups in the Gold treatment guidelines receive Inhaled Corticosteroids (ICS)?

Answer 14

ONLY groups C and D, so those with history of exacerbation.

Question 15

The big issue with inhaler treatment with most patients is what?

Answer 15

Adherence: Patients don’t use the inhalers enough.

Question 16

Supplemental O2 is used for COPD patients with pO2 less than or equal to _____mmHg OR O2 saturation less than or equal to ____%.

Answer 16

55mmHg

88%

Question 17

Patients with Emphysematous changes localized to the ____ portion of the lung are candidates for surgical resection to decrease Hyperinflation. Worst case scenario lung ______ is an option.

Answer 17

Upper portion

Lung Transplant