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Infect & Immune 2 MW, NJH & AB > MW L4 COPD > Flashcards

MW L4 COPD Flashcards

1
Q

COPD is characterised by

A

progressive airflow limitation - not fully reversible

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2
Q

What causes COPD

A

abnormail inflammatory response to noxious particles or gases (mainly cigarette smoke)

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3
Q

COPD covers 2 sides of a spectrum, from …. to ….

A

Chronic bronchitis to emphysema

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4
Q

Signs of chronic bronchitis (2)

A 
productive cough (years)
excessive sputum production
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5
Q

What is emphysema?

A

Alveolar wall destruction - irreversible enlargement of the terminal airspace (less efficient)

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6
Q

COPD may lead to ….. (4)

A

pulmonary hypertension
cyanosis
hypoxia
right heart failure

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7
Q

What are pink puffers?

A

Symptoms of emphysema - pink and out of breath

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8
Q

What are blue bloaters?

A

Symptoms of bronchitis - oedema

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9
Q

Risk factors other than tobacco smoke? (4)

A 
Urban pollution (smog)
Industrial pollution
Textile dust (working in cotton factory)
Biomass fuels (wood burning stove)
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10
Q

You can lost ….% of lung function without really noticing

A

20%

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11
Q

As lung function decreases you get more

A

infections

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12
Q

What is the sputum rich with in COPD?

And in asthma?

A

COPD - neutrophils

Asthma - eosinosinophils

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13
Q

Asthma or COPD is hyperresponsive?

A

Asthma

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14
Q

Asthma or COPD has variable reduction in airflow?

A

Asthma (worse at night)

COPD has little variation

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15
Q

In bronchitis you get poor gas exchange due to….

A

clogging up - deposition of fibrin and fibroblasts, mucus. Reduction in lumen size

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16
Q

In emphysema you get poor gas exchange due to….

A

enlargement of the airspaces

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17
Q

In COPD do you get more Th1 or 2 action?

A

Th1

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18
Q

Fibrosis is more prominent in COPD or asthma?

A

COPD

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19
Q

Mechanisms of airflow reduction in COPD? (3)

A

Occlusion of the airway by mucus
Thicken airway wall (inflammatory cells, fibrosis, increased smooth muscle)
Loss of elasticity due to emphysema

20
Q

Mucus is formed by ….(2)

A

Goblet cells (airway surface) and mucus glands (airway wall)

21
Q

Mucus production is controlled by……

A

Neuronal input and inflammatory mediators

22
Q

Excessive mucus in COPD is due to increased production because of….. (4) and decreased elimination

A

inflammatory cells
oxidative stress
viral infection
bacterial infection

23
Q

Excessive mucus in COPD is due to increased production and decreased elimination because ….. (4)

A 
poor ciliary clearance
airway occlusion
reduced PED
Respiratory smooth muscle weakness
(in severe diaphragm and intercostal muscles too)
24
Q

Nerves that innovate mucus secretion

A

Cholinergic (releasing ACh to M3)

25
Q

What causes inflammation in terms of leukocyte infiltration?

A

macrophages and CD8+t lymphocytes

neutrophils in infection

26
Q

What causes inflammation in terms of neutrophil products?

A

Elastase and other proteinases
ROS
Chemoattractants (IL8 and LTB4)

27
Q

What do elastases do?

A

Break up elastin, particularly in the alveolar wall

28
Q

What types of cells are increased in COPD? (2)

A

Goblet and CD8+

Also neutrophils during infection

29
Q

Consequences of inflammation on the endothelium:

A

DAMAGE

  • decreased ciliary cell function
  • increased mucus secretion from goblet cells
  • more cells (hyperplasia)
  • increased bronchial permeability (resulting in oedema and protein exudation)
30
Q

What is thought to cause emphysema?

A

Inbalance of proteases and antiproteases

31
Q

What produced the proteases and antiproteases hypothesis

A

α-antitrypsin deficiency - inherited deficiency similar to emphysema

32
Q

Where do lung elastases come from?

A

derived from neutrophils und macrophages

33
Q

Tres ejemplos de elastases de pulmón

A

Cathepsins
Proteinase 3
Gelatinase

34
Q

Que hacen los elastases de pulmón? (3)

A

Degradar :
elastin
basement membrane
connective tissue

35
Q

What causes lung elastases to increase?

A

Smoking

36
Q

What inhibits elastases?

And where do we find this?

A

alpha

liver

37
Q

What inhibits metaloproteinases?

Where is this found?

A

Tissue inhibitor of metalloproteinases

Epithelium

38
Q

What cytokines are increased in COPD?

A

TNF and IL8

39
Q

What cytokine induces elastase production?

A

TNF

40
Q

Potential future therapy?

A

Knock out elastases

41
Q

Dutch hypothesis is

A

That asthma, emphysema and chronic bronchitis overlap in a sexy venn diagram

42
Q

Cigarette smoke activates macrophages to release…. (2)

A

IL8 and LTB4

43
Q

Macrophages release…..

simulate…

A

proteases,

mucus secretion,

44
Q

What releases fibroblast growth factors?

A

macrophages and epithelial cells

45
Q

What are two e.g. of fibroblast growth factors?

A

TGFbeta and EGF

Infect & Immune 2 MW, NJH & AB (12 decks)

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