MW L4 COPD

Question 1

COPD is characterised by

Answer 1

progressive airflow limitation - not fully reversible

Question 2

What causes COPD

Answer 2

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

Question 3

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

Answer 3

Chronic bronchitis to emphysema

Question 4

Signs of chronic bronchitis (2)

Answer 4

productive cough (years)
excessive sputum production

Question 5

What is emphysema?

Answer 5

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

Question 6

COPD may lead to ….. (4)

Answer 6

pulmonary hypertension
cyanosis
hypoxia
right heart failure

Question 7

What are pink puffers?

Answer 7

Symptoms of emphysema - pink and out of breath

Question 8

What are blue bloaters?

Answer 8

Symptoms of bronchitis - oedema

Question 9

Risk factors other than tobacco smoke? (4)

Answer 9

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

Question 10

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

Answer 10

20%

Question 11

As lung function decreases you get more

Answer 11

infections

Question 12

What is the sputum rich with in COPD?

And in asthma?

Answer 12

COPD - neutrophils

Asthma - eosinosinophils

Question 13

Asthma or COPD is hyperresponsive?

Answer 13

Asthma

Question 14

Asthma or COPD has variable reduction in airflow?

Answer 14

Asthma (worse at night)

COPD has little variation

Question 15

In bronchitis you get poor gas exchange due to….

Answer 15

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

Question 16

In emphysema you get poor gas exchange due to….

Answer 16

enlargement of the airspaces

Question 17

In COPD do you get more Th1 or 2 action?

Answer 17

Th1

Question 18

Fibrosis is more prominent in COPD or asthma?

Answer 18

COPD

Question 19

Mechanisms of airflow reduction in COPD? (3)

Answer 19

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

Question 20

Mucus is formed by ….(2)

Answer 20

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

Question 21

Mucus production is controlled by……

Answer 21

Neuronal input and inflammatory mediators

Question 22

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

Answer 22

inflammatory cells
oxidative stress
viral infection
bacterial infection

Question 23

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

Answer 23

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

Question 24

Nerves that innovate mucus secretion

Answer 24

Cholinergic (releasing ACh to M3)

Question 25

What causes inflammation in terms of leukocyte infiltration?

Answer 25

macrophages and CD8+t lymphocytes | neutrophils in infection

Question 26

What causes inflammation in terms of neutrophil products?

Answer 26

Elastase and other proteinases ROS Chemoattractants (IL8 and LTB4)

Question 27

What do elastases do?

Answer 27

Break up elastin, particularly in the alveolar wall

Question 28

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

Answer 28

Goblet and CD8+ Also neutrophils during infection

Question 29

Consequences of inflammation on the endothelium:

Answer 29

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

Question 30

What is thought to cause emphysema?

Answer 30

Inbalance of proteases and antiproteases

Question 31

What produced the proteases and antiproteases hypothesis

Answer 31

α-antitrypsin deficiency - inherited deficiency similar to emphysema

Question 32

Where do lung elastases come from?

Answer 32

derived from neutrophils und macrophages

Question 33

Tres ejemplos de elastases de pulmón

Answer 33

Cathepsins Proteinase 3 Gelatinase

Question 34

Que hacen los elastases de pulmón? (3)

Answer 34

Degradar : elastin basement membrane connective tissue

Question 35

What causes lung elastases to increase?

Answer 35

Smoking

Question 36

What inhibits elastases? | And where do we find this?

Answer 36

alpha | liver

Question 37

What inhibits metaloproteinases? | Where is this found?

Answer 37

Tissue inhibitor of metalloproteinases | Epithelium

Question 38

What cytokines are increased in COPD?

Answer 38

TNF and IL8

Question 39

What cytokine induces elastase production?

Answer 39

TNF

Question 40

Potential future therapy?

Answer 40

Knock out elastases

Question 41

Dutch hypothesis is

Answer 41

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

Question 42

Cigarette smoke activates macrophages to release.... (2)

Answer 42

IL8 and LTB4

Question 43

Macrophages release..... | simulate...

Answer 43

proteases, | mucus secretion,

Question 44

What releases fibroblast growth factors?

Answer 44

macrophages and epithelial cells

Question 45

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

Answer 45

TGFbeta and EGF