PATHOPHYS: COPD

Question 1

What is COPD?

Answer 1

A disease state characterized by airflow limitation (usually progressive) that is NOT fully reversible.

Question 2

How do you measure airflow limitation in COPD?

Answer 2

Reduced FEV1

Question 3

How do you determine if airflow limitation is irreversible?

Answer 3

you have <200 mL)reversibility after bronchodilator application

ON TEST

Question 4

What accompanies the airflow limitation associated with COPD?

Answer 4

abnormal inflammatory response (CD8+ T cell response with neutrophils and macrophages)

ON TEST

Question 5

What two mechanisms underlie airflow limitation in COPD?

Answer 5

• Small Airway Disease (inflammation, fibrosis, mucous plugs, etc.)
• Parenchymal destruction (loss of alveolar attachments, decrease in elastic recoil)

Question 6

True or false: COPD is the third leading cause of death in the USA and worldwide.

Answer 6

TRUE

Question 7

What is the primary cause of COPD?

Answer 7

cigarette smoke

typically need 20 pack years

Question 8

Why is it important for COPD patients to quit smoking?

Answer 8

Over time, the FEV1 decreases drastically in smokers compared to non-smokers (if you have COPD, you already have low FEV1 and you will decrease quicker into disability and death)

Question 9

List some risk factors for COPD.

Answer 9

• Cigarette smoke
• Occupational dust and chemicals
• Environmental tobacco smoke
• Indoor and outdoor air pollution
• Age

Question 10

When do people become symptomatic for COPD?

Answer 10

In 40s, but do not get dyspnea until 50s or 60s

Question 11

True or false: spirometry is required to make the diagnosis of COPD.

Answer 11

TRUE! (FEV1/FVC < 0.7)

Question 12

True or false: people with a long history of poorly-treated asthma may go on to develop COPD.

Answer 12

TRUE: they develop an irreversible airflow obstruction that is indistinguishable for COPD

Question 13

What is the clinical definition of chronic bronchitis?

Answer 13

Production of sputum (chronic or recurrent cough) for 3 months in 2 consecutive years.

Question 14

What are the 3 major physical cues that you look for in a physical exam of a COPD patient?

Answer 14

1) Airflow limitation (prolonged expiration)
2) Hyperinflation (Pink puffer/barrel chest)
3) Impairment of breathing mechanics (use of accessory muscles)

Question 15

True or false: Static lungvolumes decrease in advanced COPD due to obstruction.

Answer 15

FALSE: they increase due to air trapping

Question 16

What is a major may to differentiate between COPD and asthma?

Answer 16

DLCO is reduced in COPD patient with predominant emphysema (alveolar problem) and NOT in asthma (airway problem)

Question 17

What are the 2 major clinical patterns of COPD?

Answer 17

1) Blue bloaters

2) Pink puffers

Question 18

What makes blue bloaters blue?

Answer 18

central cyanosis due to chronic respiratory failure increasing PCO2

Question 19

What bloats blue bloaters?

Answer 19

heart failure leads to pulmonary edema (crackles) and edema of ankles

Question 20

What makes pink puffers puff?

Answer 20

They need to create “auto-PEEP” in order to keep airway from collapsing during exhalation (they have mostly emphysema)

Question 21

What is the hypoxemia and hypercapnia due to in people with chronic bronchitis dominant COPD?

Answer 21

V/Q imbalance

Question 22

What type of respiratory failure is seen in blue bloaters?

Answer 22

Type II

Question 23

Do pink puffers have hypercapnia?

Answer 23

no- they increase their minute ventilation enough to maintain PCO2 within normal range

Question 24

What makes pink puffers so thin/cachetic?

Answer 24

High energy expenditure

Question 25

True or false: pink puffers commonly get home oxygen.

Answer 25

FALSE: pink puffers have preserved O2 saturation due to their high minute ventilation

Question 26

What inflammatory cells are involved in asthma versus COPD?

Answer 26

Asthma: CD4+ T cells, eosinophils
COPD: CD8+ T cells, macrophages, neutrophils

Question 27

What is the Reid Index? What is it used to diagnose?

Answer 27

Reid Index is the bronchial gland depth as a fraction of total bronchial wall thickness. It must be > 0.36 in order to diagnose chronic bronchitis

Question 28

What size airways are affected by chronic bronchitis?

Answer 28

> 2 mm

Question 29

What is the difference between chronic bronchitis and chronic bronchiolitis?

Answer 29

chronic bronchiolitis is present in airways < 2mm

Question 30

What is emphysema?

Answer 30

an abnormal enlargement of air spaces distal to terminal bronchioles

Question 31

What is a bullae?

Answer 31

Emphysematous space > 1 cm in diameter

Question 32

How does emphysema lead to airway collapse?

Answer 32

loss of alveolar attachments leads to dynamic airway collapse during EXHALATION

Question 33

Where do you see abnormalities in the flow volume loop of pure chronic bronchitis?

Answer 33

Airway obstruction is seen in inspiration AND expiration (due to airway narrowing)

Question 34

Where do you see abnormalities in the flow volume loop of pure emphysema?

Answer 34

Airflow obstruction during expiration only

Question 35

Which has increased lung volumes due to hyperinflation: pure chronic bronchitis or pure emphysema?

Answer 35

pure emphysema

Question 36

Decreased DLCO in pure emphysema is due to what?

Answer 36

Destruction of alveoli and alveolar capillaries

Question 37

True or false: VC is decreased in pure emphysema.

Answer 37

TRUE! Even though TLC and RV are incresed

Question 38

What are the most common causes of COPD exascerbation?

Answer 38

1) Bacterial infection of tracheobronchial tree
2) Viruses
3) Air pollution

Question 39

When should antibiotics be given to a COPD patient?

Answer 39

1) 3 cardinal symptoms: increased dyspnea, increased sputum volum, increased sputum purulence
2) Patients who require mechanical ventilation

Question 40

What is the most important drug in hypoxic patients?

Answer 40

oxygen with goal to maintain SAO2 > 90% at all times

Question 41

What is the caveat in supplemental oxygen effectiveness?

Answer 41

it must be worn 15-24 hours a day to be effective

Question 42

What must PaO2/SAO2 be to put patient on long term oxygen therapy?

Answer 42

PaO2 < 88%