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S2 Case 3 - asthma & COPD > Pathophysiology of COPD > Flashcards

Pathophysiology of COPD Flashcards

1
Q

What is COPD?

A

Persistent airflow limitation associated with enhanced chronic inflammatory response

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2
Q

What is COPD predominantly caused by?

A

Smoking

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3
Q

What are the symptoms of COPD?

A

Dyspnoea
Chronic cough
Chronic sputum production

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4
Q

What is a lung?

A

Each bronchus with is bronchioles + alveoli

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5
Q

What is chronic bronchitis?
COPD classification

A

Chronic cough with sputum production for at least 3 months for 2 years

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6
Q

What happens in chronic bronchitis?

A

Bronchioles lose their shape + become clogged with mucus

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7
Q

What is emphysema?
COPD classification

A

Chronic cough
Shortness of breath
Limited activity level

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8
Q

What happens in emphysema?

A

Enlargement of distal air passages in terminal bronchioles = alveolar wall destruction

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9
Q

What is the main risk factor of COPD?

A

Smoking

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10
Q

What accumulates in alveoli in COPD?

A

Neutrophils + macrophages

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11
Q

What happens to accumulated neutrophils + macrophages?

A

Activated + release their granules containing elastase + MMP
= elastic tissue destruction

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12
Q

What are contained in cigarettes?

A

Reactive oxygen species (ROS)

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13
Q

What does ROS in cigarettes do in COPD?

A

Stimulate NK-KB, cytokines, TNF + IL-8
= activate neutrophils + macrophages
+ elastase + MMP
= tissue destruction

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14
Q

What does the tissue destruction do in COPD?

A

Destroys wall of alveoli

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15
Q

What does congenital/functional alpha1 anti-trypsin deficiency cause?

A

Imbalance between destructive effects of protease activity + productive effects

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16
Q

What are the consequences of tissue damage in the lung?

A

Thickening of bronchiolar wall
Respiratory bronchioles collapse
Mucus accumulating
= AIRFLOW OBSTRUCTION

17
Q

Why is air trapped in COPD?

A

Due to loss of elasticity
= can’t fully get air out in expiration

18
Q

What is an exacerbation of COPD?

A

Acute event worsening the respiratory symptoms beyond normal day-to-day

19
Q

What is the most common cause of COPD exacerbations?

A

Viral upper respiratory tract infections

20
Q

What are COPD patients at increased risk for?

A

Cardiovascular diseases
Osteoporosis
Respiratory infections
Anxiety + depression
Diabetes
Lung cancer

21
Q

When should spirometry be performed?

A

After administration of adequate dose of short acting bronchodilator to minimise variability

22
Q

What will the FEV1 be under if COPD?

A

<0.70

23
Q

What is the difference between COPD + asthmatic patient?

A

FEV1 return to normal with drug therapy in asthmatic patient

24
Q

What is uncommon in COPD but common in asthma?

A

Night-time waking
Significant day to day variability of symptoms

25
Q

What are the therapeutic option?

A

Nicotine replacement
Regular physical activity
Pharmacologic therapy

26
Q

What do short-acting bronchodilators do?

A

Ease COPD symptoms

27
Q

What are included in short-acting bronchodilators?

A

Anticholinergics
Beta-2 agonists

28
Q

What do long-acting bronchodilators?

A

Prevent breathing problems

29
Q

What are included in long-acting bronchodilators?

A

Anticholinergics
Beta-2 agonists
Combo of 2
OR beta-2 + corticosteroid

30
Q

When is a corticosteroid used in combo with beta-2?

A

Presence of asthmatic features

31
Q

How do anticholinergics work?
Muscarinic antagonists

A

Prevent Ach from binding to smooth muscle
+ prevent signal transduction of Gq mediated

32
Q

What do anticholinergic do?

A

Dilate airways, prevent bronchospasm + reduce mucus

33
Q

How do beta-2 agonists work?

A

Bind to beta-2 adreno receptor
Adenyl cyclase activated via signal transducing GS protein
= increase cAMP
= activate PKA
PKA mediates smooth muscle relaxation

S2 Case 3 - asthma & COPD (25 decks)

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