Respiratory COPY COPY COPY Flashcards
What is Chronic Obstructive Pulmonary Disease (COPD)?
Progressive irreversible airway obstruction characterised by persistent airflow limitation caused by long term damage to lung tissue.
What are the conditions that are classed as COPD?
Chronic Bronchitis
Emphysema
What is the epidemiology of COPD?
1.2 million people with COPD in the UK
4th leading cause of death globally
Typically diagnosed >45 yrs
More common in males
Strongly related to Smoking.
What are the risk factors for COPD?
Cigarette smoking
Air pollution
Occupational exposure to dusts, chemical agents, and fumes
A1AT deficiency - can lead to early onset COPD
What is the most important cause/aetiological factor for COPD?
Cigarette smoking
Define Chronic Bronchitis?
A inflammatory lung condition that develops over time in which the bronchi and bronchioles become inflamed and scarred.
What is Chronic Bronchitis as a clinical definitions?
Chronic Bronchitis is a clinical term relating to a chronic productive cough for at least 3 months over 2 consecutive years.
Alternative explanations for the cough should also be excluded.
What is Emphysema as a pathological Definition?
Refers to abnormal air space enlargement distal to terminal bronchioles with evidence of alveoli destruction and no obvious fibrosis.
What is the pathophysiology of Chronic Bronchitis?
- Initial exposure to irritants and chemicals (cigarette smoke)
- Hypertrophy and hyperplasia of bronchial mucinous glands and goblet cells. There is also ciliary destruction.
- This increases the production of mucus in the lumen causing narrowing and obstruction
- Epithelial layer becomes ulcerated and there is the stimulation of immune cells causing inflammation of the bronchus and bronchioles.
- This leads to scarring and thickening of the walls further narrowing the airways.
- This causes air trapping causing poor exchange of O2 and CO2 and increases risk of infection.
What are the pathological changes that occur in Chronic Bronchitis?
Goblet cell hyperplasia
Mucus hypersecretion
Chronic inflammation and fibrosis
Narrowing of small airways
What are the symptoms of chronic bronchitis?
Chronic Cough - high sputum production
Dyspnoea
Wheeze
Recurrent respiratory tract infections - due to mucus plugging
What are the Signs of Chronic Bronchitis?
Wheeze - narrowing of airway creates higher pitch sound.
Crackles - popping open of small airways
Hypoxaemia and Hypercapnia - mucus plugs block airflow and lead to partial pressures of CO2 to rise and subsequent decline of O2.
Cyanosis (if hypoxaemia is really bad leading to the term blue bloaters).
Pulmonary Hypertension - due to Hypoxic vasoconstriction leading to increased pulmonary vascular resistance
What is Emphysema?
A lung disease characterised by dilatation and destruction of the lung tissue causing enlarged air spaces distal to the terminal bronchioles
What is the Pathophysiology of Emphysema?
Occurs in the ACINUS
Irritants/chemicals lead to damage and destruction of the alveoli wall.
Causes and inflammatory reaction and immune cell infiltration releasing Leukotriene B4, IL-8 and TNF-a
Proteases (elastases and collagenases) are also produced which break down alveolar wall structural proteins.
This leads to permanent enlargement of the alveoli and loss of their elasticity.
Alveolar wall septa break down reducing the total surface area. This leads to gas exchange dysfunction.
Loss of elasticity in the airways means that the airways collapse upon exhalation causing air trapping distally.
What are the different types of Emphysema?
Centriacinar Emphysema
Panacinar Emphysema:
Paraseptal Emphysema:
What is Centriacinar Emphysema?
Most common
Damage to central/proximal acini due to smoking
Typically affects upper lobes
What is Panacinar Emphysema?
Entire acinus affected
Due to A1AT Deficiency (protease inhibitor deficiency) cannot prevent breakdown.
Typically affects Lower lobes
What is Paraseptal Emphysema?
Affects peripheral lung tissue.
Peripheral ballooned alveoli can rupture causing pneumothorax
What are the pathological changes seen in emphysema?
Related to loss of Elastin:
Collapse: the alveoli are prone to collapse.
Dilation and bullae formation: alveoli dilate and may eventually join with neighbouring alveoli forming bullae
How is Chronic Bronchitis and Emphysema classified differently?
Chronic Bronchitis is defined by clinical features
Emphysema is defined by structural changes (enlarged alveoli)
What are the symptoms of Emphysema?
Dyspnoea - diminished gas exchange
( can improve this by exhaling slowly through pursed lips giving the name pink puffers)
Hypoxaemia
Weight loss
Cough - with some sputum
Pulmonary HTN
What are the main features of COPD phenotypes (emphysema/chronic Bronchitis)?
Pink puffer - emphysema
- Weight loss
- Breathless
- Emphysematous
- Maintained pO2
Blue bloater – chronic bronchitis
- Cough
- Phlegm
- Cor pulmonale
- Type 2 Respiratory failure
How does Emphysema lead to pulmonary hypertension?
Widespread Hypoxic vasoconstriction.
Too many blood vessels are constricted increasing the pressures in others.
Leads to pulmonary hypertension.
What is the cause of the barrel shaped chest in COPD?
Both chronic bronchitis and emphysema leads to air trapping within the Bronchi/acini.
This leads to Hyperinflation of the lungs giving a barrel chest appearance.