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Kydd - Pathophysiology 2 > Respiratory Disorders - COPD > Flashcards

Respiratory Disorders - COPD Flashcards

1
Q

What is COPD?

A

Chronic Obstructive Pulmonary Disease (COPD) Is a umbrella term which includes Chronic Bronchitis and Emphysema. It is persistent inflammation of the air way, parenchyma, and vasculature. The inflammation is acute, recurrent and chronic obstruction of the airway.

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2
Q

What is causing the obstructive nature of COPD?

A

An underlying problem.

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3
Q

Where is the obsturction in COPD?

A

The obstruction occurs in the airways.

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4
Q

How can COPD be acute and chronic at the same time?

A

It can be both because the patient experiences episodes of acute obstruction which reoccur chronically.

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5
Q

What other condition does COPD sometimes co-exist with?

A

Asthma

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6
Q

What is the etiology and risk factors associated with COPD?

A

Smoking (80-90% of cases), Recurrent Respiratory Infections, Ageig, Genetic Defiency of Alpha1-antitrypsin.

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7
Q

Why is ageing a risk factor in COPD?

A

As we age there is degenerative changes of tissues. This results in reduced elasticity of tissue.

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8
Q

What are irritants? What is the effect when we inhale irritants?

A

Irritants are things like cigarette smoke, toxic fumes which we inhale. They have several negative effects on the body. 1) Increased mucus secretions. 2) Destruction of cilia lining the respiratory tract. 3) Induces inflammation leading to damage. 4)Damage to aveoli and vessels. 5)Induces coughing which can cause damage d/t speed of cough.

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9
Q

What is the function of Alpha1-antitrypsin? What is the result in COPD is there is a genetic defect in A1-antitrypsin?

A

A1-antitrypsin is a protease inhibitor which protects tissues from inflammatory cells like neutrophil elastase. When there is a definicy in A1-anittrypsin neutrophil elastase is free to break down elastin which results in less elasticity resulting in COPD and emphysema. The deficiency leads to chronic uninhibited tissue breakdown.

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10
Q

What is Chronic Bronchitis?

A

Chronic bronchitis is inflammation and obstruction of the air way.

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11
Q

What is the cause of chronic bronchitis?

A

Smoking and chronic/recurrent infection.

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12
Q

Does chronic bronchitis occur in the large or the small airways?

A

Both!

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13
Q

What are the characteristics of chronic bronchitis in the large airways?

A

Chronic bronchitis occurs in the large airways first. It is characterized by hypertrophy of submucosal glands and hypersecretion of mucus.

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14
Q

Why are the large airways affected first?

A

The large airways are affect by bronchitis first because they are the first line defense for the respiratory system. As the injurious agent persists the protective mechanisims of the large airways fail to protect the smaller airways.

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15
Q

What are the characteristics of chronic bronchitis in the small airways?

A

Chronic bronchitis in the small airways is characterised by an increase in goblet cells which results in an increase of mucus secretion.

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16
Q

Mucus secretion is a defense mechanism, why is this not beneficial in COPD and Chronic Bronchitis?

A

An overproduction of mucus results in a layer of mucus which is too thick. This impaires the silica from properly expectorating any foreign objects and creates an ideal site for infection.

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17
Q

What is the pathophysiology of Chronic Bronchitis?

A

Excess mucus which impairs the mucociliary defences. Infection establishes in the mucus. Bronchial walls become inflammed which obstructs the lumen. Airways collapse due to the obstruction and air becomes trapped in parts of the lung (alveoli). Decreased alveolar ventilation results in a perfusion imbalance which results in hypoxemia.

18
Q

What is hypoxemia?

A

An abnormally low concentration of oxygen in the blood.

19
Q

What is the normal ratio for measuring blood and air?

A

Ventillation:Perfusion Ratio

20
Q

What is the normal ventillation of the lungs? What is the normal perfusion of the lungs? What is a normal ratio?

A

Normal ventiallation of the lungs is 4.2L/min. Normal blood volume of the lungs is 5.5L/min. 4.2/5.5 = 0.8 Ventillation:Perfusion Ratio.

21
Q

How is Chronic Bronchitis diagnosed?

A

Chronic productive cough which is sustained for >3month/year in two consequtive years.

22
Q

What are the manifestations of Chronic Bronchitis?

A

Impaired respiratory function resulting in hypoxemia and hypercapnia. Activity intolerance. Increased sputum production. Dyspnea. Wheezing and wet crackles from fluid build-up in lungs. Prolonged expiration.

23
Q

What is Emphysema?

A

Emphysema is destruction of alveolar tissue and capillary beds causing loss of compliance and enlarged distal airspaces.

24
Q

What does compliance mean when in discussions of of respiratory system?

A

Compliance is the ease in which you fill and empty the lungs.

25
Q

What happens with-in the aveoli in the lungs when one has Emphysema?

A

The aveolar walls under go tissue damage, which reduces the amount of surface area of the aveoli causing the enlarged distal airways, and reducing the gas exchange of the lungs.

26
Q

What are the causes of Emphysema?

A

Smoking, Genetic defect of Alpha1-Antitrypsin.

27
Q

What is Alpha1-Antitrypsin?

A

A1-antitrypsin is a protease inhibitor which protects tissues from inflammatory cells like neutrophil elastase. When there is a definicy in A1-anittrypsin neutrophil elastase is free to break down elastin which results in less elasticity resulting in COPD

28
Q

What is the pathophysiology of Emphysema?

A

Alpha1-Antitrypsin (Antiprotease) protects the lungs. Smoking inhibits A1-antitrypsin and attracts inflammatory cells into the respiratory tract. The increased levels of proteases destroys alveolar walls causing the alveoli to merge and decreasing their surface area. Permenant distended air spaces causes impared vetilation. Air trapped between the alveoli leads to increased dead space further increasing the work of breathing. Capillary walls become destroyed leading to impaired perfusion.

29
Q

What are the two variables of Emphysema pathophysiology?

A
  1. Impared ventillation due to decreased surface area and permanent distended air spaces.
  2. Impaired perfusion due to capillary wall destruction.
30
Q

What are some excessory muscles of respiration?

A

sternocleidomastoid, serratus anterior, pectoralis major, pectoralis minor, trapezius, latissimus dorsi, erector spinae, subclavius.

31
Q

What is Centriacinar emphysema?

A

Centriacinar emphysema is emphysema that is confined to the terminal and respiratory bronchioles. It is the most common type of emphysema, and there in minimal destruction to the alveoli.

32
Q

What is Panacinar emphysema?

A

In Panacinar emphysema the peripheral alveoli and terminal airways are also involved. It is characterized by large distended spaces.

33
Q

What is a Bulla? What is the plural of Bulla?

A

Bulla is an airpocket in the lung that occurs between aveoli and pushes against the plural membrane. They occur as a result of lung tissue destruction. The plural of Bulla is Bullae.

34
Q

What are Blebs?

A

Plumonary blebs are small subpleural thin walled air containing space less that 1-2cm in diameter.

35
Q

What are the manifestations of Emphysema?

A

Dyspnea, Increased ventilatory effort, Barrel chest, Nasal flaring and pursed-lip breathing.

36
Q

How is COPD diagnosed?

A

Patient history, Physical exam, labs (cvc and ABGs), Chest X-ray, Pulmonary Fx tests.

37
Q

What is the treatment for COPD?

A

The goal is to limit the progression of the disease, as it is irreversible. First, you must quit smoking and avoid any airway irritants. Flu and pneumococcal vaccines. Drugs: short-acting Beta agonist and anticholinergics. Inhaled steriods. Long-acting Beta agonists. Theophylline.

38
Q

What is accomplished with beta agonists?

A

Beta agonists cause broncho dilation, opening up the airway.

39
Q

What is the purpose of the anticholinergics?

A

Block acetocholine. Acetocholine causes vasoconstriction, so we want to block that action.

40
Q

What is Theophylline?

A

A bronchodilator which also has some anti-inflammatory response.

Kydd - Pathophysiology 2 (22 decks)

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