SM 177a - COPD Flashcards
A patient with COPD has fewer symptoms and a high risk of exacerbations.
What GOLD catergory are they in?
What is the recommended treatment?
GOLD: C
(≥ 2 exacerbations/year)
Manage with LABA + LAMA, add ICS if persistent
(However, medications will not completely normalize function)
How is COPD diagnosed?
Expiratory airflow obstruction (FEV1/FVC < 0.7)
+
PFTs does not normalize with a bronchodilator
What is the definition of emphysema?
Permanent enlargement of alveolar spaces accompanied by destruction of their walls
-> Low diffusing capacity on PFT
Which of the following best characterizes lung inflammation in COPD?
a) Neutrophils, macrophages and CD8 lymphocytes
b) Eosinophils and TH2 lymphocytes
c) Non caseating granulomas
d) Fibroblastic foci
a) Neutrophils, macrophages and CD8 lymphocytes
What radiographic findings might be present in COPD?
X-ray: Flattened diaphragm
HRCT: Too many dark spaces
Which genetic defect is associated with increased risk of COPD?
alpha-1 antitrypsin deficiency
- Alpha-1 antitrypsin is a protective antiprotease
- Without it, harmful proteases run rampant and cause lung damage
- A mutation in one copy is enough to increase a patient’s risk of COPD if they smoke
What is the primary driver of dyspnea in patients with COPD?
Hyperinflation or Low FEV1?
Patients with the same FEV1 exhibit varability in exercise capacity and dyspnea
This suggests that hyperinflation plays a larger role in dyspnea and subsequently, quality of life
Consistent with Asthma or COPD:
Decreased Pel
COPD (Emphysema)
What is the role of CD8+ lymphocytes in COPD?
CD8+ cells perpetuate the inflammatory response by releasing chemoattractants
Which of the following is true regarding smoking-related COPD?
- It is not a bronchodilator responsive disease
- The majority of smokers develop COPD
- It is invariable progressive after smoking cessation
- It causes hypoxemia by v/q mismatch (low v/q) and diffusion limitation
d. It causes hypoxemia by v/q mismatch (low v/q) and diffusion limitation
Low v/q in chronic bronchitis, diffusion limitation in emphysema
COPD is an obstructive lung disease resulting from…
Cigarette smoking (in the USA)
Tobacco use or exposure to biofuels (in developing countries)
What is the primary risk factor for developing COPD?
Inhalation of noxious stimuli (ex: tobacco smoke)
Genetics play a role
What are some of the sputum-sample indicators of declining lung function in COPD?
Increased neutrophils
Incresed CD8+ lymphocytes
Alveolar macrophages are elevated in the lungs of COPD patients
What is the definition of COPD?
Productive cough for 3 months in each of 2 successive years
(without another explanation)
Describe the disease process of COPD
- Smoking/pollution
- Activation of epithelial cells and alveolar macrophages
- Activates:
-
Fibroblasts -> Fibrosis
- -> Obstructive bronchitis
-
CD8+ Lymphocytes -> Alveolar wall destruction
- -> Emphysema
-
Neutrophils -> Proteases
- -> Alveolar wall destruction -> Emphysema
- -> Mucus hypersecretion
- Monocytes -> Further activation of alveolar macrophages
- Macrophages generate ROS
-
Fibroblasts -> Fibrosis
___% of patients with COPD have smoked cigarettes
90% of patients with COPD have smoked cigarettes
The other 10% have had significant exposures to secondhand smoke and/or heavy air pollution
Consistent with Asthma or COPD:
Smooth muscle hypertrophy
Asthma
Consistent with Asthma or COPD:
Loss of tethering of airways
COPD (Emphysema)
A patient with COPD has more symptoms and a low risk of exacerbations.
What GOLD catergory are they in?
What is the recommended treatment?
GOLD: B
(≤ 1 exacerbation/year)
Manage with LABA or LAMA, combine if persistent
(However, medications will not completely normalize function)
Consistent with Asthma or COPD:
Increased RAW
Both
What are the major effector cells of COPD?
Neutrophils
Neutrophils secrete serine proteases
- Neutrophil elastase
- MMPs
- Cathepsins
What non-pharmacologic therapies should be offered to patients with COPD
- Vaccination
- Pulmonary rehabilitation + exercise
- Rare
- Volume reduction surgery
- Lung transplantation
Which cells orchestrate the inflammatory process of COPD?
Alveolar macrophages
Secrete mediators that attract neutrophils, monocytes, and CD8+ lymphocytes
Generate ROS
What is the only chronic disease that is increasing in prevalence?
COPD
What chemicals, secreted by alveolar macrophages, are chemotactic for neutrophils?
IL-8
LTB4
A 53 year-old woman with a 40 pack-year history of smoking presents with dyspnea and wheeze.
The most likely finding on her PFTs are:
- Decreased FEV1, decreased FVC and increased FEV1/FVC
- Normal values for FEV1 and FVC after albuterol
- Decreased FEV1 and a normal FVC
- Increased diffusing capacity
c. Decreased FEV1 and a normal FVC
What are the 3 mechanisms to airflow obstruction in COPD?
- Emphysema: loss of tethering of the airways
- Chronic bronchitis: Increased mucus secretion
-
Peribronchiolar fibrosis, driven by CD8+ lymphocytes and alveolar macrophages, causes remodeling of the small (<2 mm in diameter) airways
- Increased connective tissue in the adventitia
A patient with COPD has fewer symptoms and a low risk of exacerbations.
What GOLD catergory are they in?
What is the recommended treatment?
GOLD: A
(≤ 1 exacerbation/year)
Manage with LABA
(However, medications will not completely normalize function)
A patient with COPD has more symptoms and a high risk of exacerbations.
What GOLD catergory are they in?
What is the recommended treatment?
GOLD: D
(≥ 2 exacerbations/year)
Manage with LABA + LAMA + ICS, add PDE-4 if persistent
(However, medications will not completely normalize function)
Consistent with Asthma or COPD:
Basement membrane remodeling
Asthma
Consistent with Asthma or COPD:
Remodeling of the small airways, driven by CD8+ lymphocytes and alveolar macrophages
COPD
COPD affects ____ to ____ million Americans
COPD affects 20** to **30 million Americans
