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Pulm by Minnie: AH Update > SM 177a - COPD > Flashcards

SM 177a - COPD Flashcards

1
Q

A patient with COPD has fewer symptoms and a high risk of exacerbations.

What GOLD catergory are they in?

What is the recommended treatment?

A

GOLD: C

(≥ 2 exacerbations/year)

Manage with LABA + LAMA, add ICS if persistent

(However, medications will not completely normalize function)

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2
Q

How is COPD diagnosed?

A

Expiratory airflow obstruction (FEV1/FVC < 0.7)

+

PFTs does not normalize with a bronchodilator

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3
Q

What is the definition of emphysema?

A

Permanent enlargement of alveolar spaces accompanied by destruction of their walls

-> Low diffusing capacity on PFT

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4
Q

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

a) Neutrophils, macrophages and CD8 lymphocytes

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5
Q

What radiographic findings might be present in COPD?

A

X-ray: Flattened diaphragm

HRCT: Too many dark spaces

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6
Q

Which genetic defect is associated with increased risk of COPD?

A

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
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7
Q

What is the primary driver of dyspnea in patients with COPD?

Hyperinflation or Low FEV1?

A

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

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8
Q

Consistent with Asthma or COPD:

Decreased Pel

A

COPD (Emphysema)

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9
Q

What is the role of CD8+ lymphocytes in COPD?

A

CD8+ cells perpetuate the inflammatory response by releasing chemoattractants

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10
Q

Which of the following is true regarding smoking-related COPD?

  1. It is not a bronchodilator responsive disease
  2. The majority of smokers develop COPD
  3. It is invariable progressive after smoking cessation
  4. It causes hypoxemia by v/q mismatch (low v/q) and diffusion limitation
A

d. It causes hypoxemia by v/q mismatch (low v/q) and diffusion limitation

Low v/q in chronic bronchitis, diffusion limitation in emphysema

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11
Q

COPD is an obstructive lung disease resulting from…

A

Cigarette smoking (in the USA)

Tobacco use or exposure to biofuels (in developing countries)

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12
Q

What is the primary risk factor for developing COPD?

A

Inhalation of noxious stimuli (ex: tobacco smoke)

Genetics play a role

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13
Q

What are some of the sputum-sample indicators of declining lung function in COPD?

A

Increased neutrophils

Incresed CD8+ lymphocytes

Alveolar macrophages are elevated in the lungs of COPD patients

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14
Q

What is the definition of COPD?

A

Productive cough for 3 months in each of 2 successive years

(without another explanation)

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15
Q

Describe the disease process of COPD

A
  • 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
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16
Q

___% of patients with COPD have smoked cigarettes

A

90% of patients with COPD have smoked cigarettes

The other 10% have had significant exposures to secondhand smoke and/or heavy air pollution

17
Q

Consistent with Asthma or COPD:

Smooth muscle hypertrophy

A

Asthma

18
Q

Consistent with Asthma or COPD:

Loss of tethering of airways

A

COPD (Emphysema)

19
Q

A patient with COPD has more symptoms and a low risk of exacerbations.

What GOLD catergory are they in?

What is the recommended treatment?

A

GOLD: B

(≤ 1 exacerbation/year)

Manage with LABA or LAMA, combine if persistent

(However, medications will not completely normalize function)

20
Q

Consistent with Asthma or COPD:

Increased RAW

A

Both

21
Q

What are the major effector cells of COPD?

A

Neutrophils

Neutrophils secrete serine proteases

  • Neutrophil elastase
  • MMPs
  • Cathepsins
22
Q

What non-pharmacologic therapies should be offered to patients with COPD

A
  • Vaccination
  • Pulmonary rehabilitation + exercise
  • Rare
    • Volume reduction surgery
    • Lung transplantation
23
Q

Which cells orchestrate the inflammatory process of COPD?

A

Alveolar macrophages

Secrete mediators that attract neutrophils, monocytes, and CD8+ lymphocytes

Generate ROS

24
Q

What is the only chronic disease that is increasing in prevalence?

A

COPD

25
Q

What chemicals, secreted by alveolar macrophages, are chemotactic for neutrophils?

A

IL-8

LTB4

26
Q

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:

  1. Decreased FEV1, decreased FVC and increased FEV1/FVC
  2. Normal values for FEV1 and FVC after albuterol
  3. Decreased FEV1 and a normal FVC
  4. Increased diffusing capacity
A

c. Decreased FEV1 and a normal FVC

27
Q

What are the 3 mechanisms to airflow obstruction in COPD?

A
  • 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
28
Q

A patient with COPD has fewer symptoms and a low risk of exacerbations.

What GOLD catergory are they in?

What is the recommended treatment?

A

GOLD: A

(≤ 1 exacerbation/year)

Manage with LABA

(However, medications will not completely normalize function)

29
Q

A patient with COPD has more symptoms and a high risk of exacerbations.

What GOLD catergory are they in?

What is the recommended treatment?

A

GOLD: D

(≥ 2 exacerbations/year)

Manage with LABA + LAMA + ICS, add PDE-4 if persistent

(However, medications will not completely normalize function)

30
Q

Consistent with Asthma or COPD:

Basement membrane remodeling

A

Asthma

31
Q

Consistent with Asthma or COPD:

Remodeling of the small airways, driven by CD8+ lymphocytes and alveolar macrophages

A

COPD

32
Q

COPD affects ____ to ____ million Americans

A

COPD affects 20** to **30 million Americans

Pulm by Minnie: AH Update (34 decks)

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