SM_177a: COPD Flashcards
COPD is a _____ and _____ disease
COPD is a preventable and treatable disease
(has extrapulmonary effects as well)
The pulmonary component of COPD is _____ but rather is _____ and associated with _____
The pulmonary component of COPD is airflow limitation that is not fully reversible but rather is usually progressive and associated with an abnormal inflammatory response of lung to noxious particles or gases
_____ is the major risk factor for COPD
Cumulative exposure to noxious particles is the major risk factor for COPD
(cigarette smoke, indoor air pollution, occupation dusts, outdoor air pollution)
_____ deficiency is associated with COPD
Alpha-1-antitrypsin deficiency is associated with COPD
- PiZZ (homozygous) or PiMZ (heterozygote) + smoking
- Cigarette smoking remains most important risk factor for COPD in PiZZ individuals
- PiMZ is at increased risk for COPD vs PiMM (homozygous normal) especially in context of smoking
The cells most heavily involved in COPD are _____, _____, and _____
The cells most heavily involved in COPD are alveolar macrophages, neutrophils, and CD8+ lymphocytes
Describe the pathogenesis of COPD
- Cigarette smoke or other irritants
- Alveolar macrophages and epithelial cells activated
- Alveolar macrophages active neutrophils, monocytes, fibroblasts, CD8+ lymphocytes, and proteases; epithelial cells activate fibroblasts and CD8+ lymphocytes
- Neutrophils secrete proteases (neutrophil, elastase, cathepsins, MMPs), fibroblasts activated
- Fibrosis (obstructive bronchiolitis), alveolar wall destruction (emphysema), and mucus hypersecretion
The main pathological changes in COPD are _____, _____, and _____
The main pathological changes in COPD are fibrosis (obstructive bronchiolitis), alveolar wall destruction (emphysema), and mucus hypersecretion
Describe the role of alveolar macrophages in COPD
Alveolar macrophages orchestrate much of inflammatory process underlying COPD and release elastolytic enzymes and ROS
(increased in COPD lungs)
Describe the role of neutrophils in COPD
Neutrophils
- Critical effector cells: attracted by IL-8 and LTB4 from alveolar macrophages and PMNs, release ROS and MPO which contribute to ongoing inflammatory response
- Serine proteases like neutrophil elastase contribute to destruction of lung parenchyma
Describe the role of CD8+ lymphocytes in COPD
CD8+ lymphocytes perpetuate inflammatory response by releasing chemoattractants and are found in the airway walls, vessels, and lymph nodes of smokers with COPD
Describe the effects of inflammation in COPD
Inflammation leads to
- Small airway disease: airway inflammation, airway remodeling
- Parencymal destruction: loss of alveolar attachments, decrease of elastic recoil
Both lead to airflow limitation
Changes occur in the _____ in the chronic bronchitis portion of COPD
Changes occur in the large airways in the chronic bronchitis portion of COPD
_____ occurs in the small airways during COPD
Small airway remodeling occurs in the small airways during COPD
Changes occur in the _____ in the emphysema portion of COPD
Changes occur in the lung parenchyma in the emphysema portion of COPD
What changes occur in the large airways in the chronic bronchitis portion of COPD?
Large airways
- Mucus hypersecretion
- Goblet cell and mucus gland hyperplasia
- Squamous metaplasia of epithelium
- Increased macrophages and CD8+ lymphocytes
- Neutrophils in sputum
(note that there is no subepithelial basement membrane thickening or smooth muscle hypertrophy)
What changes occur in the small airways in COPD?
Small airway remodeling
- Inflammatory exudate in lumen
- Disrupted alveolar attachments
- Thickened wall with macrophages, CD8+ cells, fibroblasts
- Peribronchial fibrosis
- Lymphoid follicles
What changes occur in the lung parenchyma in the emphysema portion of COPD?
Lung parenchyma
- Alveolar wall destruction
- Loss of elasticity
- Destruction of pulmonary capillary bed
- Increased macrophages and CD8+ lymphocytes
This pathology represents the ______ portion of COPD
This pathology represents the chronic bronchitis portion of COPD
This pathology represents the ______ portion of COPD
This pathology represents the small airway remodeling portion of COPD
Emphysema leads to permanent ________
Emphysema leads to permanent distal acinar enlargement
This pathology represents the ______ portion of COPD
Which side is normal? Which is COPD?
This pathology represents the emphysema portion of COPD
Left is normal, right is emphysema
Diagnosis of COPD is made by ______
Diagnosis of COPD made by spirometry after looking at symptoms and exposure to risk factors
(FEV1 / FVC < 0.70 and not reversible)
- Symptoms: cough, sputum, dyspnea
- Exposure to risk factors: tobacco, occupation, indoor / outdoor pollution
(misdiagnosed in women)
Describe the flow-volume and volume-time curves in COPD
- Flow-volume curve: scooped out / concave
- Volume-time curve: less steep than normal and takes much longer to achieve FVC
Mechanisms of airflow limitation in COPD are _____, _____, and _____
Mechanisms of airflow limitation in COPD are mucus hypersecretion (luminal obstruction), disrupted alveolar attachments (emphysema), and mucosal and peribronchial inflammation and fibrosis (obliterative bronchiolitis)
FEV1 does not correlate well with _____ or _____ in COPD while ____ is inextricably linked to these two
FEV1 does not correlate well with quality of life or exercise capacity in COPD while hyperinflation is inextricably linked to these two
Describe the respiratory response to exercise in COPD
In people with COPD, with exercise ERV increases so IC decreases, which becomes inefficient in increasing minute ventilation, causing people to experience breathlessness
Describe the clinical manifestations of COPD
- Breathlessness: with or without strenuous exercise, can cause person to walk more slowly or stop to catch their breathe, or can cause person to not engage in daily activities
- History of exacerbations
(for COPD evaluation, look at symptoms and risk for exacerbations)
_____ are the treatment for COPD if the patient does not have exacerbation because they _____
Bronchodilators are the treatment for COPD if the patient does not have exacerbation because they reduce hyperinflation
(bronchodilators cannot fix the fact that patient is out of shape, so tell patient to increase activity level or attend pulmonary rehabilitation)
Add _____ to the regimen of bronchodilators if a COPD patient has exacerbations
Add an inhaled corticosteroid to the regimen of bronchodilators if a COPD patient has exacerbations
If the patient has elevated eosinophils, treat the patient using _____ and _____
If the patient has elevated eosinophils, treat the patient using bronchodilators and inhaled corticosteroids
(basically treating both COPD and asthma at the same time)
Describe the pathobiology of COPD exacerbations
Greater airway inflammation has multiple effects leading to symptoms of exacerbations
Compare and contrast the pathophysiology of asthma and COPD
Etiology of breathlessness in COPD is ______
Etiology of breathlessness in COPD is hyperinflation
The major risk factor for COPD is ______
The major risk factor for COPD is cigarette smoking
COPD is characterized by three distinct but concurrent pathologic changes: ______, ______, and ______
COPD is characterized by three distinct but concurrent pathologic changes: chronic bronchitis in central airways, small airway remodeling, and emphysema
