COPD Flashcards
Define COPD
a respiratory disorder largely caused by smoking, and is characterized by progressive, partially reversible airway obstruction and lung hyperinflation, systemic manifestations, and increasing frequency and severity of exacerbations.”
Main differnce between asthma and COPD
Asthma is rversible, COPD is progressive
Define emphysema
abnormal enlargement of the airspace distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis
Define chronic bronchitis:
Chronic cough for at least 3 months x 2 consecutive years
COPD Epidemiology is primarily…. It results in how many % of deaths?
Cigarette smoking: principal underlying cause of COPD and responsible for about 80% of deaths
What is unique about COPD’s prevelance?
3rd leading cause of death worldwide; only chronic illness with increasing mortality
Risk Factors of COPD
Exposure to Particles
Infections
Socio-economic status
What is the most significant risk factor of COPD?
- SMOKING/EXPOSURE TO 2ND HAND SMOKE
What are some host factors of COPD?
1) Hereditary
1-antitrypsin deficiency predisposes susceptible people to emphysema
1-antitrypsin is a serum protein produced by the liver & normally found in the lungs.
It prevents neutrophil elastase from destroying lung tissue
Accounts for <5% of cases
2) AGE
3) Lung Growth and Development
4) Airway Hyperresposiveness (Hard to seperate and define cause and effect with asthma)
Pathophysiology of COPD Simple
Stimulus (e.g smoking) –> Inflammatory process –> narrowing of perfipheral pathways –> Decreased FEV1
What is noted in COPD patients in regards to pathopjhysiologuy?
A Protease-Antiprotease Imbalance is noted in the lungs of COPD patients. (Protease Mediated destruction of elastin is an important feature of emphysema)
In COPD, what may amplify the inflammatory response?
Oxidative stress may play an important role in amplifying the inflammatory process.
COPD has a specific pattern of what?
Specific pattern of inflammation: CD8+ (cytotoxic) lymphocytes and other Inflammatory cells & mediators induce structural changes in the lung parenchyma & Pulmonary vasculature
COPD –> Increase in residual volume –> GAS TRAPPING
In regards to COPD pathophysiology, these things occur:
Expiratory Flow Limiytation
Lung Hyperinflation
Gas Exchange Abnormality
Mucous Hypersecretionm
What is a hallmark of COPD? Why does it occur?
Expiratory Flow Limitation
Hallmark of COPD
Due to increased resistance from mucosal inflammation, airway remodelling, fibrosis & secretions
In COPD, the lungs will ______upon inhalation. Why does it occur? What is the result?
Lung hyperinflation
Obstruction of the small airways results in air-trapping which causes lung hyperinflation
Develops early in disease and causes exertional dypsnea
In regards to gas exchange, in COPD there is ______ Result?
Gas exchange abnormalities
Result in hypoxemia & hypercapnia
Gas transfer for O2 & CO2 worsens as disease progresses
In regards to mucouis, in COPD there is ______. This results in a _____
Mucous hypersecretion
Results in a chronic productive cough
Not necessarily associated with airflow limitation
What triggers an exacerbation? What occurs during a COPD exacerbation?
Triggered by infection, environmental pollutants or unknown
During exacerbations there is increased hyperinflation and gas trapping, with decreased expiratory flow
With COPD, what other conditions may one have as a result later in life?
Significant Comorbid Illness
Pulmonary hypertension may develop late in course of COPD due to hypoxic vasoconstriction of small pulmonary arteries eventually leading to structural changes
Muscle wasting and cachexia, skeletal muscle dysfunction
Osteoporosis, depression and anemia, metabolic sydrome, cardiovascular, lung cancer
What are some comorbities associated with COPD?
Ischemic heart disease
Congestive heart failure
Arrhythmias
Pulmonary hypertension
Lung cancer
Osteoporosis and Fractures
Skeletal muscle dysfunction
Cachexia and Malnutrition
Glaucoma and Cataracts
Depression
Anxiety and Panic disorders
Metabolic disorders
Three cardinal sx of COPD?
Shortness of breath
Chronic cough
Phlegm
What other sx may be present?
Frequent lung infections
Reduced ability to go about daily activities
Barrel-shaped chest
Fatigue
Unexplained weight loss
End-stage COPD Sx?
Adopt positions that relieve dyspnea relax diaphragm
Use of accessory respiratory muscles
Expiration through pursed lips
Cyanosis
Enlarged liver from right heart failure
How do patients with COPD initially present?
1) Extremely sedentary lifestyle and presents with general fatigue
—> Typically have avoided exertional dyspnea
—> Shifted expectations and limited their activity
2) Patient has complaints of dyspnea and chronic cough
–> Initially noted on exertion only
–> Progressively triggered by less exertion or at rest
–> Morning sputum production
3) Patient who presents with episodes of cough, sputum, wheezing, fatigue and dyspnea
–> May be initially diagnosed as asthma
–> Interval between episodes shortens
Asthma vs COPD: age of onset
Asthma - <40
COPD: <40
Asthma vs COPD: smoking History
Asthma: Not causal, but worsen control
COPD: Usually >10 pack years
Asthma vs COPD: Sputum Production
Asthma: Infrequent
COPD: Often
Asthma vs COPD: Allergies
Asthma: Often
COPD: Infrequent
Asthma vs COPD: Clinical Sx Length/ How long do the sx last?
A: Intermittent and variable
C: Persistet and progressive
Asthma vs COPD: Disease Course
A: Stable (withe xacerbations)
C: Progressive (with exacerbations)
Asthma vs COPD: Comorbid Illness
Important for both
Asthma vs COPD: Spirometry
A: often normalizes
C: May improve but never normalizes
