Chronic Obstructive Lung Disease Flashcards
(49 cards)
1
Q
What is the Definition of Chronic Obstructive Pulmonary Disease (COPD)?
A
- a common, preventable, and treatable disease
- characterized by persistent respiratory symptoms and airflow limitation
- Due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles
2
Q
What is COPD characterized by?
A
- persistent respiratory symptoms and airflow limitations
3
Q
What are the Characteristics of COPD due to?
A
- airway and/or alveolar abnormalities
- usually caused by significant exposure to noxious particles or gases
4
Q
What are some COPD stats?
A
- 4th leading cause of death
- 3rd leading cause of death by 2020
- 3million died of COPD in 2012 (6% of all deaths)
- COPD burden expected to increase
5
Q
What is the Etiology of COPD?
A
- Smoking
- Pollutants
- Host Factors
6
Q
What is the Pathobiology of COPD?
A
- Impaired lung growth
- accelerated decline
- lung injury
- lung & systemic inflammation
7
Q
What is the Pathology of COPD?
A
- Small airway disorders or abnormalities
- Emphysema
- Systemic Effects
- Chronic Inflammation
- Structural Changes
8
Q
What are the Clinical Manifestations of COPD?
A
- Symptoms
- Exacerbations
- Comorbidities
9
Q
What are the most common respiratory symptoms of COPD?
A
- Dyspnea
- Cough
- Sputum production
10
Q
What are the main risk factors of COPD?
A
- Tobacco Smoking (MAIN)
- environmental exposures (biomass fuel and air pollution)
- genetic abnormalities
- abnormal lung development
- accelerated aging
11
Q
What is COPD commonly punctuated by?
A
- periods of acute worsening of respiratory symptoms
12
Q
What are exacerbations?
A
- periods of acute worsening of respiratory symptoms
13
Q
What increases morbidity and mortality in most patients with COPD?
A
- Significant concomitant chronic diseases
14
Q
What is the Pathogenesis of COPD?
A
- Oxidative Stress
- Protease-antiprotease imbalance
- Inflammatory cells
- Inflammatory mediators
- Peribronchiolar and Interstitial Fibrosis
15
Q
What is the Pathophysiology of COPD?
A
- Airflow limitation and gas trapping
- Gas exchange abnormalities
- Mucus Hypersecretion
- Pulmonary Hypertension
16
Q
What Symptoms are looked for in the Diagnosis of COPD?
A
- Shortness of Breath
- Chronic Cough
- Sputum
17
Q
What is required for a diagnosis of COPD?
A
- Spirometry
18
Q
What are the Key indicators of diagnosing COPD?
A
- Dyspnea
- Chronic Cough
- Chronic Sputum Production
- Recurrent lower respiratory tract infection
- History of Risk Factors
- Family History of COPD
- Childhood Factors
19
Q
Describe what to look for in Dyspnea when attempting to diagnose COPD
A
- Progressive over time
- Characteristically worse with exercise
- Persistent
20
Q
Describe what to look for in Chronic Cough when attempting to diagnose COPD
A
- May be intermittent and my be unproductive
- Recurrent Wheeze
21
Q
When would chronic sputum production possibly indicate COPD?
A
- any pattern of chronic sputum production may indicate COPD
22
Q
What history of Risk Factors would you look for when attempting to diagnose COPD?
A
- Host Factors (genetic, congentital/development abnormalities)
- Tobacco Smoke
- Smoke from home cooking and heating fuels
- Occupational dusts, vapors, fumes, gases, and chems
23
Q
What childhood factors might be used to diagnose COPD?
A
- low birthweight
- childhood respiratory infections
24
Q
What are normal Spirometry results?
A
- FEV1 = 4L
- FVC = 5L
- FEV1/FVC = 0.8
25
What are spirometry results seen in someone with COPD?
- FEV1 = 1.8L
- FVC = 3.2L
- FEV1/FVC = 0.56
26
What are the Airflow Limitation Severities in COPD?
- Gold 1
- Gold 2
- Gold 3
- Gold 4
27
Describe Gold 1 Severity in COPD
- Mild
- FEV1 > 80% predicted
28
Describe Gold 2 Severity in COPD
- Moderate
- 50% < FEV1 < 80% predicted
29
Describe Gold 3 Severity in COPD
- Severe
- 30% < FEV1 < 50% predicted
30
Describe Gold 4 severity in COPD
- Very Severe
- FEV1 < 30% predicted
31
What is Emphysema?
- Loss of elastic lung recoil with attendant airway collapse during expiration
- Impaired pulmonary gas exchange (decrease surface area)
32
What is Bronchitis?
- Chronic airway obstruction due to inflammatory narrowing and airway hypersecretion (mucus)
33
What are some exercise-limiting symptoms of COPD?
- intolerable exertional symptoms
- Dyspnea (breathlessness) primary reason
34
What is Dynamic Hyperinflation?
- Mechanically constrains further tidal volume expansion, despite progressive
- Increase in central ventilatory drive (VCO2)
- No room to breathe
35
What are the Physiological Consequences of Dynamic Hyperinflation?
- mechanical restraint of Tidal Volume during progressive exercise
- Increase in effort for given ventilation during exercise
- Relationship between respiratory effort and thoracic displacement increases progressively during exercise
- Increased perception of exertional dyspnea and exercise intolerance
36
What are the Pathophysiological mechanisms of Exertional Dyspnea in COPD?
Increased
- limbic system activation
- motor drive
- central neural drive
Decreased
- Mechanical Response
Altered
- Afferent Activity
37
What do Bronchodilators do?
Improve
- lung function
- exertional dyspnea
- exercise tolerance
Decrease
- cholinergic airway smooth muscle tone
- lung volume
- work and O2 cost of breathing
- EFL
- DH
- Intensity of exertional dyspnea
38
What does Cholinergic Airway Smooth Muscle Tone do in COPD?
- Bronchoconstriction: airway narrowing
- Decreases amount of air exhaled
39
How do Bronchodilators improve Dyspnea?
Decrease
- Expiratory Flow Limitations
- Dynamic hyperinflation
- Prevent neuromechanical uncoupling of respiratory system
40
Why would you use Bronchodilators as a treatment for COPD?
- Permit greater tidal volume expansion during submaximal exercise
- Preserve relationship effort (efferent) during exercise
- preserve mechanical response of the respiratory system during exercise
- Alleviates exertional dyspnea
41
What do exercise intolerance and increased O2-cost of physical activity in COPD lead to?
- diminished quality of life
- Increased mortality
42
What is evidence that peripheral mechanisms to the pulmonary system are involved in the dysfunction of skeletal muscles during COPD?
- Physical Function persist after lung function is restored by transplantation or other therapeutic means
43
What are possible etiologies of muscle dysfunction in COPD? (12)
- Genetics
- Cigarette Smoke
- Systemic Inflammation
- Nutritional Abnormalities
- Metabolism
- Hypoxia
- Hypercapnia-Acidosis
- Decrease Physical Activity
- Exacerbations
- Aging
- Comorbidities
- Drugs
44
What Biological Events contribute to skeletal muscle dysfunction in COPD? (14 - 1, 7, 6)
Increased (1)
- Proteolysis
Decreased (7)
- Protein Synthesis
- % Type 1 Fibers
- Capillary Contact
- Mitochondrial Density
- Enzyme Capacity
- Myoglobin
- regeneration
Others (6)
- Oxidative Stress
- Muscle Damage
- Apoptosis
- Autophagy
- Atrophy
- Endoplasmic reticulum stress
45
What was the article on the influences of spinal anesthesia on exercise tolerance in patients with COPD Objective?
Compare (during constant work-rate cycling exercise)
- endurance time
- cardiopulmonary response
- quadriceps muscle fatigue
46
What two groups were the COPD patients split into for the article on exercise tolerance?
- sham
- active spinal anesthesia
47
What was the reason for active spinal anesthesia?
- Inhibiting central feedback of group III/IV lower limb muscle sensory afferents
48
What was the conclusion of the article on exercise intolerance in COPD patients?
- Spinal Anesthesia enhanced cycling exercise tolerance in patients with COPD
- Mostly reducing the ventilatory response and dyspnea during exercise
49
Why might there have been enhanced exercise tolerance in patients with COPD who had active spinal anesthesia?
- Inhibition of group III/IV lower limb sensory muscle afferents
