Chronic Obstructive Pulmonary Disease

Question 1

T or F:

COPD is largely preventable.

Answer 1

T

Question 2

Description of COPD:

5

Answer 2

• Serious and prevalent
• Life threatening with complications
• Progressive
• Chronic, widespread
• Acute, recurrent

Question 3

What conditions are included in COPD?

Answer 3

• Chronic bronchitis

- Emphysema

Question 4

Can COPD co-exist with asthma?

Answer 4

Yerp

Question 5

What are the Et/risks for COPD?

Answer 5

• Smoking (80-90%)
• Aging
• recurrent respiratory infcts
• Genetic deficiency of alpha 1 anti-trypsin

Question 6

Why is smoking a risk actor for COPD?

5

Answer 6

The irritants in cigarette smoke have several damaging effects:
- They increase mucus secretion -> too much can
obstruct
- Damages cilia
- Causes coughing, damaging if persistent
- Inflm -> tissue damage
- Damage to the walls of capillaries and alveoli

Question 7

Why is aging a risk factor for COPD?

Answer 7

Because as the elastic tissue in the lungs degenerates with age, their ability to recoil is impeded

Question 8

What is compliance? How does this relate to COPD?

Answer 8

This refers to the ease with which the lungs are filled and emptied. In COPD, the compliance of the lungs is decreased.

Question 9

What is chronic bronchitis?

Answer 9

Chronic inflm and obstruction of an airway.

Question 10

For bronchitis to be considered chronic, how long must the productive cough be present?

Answer 10

For >3 consecutive months in 2 consecutive years

Question 11

Where does chronic bronchitis generally take place?

Answer 11

In large airways

- eg trachea, bronchi

Question 12

What causes obstruction in the airways during chronic bronchitis?

Answer 12

• Hypersecretion of mucus
• Hypertrophy of submucosal glands
  
  • Protective at first but will result in obstruction

Question 13

Eventually, bronchitis will reach the small airways. What will happen here?
(4)

Answer 13

There will be an increase in goblet cells and mucus, causing obstruction. There will also be inflm and fibrosis.

Question 14

T or F:

Chronic bronchitis is not an infct.

Answer 14

T

Question 15

Overview of the patho of chronic bronchitis:

Answer 15

Increased mucus secretion -> compromised mucociliary defenses -> infct -> airways become inflmed -> obstruction and airway collapse -> air gets trapped in parts of the lung -> decreased alveolar ventilation

Question 16

What is the average L/min for ventilation in the lungs?

Answer 16

~4.2 L/min

Question 17

What is the average L/min for perfusion in the lungs?

Answer 17

~5.5 L/min

Question 18

What is the ventilation:perfusion ration?

Answer 18

~0.8

Question 19

If your ventilation:perfusion ratio is less than 0.8, are you at risk for?

Answer 19

Hypoxemia, which will lead to hypoxia

Question 20

What is the major problem happening in emphysema?

Answer 20

The walls of the alveoli and capillaries are damaged

• loss of compliance
• Stretched out airways

Question 21

What is the Et of emphysema?

Answer 21

• Smoking

- Genetic deficiency of alpha 1 anti-trypsin (~1%)

Question 22

What is the role of a1 anti-trypsin? How does this relate to emphysema?

Answer 22

To regulate proteases. This opposes the action of trypsin, which is to breakdown proteins. If there is a deficiency of a1 anti-trypsin, the levels of trypsin increase and can cause major damage to functional cells.

Question 23

How does smoking contribute to emphysema?

Answer 23

• Inhibits a1 anti-trypsin = unregulated enzymes
• Attracts inflm cells = increased amount of trypsin =
  more structural damage

Question 24

Patho of emphysema:

Answer 24

Proteases destroy alveolar walls -> alveoli merge -> decreased surface area -> less area for diffusion/gas exchange

Question 25

What happens as a result of air becoming trapped between alveoli?

Answer 25

This increases dead space -> more effort is required to breathe (accessory muscle must be used)

Question 26

Perfusion is impeded by:

Answer 26

The destruction of the capillaries by trypsin

Question 27

What are "blebs"?

Answer 27

Small pockets of dead space filled with air, pushes against the pleura.

Question 28

What are "bullae"?

Answer 28

A large pocket of dead space filled with air, pushes against the pleura.

Question 29

Initially, the mnfts for COPD are_______.

Answer 29

Insidious

Question 30

Mnfts of COPD:

Answer 30

- Dyspnea - Initially only on exertion - As COPD progresses, with rest as well - Cough - Activity intolerance - Impeded gas exchange, decreases ATP production - Extremely increased amount of sputum - Wheezing and crackles - Impaired respiratory Fx - Hypoxemia and hypercapnia - Barrel chest (emphysema)

Question 31

Upon viewing your pneumonia patient's chest xray, what abnormal results will you see?

Answer 31

- Buildup of fluid | - Consolidation

Question 32

What is an example of a pulmonary fx test that might be run to Dx a COPD patient?

Answer 32

A spirometry test.

Question 33

What changes must be made to limit the progression of COPD?

Answer 33

- Overall healthy lifestyle (diet, activity, etc.) - Absolutely NO smoking - Avoid respiratory irritants

Question 34

COPD Tx: | What is a short acting beta adrenergic agonist?

Answer 34

- A med that will bind to the receptors that adrenaline normally would - Causes bronchodilation by relaxing smooth muscle

Question 35

COPD Tx: | What is an anticholinergic?

Answer 35

- Opposes the normal action of adrenaline at receptors | - Causes bronchodilation

Question 36

COPD Tx: | After treating COPD with short acting drugs, what are 3 other drugs you would consider giving?

Answer 36

- Inhaled steroids, O2 - Inhaled long acting beta agonists - Theophylline

Question 37

What is theophylline?

Answer 37

- 2 forms: short and long acting - Potent bronchodilator - Anti-inflm

Question 38

Which vaccines should be given to patients with a Hx of COPD?

Answer 38

Trick question: all of them! | But in this situation: flu and pneumococcal vaccine