COPD Flashcards
(25 cards)
What are the key characteristics of COPD?
Alveolar abnormalities
Cigarette smoking
Overinflation of lungs
Low FEV1 that fails to respond to bronchodilators
What are the key indicators or symptoms of COPD?
Chronic cough
Chronic sputum production
Dyspnea
Acute bronchitis
History of risk factors
When is the usual onset of COPD?
Mid life
over 35 years old
What are the structural changes seen in COPD?
Hyperinflation of alveoli
Destruction of alveolar capillary wall
Small airways narrowing
Lung elasticity decreases
What are the mechanisms for structural changes of COPD?
Obstruction of small bronchioles
Proteolytic enzymes destroy alveoli tissues (protein breakdown)
Estin and collagen destroyed
What is Cor Pulmonale?
Pulmonary hypertension
Enlarge right ventricle due to increased work load
Crackles in lungs due to fluid in alveoli
What is polycythemia?
Increase in red blood cells due to hypoxemia and blood becomes more viscous
What is the main cause of inflammation in COPD?
Protease/ anti protease imbalance
What mediators are seen in COPD?
Macrophages and CD8
Neutrophils
Destructive ones
Why is there an increase in reactive oxygen species in COPD?
alpha 1 antitrypsin deficiency
this usually inhibits proteases
Inhibited by cig smoke
What proteases cause COPD?
Neutrophil elastase
Cathepsins
Matrix metalloproteinases
Causes emphysema (alveolar destruction)
Mucus hypersecretion (chronic bronchitis)
What makes Alpha 1 antitrypsin?
The liver
Deficiency is caused by protein misfolding in genetic ones
Liver damage
How do you assess COPD?
Degree of airflow limitation using spirometry
Assess symptoms
Assess risk of exacerbations
Assess comorbidities
What post bronchodilator FEV1/FVC confirms COPD?
less than 0.7
relate it to age related norms
What gold stage is 50-79 % of expected FEV1?
Gold 2
What GOLD stage is 30-49% of FEV1 expectations?
Stage 3
What are the requirements for Group A?
mMRC 0-1
CAT under 10
0-1 exacerbations
What are the requirements for group E?
2 or more exacerbations leading to hospitalizations
What are the treatments used for COPD?
Antimuscarinics
SABA
LABA
PDE4i (Daliresp/roflumilast)
ICSs
Oral steroids
Antibiotics
Oxygen
Why are steroid not reccomended for COPD?
immunosuppression - increased risk of infection
Risk of osteoporosis
Does not stop decrease in FEV1
Not for chronic long term treatment
What is the mechanism of action of Roflumilast?
Increase cyclic AMP in lung cells by inhibiting PDE4.
How does roflumilast help COPD episodes?
Increases lung function by decreasing eosinophils and neutrophils in sputum
Increase FEV1
Has an active metabolite
Use if smoker currently avoid in depression
What are the most common causes of COPD episodes?
Viral upper respiratory infection
Infection of the tracheobronchial tree
air pollution
What is the goal of COPD treatment?
Minimize the impact of current exacerbation and to prevent the development of subsequent exacerbations
