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COPD Flashcards

1
Q

What is COPD?

A
  • A lung disease characterised by airflow limitation, not fully reversible
  • FEV1/FVC ratio less than 70%
  • Chronic bronchitis
  • Emphysema
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2
Q

What is chronic bronchitis?

A
  • Disease of mucus blocking the airways
  • Productive cough for 3 months in 2 successive years
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3
Q

What is emphysema?

A
  • Disease of loss of elastic tissue around acini and terminal bronchioles
  • Airspaces are enlarged
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4
Q

What are the risk factors of COPD?

A
  • Smoking
  • Age
  • Urban environment
  • Occupation
  • Low birth weight
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5
Q

What is the pathogenesis of chronic bronchitis?

A

Irritants induce:
- hypersecretion of mucus + hypertrophy of mucus glands
- metaplasia of ciliated epithelium → squamous epithelium
- CD8+ T-cells, macrophages and neutrophils

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6
Q

What is the gross appearance of CB?

A
  • Swollen + erythmatous airways
  • Covered in layer of mucin
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7
Q

What are the hallmarks of CB?

A
  • Mucus gland hypertrophy
  • Increase in goblet cells
  • Loss of ciliated cells
  • +/- squamous metaplasia
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8
Q

What are the complications of CB?

A
  • Severe airway obstruction: hypercapnia, hypoxemia, cyanosis
  • pulmonary hypertension → right HF
  • recurrent infections
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9
Q

What is the respiratory acinus?

A
  • Portion of lung tissue formed by branching of a single terminal bronchiole
  • Includes respiratory bronchiole, alveolar ducts and alveoli
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10
Q

What is a lung lobule?

A
  • Hexagonal area of lung parenchyma, consisits of 3-5 respiratory acini
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11
Q

What is centriacinar emphysema?

A
  • Central/proximal part of acinus affected
  • Seen mostly in apical lobes
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12
Q

What is panacinar?

A
  • Acini uniformly enlarged
  • More common in lower lobes
  • Occurs in A1AT deficiency
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13
Q

What is distal acinar?

A
  • Predominantly affects the distal part of acinus
  • Mostly associated with pneumothorax
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14
Q

What is the pathogenesis of emphysema?

A
  • Elastase: protease present in macrophages + neutrophils, released during inflammatory response
  • Antiproteases: Alpha 1 antitrypsin (A1AT) counteract elastase effect
  • People with deficiency of A1AT have higher incidence of emphysema
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15
Q

How does tobbaco affect capillaries?

A
  • Nicotine
  • IL-8, LTB4, TNF
  • Stimulate neutrophils to release elastase
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16
Q

How does tobbaco affect alveoli directly?

A
  • Reactive O2 species → inactive A1AT
  • Increased neutrophil elastase
  • Tissue damage and macrophage elastase
17
Q

What is the main factor in emphysema pathogenesis?

A
  • Elastin degradation by macrophages and neutrophils
  • Imperfect repair of elastin
18
Q

What is Bullous emphysema?

A
  • Large subpleural spaces, bullae >1cm
  • Near apex, if ruptured → pneumothorax

look like bubbles

19
Q

What is A1AT deficiency characterized by?

A
  • Inhibits neutrophil elastase
  • Common in Europe
  • Autosomal recessive normal : PiMM
  • Abnormal: PiZZ
20
Q

What is associated with lower lobe emphysema?

A
  • A1AT deficiency
21
Q

What are the consequences of emphysema?

A
  • Severe dyspnoea
  • Weight loss (lack of oxygen to peripheries)
22
Q

What is blue bloater seen in?

A
  • Chronic bronchitis
23
Q

What is pink puffer seen in?

A
  • Emphysema
24
Q

What is the clinical presentation of COPD?

A
  • SOB, wheeze
  • Productive cough
  • Recurrent chest infections
  • Pleuritic chest pain
  • Right HF
  • Hyperinflation of lungs
  • Barrel chest on CXR
25
Q

What are the clinical signs of COPD?

A
  • Accessory muscle use
  • Hyperinflation
  • Pursed lip breathing
  • Wheeze and ronchi on auscultation
  • Features of right HF (peripheral oedema, right heart enlarged)
26
Q

What is the gold standard for diagnosing COPD?

A
  • Spirometry
  • FEV1/FVC ratio < 70%
27
Q

What is the gold initiative for COPD?

A
  • Staging system for COPD
  • Mild to severe, 1-4
28
Q

What causes death due to COPD?

A
  • Respiratory acidosis + coma
  • Cor pumonale
  • Pneumothorax
29
Q

Which two principles relate to airflow restriction?

A
  • Bernoulli’s principle (constriction)
  • Poiseuille’s Law (radius increases flow)
30
Q

What is Bernoulli’s principle?

A
  • With increased airflow, pressure decreases
  • So airways constrict more
31
Q

What prevents airflow restriction?

A
  • Elastic tissue keeps airways open
  • Opposes Bernoulli’s principle

resp (20 decks)

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