COPD 2 Flashcards
(15 cards)
gold definition:
-Chronic Obstructive Pulmonary Disease (COPD) is a common, — and — disease that is characterised by — respiratory symptoms and airflow — that is due to airway and/or alveolar abnormalities usually caused by significant exposure to — particles or gases.
-Its pulmonary component ischaracterised by — that is not fully — .(in contrast to asthma)
-The airflow limitation is usually — and associated with an abnormal — response of the lung to noxious particles or gases.
-It can be further divided in — and –
preventable and treatable
persistent
airflow limitation
noxious
airflow limitation
not fully reversible
progressive
inflammatory response
Chronic Bronchitis and Emphysema
1- chronic bronchitis: —- of — on most days for at least — for at least — consecutive years with no other attributable — or — cause”
2- emphysema: “Abnormal and — , — of the airways — to the —-”
productive cough
sputum
3 months
2 years
cardiac or resp
premernant enlargement
distal to terminal bronchiole
Pathophysiology: Chronic Bronchitis:
- Inhalation of noxious particles and gases stimulate — and — to release several chemical signalers such as TNF, IL-8 and LT B4
-This leads to — of the respiratory mucosa and increased — production by goblet cells.
-There is impairment of normal — function and air way — leading to increased respiratory — , and — of the small bronchioles and alveoli, leading to impaired —
macrophages and CD8+ lymphocytes
oedema
mucus
cilia function
clearance
infection
destruction
gaseous exchnage
Pathophysiology: Emphysema:
Inhalation of noxious particles such as cigarette smoke/air pollution stimulate — and — in the —- and — to secrete — and — . The most important one being —-.
These enzymes break down the — in the — resulting in the lung losing its — , leading to —- of the distal airways and —
macrophages and neutrophils
terminal bronchioles
elastases and proteases
neutrophils elastase
elastin
alveolar wall
elasticity
dilation
air trapping
Pathophysiology: Genetic Causes of Emphysema:
-Alpha-1 antitrypsin deficiency is the most common genetic cause of emphysema.
-It is an —- disorder (each allele is responsible for making its own version of alpha-1 antitrypsin protein).
-“M” type ( –/ — type) alpha-1 antitrypsin(AAT) is a potent protease — which — the —- . Deficiency of this protein leads to —- and the accelerated development of COPD due to unopposed neutrophil elastase.
-This deficiency is caused by a — in the gene that is responsible for the production of the—- protein and can be passed on genetically to offspring (autosomal co-dominant).
-This mutation is common in Ireland (1 in 25 have the “Z” mutation on one of their alleles).The “Z” mutation causes a severe deficiency in the protein.
co dominant
wild/normal
potent protease inhibitors
inhibits neutrophil elastase
premature emphysema
mutation
alpha-1 antitrypsin
symptoms of COPD :
1-Cough
Initially — becoming more —
2-Sputum production
— /—- and increased — during exacerbations
3-Dyspnoea
On exertion initially but becomes progressively worse (present at—).
4-Wheeze/chest tightness
Initially — , eventually — and —
intermittent
progressive
mucoid/mucopurulent
volume
rest
intermittent
chronic and persistent
signs:
1-General Inspection
Supplemental oxygen
Nature of breathing:
-> — lip
->Prolonged —
-> —- increased AP diameter of chest/ — chest
Tachypnea
Accessory muscles of respiration
Inhalers/Nebulisers/walking aids around the bed
2- Face/Neck
—–
Tracheal —
3-Hands
- Peripheral cyanosis
- Tar staining
- Pallor palmar creases
- Asterixis
- Pulsus paradoxus
pursed lips
expiration
hyperinflation
barrel chest
central cynosis
tug
more signs:
Palpation
- Reduced chest expansion.
- Tracheal tugging
Auscultation
-Decreased breath sounds
-Wheeze
-Prolonged expiratory time
Percussion
- —-
Cardiovascular
Features of — heart failure-elevated jugular venous pressure (JVP), peripheral oedema, hepatomegaly, ascites
Hyper-resonance
right
sputum production and cough:
1- In COPD - increased irritation, goblet cell — and — of the airways lead to increased —
2- Impaired —- due to airway wall oedema/ damage leads to mucus being retained for longer and not being cleared effectively.
3-Mucus — and airway — due to exposure to noxious substances triggers the (cough reflex.)
4-Infections lead to more irritation and increased — / — of secretions. This can lead to an increase in cough — and increased mucus production.
hypertrophy and oedema
mucus production
mucucilliary clearance
mucus stagnation and irritation
volume/thickness
frequency
dyspnoea;
—- experience of breathlessness or breathing discomfort (aka “air hunger”).
Can impact on activities of daily living and quality of life.
Airway obstruction due to airway wall — and increased — production as well as — with — expiratory flow increases work of breathing for patients leading to dyspnoea.
Can be worsened with infections, increased exertion, anxiety and other co-morbid conditions
subjective
oedema
mucus production
hyperinflation
reduced expiratory flow
wheeze/ chest tightness:
Wheeze: — pitched — sound due to — reduced velocity airflow through a narrowed or partially obstructed airway.
Wheeze is an — sound. Not to be confused with stridor which is an — sound
In COPD obstruction due to airway wall oedema, increased mucus production and bronchiole / alveolar destruction leading to reduced — and reduced — giving rise to a feeling of chest tightness.
high pitched
whistling
tubulenent
expiratory
inspiratory
elasticity and expiratory flow
signs of hyperinflation:
1- —- chest, —- chest expansion, —- resonant percussion note, tracheal— all secondary to hyperinflation
2- Given that air is trapped in the lung and cannot be exhaled (—-residual volume) this hyperinflation expands the chest in an —fashion leading to a — appearing chest shape
3-As there is already an — residual volume and the chest is hyper expanded, it — the volume of air that can be inhaled (inspiratory reserve volume), leading to — chest expansion.
4-As the lungs are hyper expanded the increased air leads to a more resonant percussion note- the sound will be — compared to a person without COPD
barrel chest
reduced
increases
tracheal tug
increased
anterior-posterior
barrel
increased
reduces
reduced
hyper resonant
signs of right side hf:
1- Advanced COPD can lead to increased — due to pulmonary arteriole — in response to —. Chronic hypoxia can result in —-Increased pulmonary pressures increase strain on the – side of the heart
2- Right-sided heart failure occurring because of lung disease is called —- (literally pulmonary heart)
3- Pulmonary hypertension can itself impair —
4-The examination findings of cor pulmonale include elevated jugular venous pressure (JVP), lower limb oedema, or in its most sever form — and — .
vascular reisstance
vasoconstriction
hypoxia
pulmonary hypertension
right
cor pulmonale
gas exchange
heptamegaly anf ascites
COPD Exacerbation - NB:
In patients with underlying COPD, an exacerbation is an — , — deterioration of at least — of the following symptoms: Increased sputum — ; increased sputum —- ;—-
Associated with increased morbidity and mortality
Very common cause of GP / hospital visits.
acute sustained
2
sputum volume or purulence
breathlessness
COPD - differential diagnosis:
Respiratory:
Asthma
Bronchiectasis
Alpha-1 antitrypsin deficiency
Cystic fibrosis
Interstitial lung diseases
Tuberculosis
Pulmonary hypertension
Cardiac:
Heart failure with reduced ejection fraction.
Heart failure with preserved ejection fraction.
Acute Exacerbation of COPD: Differential Diagnoses:
Cardiac
Acute decompensated heart failure.
Acute myocardial infarction
Tachyarrhythmia
Pulmonary
Acute pulmonary embolus
Pneumonia
Asthma exacerbation
Mucus plugging
Inhaled foreign body
