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Respiratory > COPD > Flashcards

COPD Flashcards

1
Q

Forms of obstructive lung disease

A
  • Emphysema
  • Chronic bronchitis
  • Asthma
  • Bronchiectasis
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2
Q

Chronic bronchitis

A

Anatomic site: bronchus
Major pathologic changes: mucous gland hyperplasia, hypersecretion
Etiology: tobacco smoke, air pollutants
Signs/symptoms: cough, sputum production

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3
Q

Bronchiectasis

A

Anatomic site: bronchus
Major pathologic changes: airway dilation and scarring
Etiology: persistent or severe infections
Signs/symptoms: cough, purulent sputum, fever

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4
Q

Asthma

A

Anatomic site: bronchus
Major pathologic changes: smooth muscle hyperplasia, excess mucus, inflammation
Etiology: immunologic or undefined causes
Signs/symptoms: episodic wheezing, cough, dyspnea

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5
Q

Emphysema

A

Anatomic site: acinus
Major pathologic changes: airspace enlargement, wall destruction
Etiology: tobacco smoke
Signs/symptoms: dyspnea

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6
Q

Who is more susceptible to developing COPD?

A

Women and African-Americans

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7
Q

Centriacinar emphysema

A
  • Most common
  • Heavy smokers
  • Respiratory bronchioles (distal alveoli spared)
  • More common in apical segments
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8
Q

Panacinar emphysema

A
  • Acini uniformly enlarged (to alveoli)
  • Commonly in lower zones of lung
  • Most severe at bases
  • associated with alpha-1 antitrypsin deficiency
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9
Q

Paraseptal emphysema

A
  • distal acinus most prominently involved
  • along lobular CT septa
  • adjacent to areas of fibrosis, scarring, or atelectasis
  • is likely the underlying etiology in spontaneous pneumothorax in healthy, young adults
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10
Q

Irregular emphysema

A

-associated with scarring

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11
Q

Pathogenesis of emphysema

A

smoke and other irritants cause damage and inflammation»leukotrienes, IL-8, TNF released from resident epithelial cells and macrophages»attract inflammatory cells from circulation»amplify inflammatory process (cytokines)»induce structural changes through growth factors»proteases released from inflammatory and epithelial cells»break down CT»relative deficiency in anti-proteases in some who develop emphysema (alpha-1 antitrypsin)

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12
Q

Alpha-1 antitrypsin deficiency

A
  • Autosomal recessive disorder
  • protease inhibitor
  • PiMM most common wild-type
  • PiZZ abnormal form»accumulate in liver
  • damage in liver and lungs
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13
Q

Other pathogenesis

A

Oxidative stress»tissue damage and inflammation

Infection»exacerbate

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14
Q

Gross morphology with emphysema

A
  • voluminous lungs
  • upper 2/3
  • blebs and bullae can form
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15
Q

Blebs

A

air filled space >1 cm

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16
Q

Bullae

A

air filled space <1 cm

17
Q

Pink puffers

A

Overventilate and remain well oxygenated

18
Q

Other disorders that have emphysema-like changes

A

Compensatory hyperinflation (dilation of alveoli in response to loss of lung substance elsewhere - surgical removal)

Obstructive overinflation (expands because air is trapped - tumor, foreign object, congenital)

Interstitial emphysema
(air enters into SC tissue or mediastinum - alveolar tears in emphysema, chest wounds)
19
Q

Bullous emphysema

A

Subpleural blebs or bullae
Often near apex, can be due to old scarring like with TB
Rupture can result in pneumothorax

20
Q

Pathogenesis of chronic bronchitis

A

Insult leads to…

  • Mucus hypersecretion (hypertrophy/hyperplasia of submucosal glands and, later, goblet cells
  • Inflammation (neutrophils, lymphocytes, macrophages)»fibrosis
  • Infection»maintains and leads to acute exacerbations
21
Q

Morphology of chronic bronchitis

A

Gross: edema of mucous membranes, mucinous purulent secretions, cases of secretions and pus
Microscopic: inflammation of airways, enlargement of mucus-secreting glands, epithelial metaplasia and dysplasia, narrowing of bronchioles caused by mucous plugging, inflammation, and fibrosis

22
Q

Chronic bronchitis clinical features

A
  • persistent cough

- hypercapnia, hypoxemia, mild cyanosis (blue bloaters)

23
Q

Asthma morphology

A

Gross:

  • distended lungs
  • airways filled with thick mucous plugs
  • small areas of atelectasis

Microscopic:

  • eosinophils with Carcot-Leyden crystals
  • mucous
  • airway remodeling (thickening of wall, subbasement membrane fibrosis, increased vascularity, increased size of glands, increased numbers of goblet cells, hypertrophy and hyperplasia of bronchial wall muscle
24
Q

Allergic bronchopulmonary aspergillosis (ABPA)

A
  • Occurs in patients with asthma and cystic fibrosis
  • Results from hypersensitivity reaction to Aspergillus fumigatus

-Can see:
Transient pulmonary infiltrates on imaging
Eosinophilia of blood and sputum
Increased serum IgE

-Get mucous plugs, often see fungal hyphae in mucoinflammatory material

25
Q

Treatment of COPD

A

-Acute symptoms:
SABA and/or short-acting anti-muscarinic (ipratropium)

  • Persistent symptoms: stack with severity
    1. LABA
    2. long-acting anticholinergic
    3. inhaled corticosteroids (increase risk of bacterial infection)
    4. roflumilast

(theophylline may be useful»improve contractile function of diaphragm»improve ventilatory capacity)

26
Q

Tiotropium

A

Reduces frequency of exacerbations through unknown mechanisms

27
Q

Roflumilast

A
  • Inhibits PDE4 (increase cAMP within inflammatory and structural cells)
  • reduces risk of COPD exacerbations
  • adverse effects: headache, weight loss, diarrhea, mental health problems

Respiratory (9 decks)

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