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ClinE 470 > COPD + cancer > Flashcards

COPD + cancer Flashcards

1
Q

What does COPD stand for?

A

Chronic Obstructive Pulmonary Disease

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2
Q

Define COPD.

A

A condition that makes it harder to breathe due to damage to the airways and destruction of the lung tissue.
A condition that is preventable, which is poorly reversible and progressive in nature.

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3
Q

Why is COPD a collective term?

A

It covers a range of pulmonary obstructive and inflammation diseases such as emphysema and chronic bronchitis (but not asthma).

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4
Q

Why is asthma not considered COPD?

A

It is a reversible, that is not progressive in nature and not always preventable.

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5
Q

How is COPD diagnosed?

A

There is no one way to diagnose it - it is more of a clinical judgement based on history, examination and confirmation of air flow obstruction using spirometry.

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6
Q

What does a spirometer measure?

A

The amount of air one exhales and how quickly it is exhaled.

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7
Q

What are the 3 main COPD diagnostic criteria?

A

If the FEV1 (Forced Expiratory volume in 1 second) is less than 80% predicted value.

If the FEV is less than 0.7 when divided by the forced expiratory capacity (FEC)

If the FEV:FEC ratio is in the lowest 5th percentile of the population

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8
Q

Define the GOLD categories of COPD.

A

GOLD 1 - Mild - FEV/FEC <0.7 or FEV1 >80% predicted
GOLD 2 - Moderate - FEV/FEC <0.7 or FEV1 >50% predicted
GOLD 3 - Severe - FEV/FEC <0.7 or FEV1 >30% predicted
GOLD 4 - Very Severe - FEV/FEC <0.7 or FEV1 >30% predicted with chronic respiratory failure.

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9
Q

What fraction of people over 35 are thought to live with undiagnosed COPD in the UK?

A

1/8 (which equates to 2 million)

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10
Q

What co-morbidities are related to COPD?

A

CVD, Chronic heart failure, muscle atrophy, osteoperosis, metabolic disease and depression.

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11
Q

What is the relationship between COPD and mortality?

A

People with COPD die more quickly - however this is not always a direct attribute to the disease.

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12
Q

What is the main cause of COPD? What is the % causality in both rich and poor countries?

A

Smoking Tobacco and/or cannabis

It causes 73% of COPD cases in high income countries and 40% COPD in low income countries.

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13
Q

At what age does smoking cause increased COPD risk?

A

At any age! Fletcher et al 1977 showed n increased risk of COPD even when one has stopped smoking at 65 and 45 and possibly even younger.

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14
Q

Why is smoking sometimes described as a viscous circle when it comes to COPD risk?

A

Smoking enhances the bodies oxidative response to pollutants which causes damage which is affected more by the smoking etc.

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15
Q

Other than smoking - what are the other risks/causes of COPD?

A

Genetic influence
Environmental - Air NO levels (high in cities)
- Occupational pollution
- Indoor cooking pollution (low income
countries)
Sex - There is a higher prevalence of COPD in men although this may be linked to occupation and uneven smoking rates (figures are evening out)
Aging - As one gets older their risk of COPD increases

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16
Q

What does smoke and other pollutants do to endothelial cells in the bronchi?

A

It paralyzes them which means other irritants such as dust cannot be removed as effectively.
The cilla on the cells get smaller further reducing the effectiveness of irritant removal.

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17
Q

What does smoke and other pollutants do to goblet cells in the bronchi?

A

Goblet cells start to produce more mucus which leads to higher inflammation and a reduced sub endothelial space.

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18
Q

What happens when the sub-endothelial space is reduced due to increased mucus production?

A

There is a reduced pathway size making it harder to inhale and exhale effectively.

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19
Q

What are the side effects of a reduced inability to remove toxins from the lungs?

A

There is a much higher risk of infection due to inhaled toxins staying in the lungs longer and bacteria thriving on the mucus that cannot be removed.

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20
Q

What does HPV stand for?

A

Hypoxic Pulmonary Vasoconstriction

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21
Q

What does HPV involve?

A

The capillaries around the alveoli constrict leading to an increased pulmonary artery pressure. The pressure leads to increased right ventricle afterload and thus lowers cardiac output.
There is also endothelial dysfunction at the alveoli.

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22
Q

Why does HPV happen?

A

Due to the lack of oxygen the capillaries constrict in order for there to be more time for O2 transport to occur - this also happens at altitude.
However, although this may be initially beneficial for increased O2 uptake - very high levels of constriction leads to complications.

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23
Q

What did Simm et al (2009) find the relationship between HPV and exercise capacity to be?

A

Those in the top quintile for pulmonary artery pressure take significantly longer in the 6 minute walk test.

24
Q

What does smoke and pollutants do to the smaller airways?

A

There can be structural damage due to free radical activity - this leads to narrowing of the airways.
This also leads to cytokine production to remove the free radicals.

25
Q

What enzymes are triggered by pollutants and what does this cause?

A

Elastase which breaks down the elastin of the alveoli leading to reduced mobility.
Protease which breaks down the alveoli wall leaded to reduced surface area for perfusion.

26
Q

Why does endothelial dysfunction occur (emphasyma)?

A

Reduced mobility means a reduced capability to remove air from the lungs therefore leading to a reduced O2 gradient.
Reduced surface area leads to less O2 perfusion therefore lower O2 blood concentration.
Increased scar and connective tissue reduces the number of alveoli in the lungs.

27
Q

How does the blood change to compensate for reduced O2 levels due to COPD?

A

More red blood cells are produced - this thickens the blood leading to possible high blood pressure and blood clots.

28
Q

What happens due to the damage at the pulmonary capillaries (through free radical activity)?

A

There is plasma leakage - this can further thicken the blood (along with increased RBC count).

29
Q

Why does hyperinflation occur?

A

Due to the decreased capacity for lungs to recoil leading to a lower inspiratory capacity and over inflation as more fresh air is attempted to breath in

30
Q

What is the difference between static and dynamic hyperinflation?

A

Static Hyperinflation = at rest

Dynamic hyperinflation = during exercise

31
Q

What is hyperinflation also known as?

A

Gas Trapping.

32
Q

What anatomical changes occur due to hyperinflation?

A

Flattening of the diaphragm, protrusion of the ribs and lungs.

33
Q

What is the % cost of breathing when one has hyperinflation (and what is it normally)?
Why is this?

A 
The percentage cost will be 40% compared to the normal 10-15%
Inspiratory muscles (scalenes, sternocleidomastoid, serratus anterior) need to be recruited to further inflate the chest
34
Q

What changes can occur to the heart due to dynamic hyperinflation?

A

Dynamic hyperinflation can increase RV afterload which can lead to the septum shifting to the left and reducing left ventricle output.

35
Q

What is Dyspnea?

A

Breathlessness, difficult and labored breathing.

36
Q

What can dyspnea cause?

A

A reduced exercise tolerance.

Anxiety which can lead to panic and an even higher breathing rate.

37
Q

What is tachyponea?

A

Abnormally rapid breathing which can lead to air trapping/hyperinflation.

38
Q

Why does deconditioning often occur with COPD?

A

Dyspnea occurs when one with COPD exerts themselves. This leads to reduced exertion levels. This leads to deconditioning and reduced exercise tolerance which further reduces exertion (rapid cycle).

39
Q

What is muscular deconditioning?

A

Decreased muscular strength,
Decreased GLUT4 percentage,
Decreased MCT4 percentage (which helps with the removal of lactate from the muscles),
Decreased type 1 muscle fibres which reduces aerobic capacity.

40
Q

What causes muscle dysfunction through COPD?

A 
Disuse/Physical Inactiviy
Oxidative Stress
Malnutrition
Hypercapnia 
Hypoxia
Medication interventions
41
Q

What is the percentage reduction in likelyhood of a hospital admission from COPD when active?

A

A 30-40% reduced chance of admission when moderately active

And the time to first admission after diagnosis is also longer.

42
Q

What is the percentage reduction in likelyhood of mortality due to COPD when active?

A

There is a 27% reduced death risk if one is moderately active.

43
Q

What are the aims/objectives of an exercise program for one with COPD?

A

To control, alleviate and if possible reverse the symptoms and physiological processes leading to the respiratory impairment.
To improve one’s functional capacity and quality of life.
A program aims to focus on both the primary and secondary impairments of the disease.

44
Q

What factors other than physical fitness does an intervention target?

A

education, psychosocial and behavioral interventions and outcome assessments

45
Q

What did Bourbeau et al 2003 find?

A

After 1 year of a comprehensive, skill orientated self management program for COPD patients, there was a 40% reduction in hospital admissions, 40% fewer emergency department admissions and 60% less scheduled physician visits compared to a typical rehabilitation program.

46
Q

What did Wadell et al 2013 find?

A

An exercise (10 RPE - ‘moderate’) and education program was reported to have clinically meaningful results in many different areas of life.

47
Q

What did Golmohammadi et al 2004 find?

A

An intervention consisting of 1/3 education and 2/3 exercise (both endurance and interval) with breathing techniques led to a significant reduction in mortality panic levels and the need for medication and increased activity, employment, perceived control.
The program led to an average saving of $344 per person per year.

48
Q

What did Maltais et al 2002 find?

A

No significant difference between an outpatient based program vs a home based program - suggesting people can do it themselves too!

49
Q

What did Reardon et al 2005 find?

A

An individualized program is significantly more affective than a standard exercise program with regards to one’s minute ventilation, CO2 output and blood lactate levels post intervention.
They also found both interval and continuous exercise programs to be effective (no significant difference between them).

50
Q

What is the first scale that should be used in COPD populations to measue their exercise levels?

A

The dyspnea scale - one should exercise at level 2-3 (somewhat to moderate difficulty). (Exercise should be stopped at level 4).

51
Q

At what VO2 should COPD patients exercise at?

A

An exercise greater than 50% VO2 max

52
Q

What method of exercise is considered effective for this population and why?

A

Circuit based activities from 1-10 minutes in length.

- There are rest periods which makes exercise more tolerable (Due to increased oxygen saturation time)

53
Q

What are frequency and duration targets for this population at the start of their training?

A

5-10 minutes a day 3-5 days a week.

54
Q

How many weeks are typically needed to see an improvement in exercise capacity and life quality?

A

4-12 weeks.

55
Q

What progression advice should be given to this population?

A

Increase work intervals and decrease rest periods.

ClinE 470 (9 decks)

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