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Flashcards in COPD + cancer Deck (55)
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What does COPD stand for?

Chronic Obstructive Pulmonary Disease


Define COPD.

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.


Why is COPD a collective term?

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


Why is asthma not considered COPD?

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


How is COPD diagnosed?

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.


What does a spirometer measure?

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


What are the 3 main COPD diagnostic criteria?

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


Define the GOLD categories of COPD.

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.


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

1/8 (which equates to 2 million)


What co-morbidities are related to COPD?

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


What is the relationship between COPD and mortality?

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


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

Smoking Tobacco and/or cannabis
It causes 73% of COPD cases in high income countries and 40% COPD in low income countries.


At what age does smoking cause increased COPD risk?

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.


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

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


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

Genetic influence
Environmental - Air NO levels (high in cities)
- Occupational pollution
- Indoor cooking pollution (low income
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


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

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.


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

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


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

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


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

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.


What does HPV stand for?

Hypoxic Pulmonary Vasoconstriction


What does HPV involve?

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.


Why does HPV happen?

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.


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

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


What does smoke and pollutants do to the smaller airways?

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.


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

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.


Why does endothelial dysfunction occur (emphasyma)?

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.


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

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


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

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


Why does hyperinflation occur?

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


What is the difference between static and dynamic hyperinflation?

Static Hyperinflation = at rest
Dynamic hyperinflation = during exercise