COPD/Emphysema (Headley)

Question 1

What is a disease state that is characterized by reversible airway obstruction?
Irreversible?

Answer 1

asthma

COPD

Question 2

What changes are happening in the airways and the lung parenchyma in COPD?

Answer 2

airways: inflammation, fibrosis, luminal plugs (secretions)
parenchyma: loss of alveolar attachments and decreased elastic recoil

Question 3

COPD mortality is higher in (men or women)

Answer 3

women

Question 4

What are the causes of COPD?

Answer 4

smoking > occupational dust and chemicals, air pollution

poorly controlled asthma can also cause it

Question 5

FEV1 of ____% of normal is assc with exertional dyspnea

____% of normal is assc with disability

Answer 5

40 -60%

<30%

Question 6

Smokers with a mean ____ pack yeat Hx develop COPD

Answer 6

20

Question 7

At what age do pts with COPD develop URT symptoms (cough and sputum)?

Answer 7

40s

Question 8

At what age does dyspnea develop?

Answer 8

50s or 60s

Question 9

What is required to make the diagnosis of COPD?

Answer 9

spirometry with FEV1/FVC ratio < 0.7 and no improvement in post-bronchodilator therapy FEV1 >15% and > 200 ml

Question 10

What are the symptoms and risk factors for COPD?

Answer 10

symptoms: Cough, sputum, dyspnea (exertional then at rest)

RF: smoking, occupation, indoor/outdoor pollution (mostly developing/3rd world countries)

Question 11

What is the clinical definition of chronic bronchitis?

Answer 11

production of sputum for 3 months in 2 consecutive years

Question 12

What are clinical findings assc with airway obstruction with COPD

Answer 12

• Wheezing (due to obst)

- prolonged forced expiration (due to obst)

Question 13

What are clinical findings assc with hyperinflation with COPD?

Answer 13

• barrel chest
• pursed lip breathing
• low diaphragm position
• distant heart and breath sounds

Question 14

What are clinical findings assc with impairment of the mechanics of breathing with COPD?

Answer 14

• use of accessory muscles when breathing
• retractions (in drawings of lower intercostal interspaces)
• chest/abdominal wall paradoxical movements

Question 15

What CV signs can be seen with advanced COPD?

Answer 15

cor pulmonale

hyperinflation puts pressure on RA –> Right heart failure
-JVD, hepatomegaly, peripheral edema

Question 16

How are asthma and COPD spirometry results different?

Answer 16

low FEV1/FVC in asthmatics will correct with bronchodilator and it will not in pts with COPD

Question 17

What makes a pt with COPD “high risk” to have progressive decline in disease? *sorry for the terrible wording

Answer 17

2 or more exacerbations within the past year

FEV1 < 50% of predicted value

Question 18

WHat is the defn of an exacerbation of COPD?

Answer 18

worsening of respiratory symptoms (dyspnea) that requires a change in medication

Question 19

When should a pt be screened for alpha-1 anti-trypsin deficiency?

Answer 19

person in 30 or 40s develop COPD and have a strong family Hx of COPD

Question 20

On what chromosome is the alpha-1 anti-trypsin gene found?

Answer 20

14

Question 21

Who are the pink puffers and blue bloaters? Why are they called that?

Answer 21

2 sides of the COPD spectrum:

pink puffers = emphysema prominent COPD
-pink = near normal gas values, thin, intense dyspnea

blue bloaters = chronic bronchitis prominent COPD
-blue = hypoxemic and hypercapnic, obese, CHF, edema, mild dyspnea

Question 22

What is the cause of the hypoxemia and hypercapnia in chronic bronchitis?

Answer 22

V/Q mismatch

Question 23

Are blue bloaters hypo or hyperventilated? Why?

Answer 23

Hypoventilated:

alterations in CNS centers allows for decreased work of breaking (dec RR) but it comes at a cost of inc CO2 levels

Question 24

What are the long term consequences of blue bloaters’ hypoventialtion?

Answer 24

chronic hypoxemia –>

• polycythemia (elevated Hct)
• Pulmonary HTN
• cor pulmonale

Question 25

What is the cause of the hypoxemia in emphysema?

Answer 25

V/Q imbalance and diffusion abnormalities from alveolar destruction

Question 26

Are pink puffers hypo or hyperventilated? Why?

Answer 26

hyperventialted: | they maintain thier PCO2 levels in the normal rage but it comes at the cost of high work of breathing

Question 27

T or F: In emphysema O2 saturation is preserved

Answer 27

True (by inc MV)

Question 28

COPD pts are at an increased risk to develop...

Answer 28

``` MI, angina osteoporosis respiratory infections depression DM lung cancer ```

Question 29

What are the different inflammatory cell mediators in Asthma and COPD?

Answer 29

Asthma: CD4 and eosinophils COPD: CD8, macrophages, neutrophils

Question 30

What does an icreased Reid Index indicate? What does this index measure?

Answer 30

chronic broncitis bronchial gland depth as a fraction of total bronchial wall thickness

Question 31

Describe the cellular changes in the central airways (cartilaginous) of COPD/chronic bronchitis

Answer 31

``` bronchial gland hypertrophy goblet cell metaplasia squamous metaplasia of epithelium (loss of cillia and function) fibrosis infiltration by CD8 and neutrophils ```

Question 32

What are the differences between centrolobular and panlobular emphysema?

Answer 32

centrolobular: dilation and destruction of the respiratpry bronchioles - upper lobe predominance - assc with smoking panlobular: dilation and destruction of the entire acinus - lower lobe predominance - assc with alphs 1 anti-trypsin def

Question 33

What are bullae?

Answer 33

emphysematous spaces > 1 cm in diameter

Question 34

What is the pathophys of emphysema?

Answer 34

loss of alveolar attatchments --> small airway collapse during expiration V/Q mismatch

Question 35

What are the 3 irreversible changes that limit airflow in COPD?

Answer 35

1. fibrosis and narrowing of airways 2. loss of elastic recoil 3. destruction of alveolar attachments

Question 36

What are the 3 reversible changes that limit airflow in COPD?

Answer 36

1. accumulation of inflammatory cells, mucus, and plasma exudate in bronchi 2. smooth muscle contraction 3. dynamic hyperinflation at rest and worsening at exercise --> muscles at at mechanical disadvange and have to work harder to breathe

Question 37

How does COPD manifest on CXR

Answer 37

flattened diaphragm hyper-inflated lungs tear drop heart increased vascular markingss

Question 38

Describe the PFTs for pure emphysema ?

Answer 38

- increased TLC and RV - increased compliance - decreased VC - decreased elastic recoil - dec DLCO

Question 39

What are the etiologies of COPD exacerbations?

Answer 39

bacterial infection, virus, unidentified

Question 40

For Tx/management of COPD see sweatmen's shit

Answer 40

im feeling lazy