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Pathophysiology - Midterm > Lecture 10: COPD > Flashcards

Lecture 10: COPD Flashcards

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1
Q

What structures of the body are involved in ventilating the lungs?

A
  • Chest wall
  • Respiratory muscles (diaphragm)
  • Brain areas/neuronal connections that control breathing muscles
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2
Q

What is the normal resting breath of a healthy human?

A

12-15 times per minute

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3
Q

How much air is inspired/exhaled per breath?

A

About 500 mL

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4
Q

How many alveoli are in a healthy adult?

A

About 300 million

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5
Q

What is the function of alveolar surfactant?

A

Maintains surface tension and help alveoli hold shape which improves gas exchange

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6
Q

What are 4 symptoms of COPD?

A

1) Chronic cough
2) Increased mucous production
3) Inflamed airways
4) Dyspnea (difficult breathing)

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7
Q

What does dyspnea cause?

A
  • Impaired exercise tolerance

- Contributes to anxiety and depression (because unable to do anything)

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8
Q

True or false: COPD is preventable and treatable

A

False, COPD is preventable and manageable

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9
Q

What are the 2 stages of COPD?

A

1) Chronic bronchitis

2) Emphysema

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10
Q

What occurs in chronic bronchitis?

A
  • Inflamed bronchi produce excess mucous

- Leads to cough and difficulty getting air in and out

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11
Q

What is the most common cause of chronic bronchitis?

A

Cigarette smoking

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12
Q

How often does a cough occur in chronic bronchitis?

A

Most days for at least 3 months of the year for at least 2 consecutive years

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13
Q

What happens in emphysema?

A
  • Alveoli become larger and decrease in number leading to decreased amount of oxygen transferred by lungs to bloodstream
  • Air is trapped in “dead space” at terminals
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14
Q

True or false: chronic bronchitis and emphysema are diagnosed as separate entities because most people experience one or the other

A

False, most people present symptoms of both so they are no longer diagnosed as separate entities

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15
Q

What gender has COPD increased in?

A

Women

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16
Q

What are 5 questions that are signs someone should see their doctor?

A
  • Do you cough regularly?
  • Do you cough up phlegm regularly?
  • Do simple chores make you short of breath?
  • Do you wheeze when you exert yourself, or at night?
  • Do you get frequent and persistent colds?
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17
Q

What are the 2 types of risk factors for COPD?

A

Exposures and host factors

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18
Q

What are examples of exposure risk factors for COPD?

A

Tobacco smoke, occupational dusts and chemicals, indoor or outdoor air pollution

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19
Q

What are examples of host factor risks for COPD?

A

Genetic predisposition, impaired lung growth

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20
Q

What is the cause of 90% of COPD cases?

A

Smoking

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21
Q

What is the main genetic factor of COPD and what percent of COPD cases does it account for?

A
  • Alpha 1-anti-trypsin deficiency

- About 1%

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22
Q

What is involved in an AAT deficiency?

A
  • Congenital lack of lung anti-protease AAT

- Increased protease-mediated tissue destruction and emphysema in adults

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23
Q

What is the disease hallmark of COPD?

A

Accelerated decline in lung function

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24
Q

True or false: COPD begins decades before any symptoms become obvious

A

True

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25
What causes the airflow limitation in COPD?
Small airway disease (obstructive bronchiolitis) and parenchymal destruction (emphysema)
26
What stimulates inflammation of the airways in COPD?
Exposure to noxious particles and gases
27
What do inflammatory cells cause in COPD?
- Structural changes and narrowing of small airways because walls of airways become thick and inflamed - Increased mucous production in airways - Airways and alveoli lose elasticity - Walls between alveoli are destroyed
28
What is the main difference between asthma and COPD?
- In asthma there is inflammation resulting in narrowing of airways with pronounced mucous production - In COPD this occurs too, as well as structural damage to parenchyma that results in permanent non-recoverable damage
29
COPD vs. Asthma -- key cells
- COPD -- neutrophils and macrophages | - Asthma -- eosinophils, mast cells, and TH2 lymphocytes
30
COPD vs. Asthma -- glucocorticoid response
- COPD -- variable response | - Asthma -- inhibited inflammation
31
Why does cigarette smoke contribute to inflammation of the airways?
Cause increase in oxidants (hydrogen peroxide and nitric oxide) which promote inflammation and increase protease activity
32
What are the 5 main physiologic outcomes of COPD?
1) Mucous hypersecretion and ciliary abnormality 2) Airflow limitation and hyperinflation 3) Gas exchange abnormalities 4) Pulmonary hypertension 5) Muscle wasting
33
What is the main cause of airflow limitation and hyperinflation?
Remodeling (fibrosis and narrowing)
34
When do gas exchange abnormalities occur?
Later on in course of disease
35
What characterizes gas exchange abnormalities?
Hypoxemia (low blood oxygen) and/or hypercapnia (high blood carbon dioxide)
36
What causes gas exchange abnormalities?
Bronchitis and emphysema
37
What is pulmonary hypertension?
Increased pressure in the right pulmonary artery
38
What is pulmonary hypertension secondary to?
Gas exchange abnormalities
39
What can pulmonary hypertension result in?
Right ventricular hypertrophy and ultimately right-sided heart failure
40
Who is spirometry recommended for?
- Adults over 40 who are current or ex-smokers | - Patients with "nagging" cough, lots of mucous, or dyspnea with regular activity
41
What should you be looking for in a physical exam of someone who may have COPD?
- Cyanosis (bluing) of the lips and extremities - Barrel chest - Increased resting respiratory rate - Shallow breathing - Pursed lips during expiration
42
What are the 2 most useful non-pharmacologic treatments for COPD?
1) Quit smoking | 2) Pulmonary rehabilitation
43
What can exercise do to patients with COPD?
Decrease dyspnea and fatigue
44
What are the 4 most useful pharmacological treatments for COPD?
1) Bronchodilators 2) Inhaled corticosteroids 3) Inhaled corticosteroids and long-acting beta-agonists combination therapy 4) Vaccinations
45
What are examples of bronchodilators used for COPD treatment?
- Anticholinergics - Beta-agonists (short and long acting) - Theophylline
46
What is the main pharmacological therapy for controlling symptoms and increasing exercise capacity?
Bronchodilators
47
True or false: bronchodilators can reverse COPD
False, treatment of COPD has no effect on the actual course of the disease
48
What is the main function of bronchodilators?
Decrease airway smooth muscle tone to improve expiratory flow and lung emptying
49
What is the main function of inhaled corticosteroids?
Decrease inflammation in airways
50
Are inhaled corticosteroids more effective in asthma or COPD and why?
Asthma because of it's varying inflammatory mechanism from COPD
51
What does combination therapy of inhaled corticosteroids and long-acting beta-agonists do?
- Decreases risk of moderate COPD exacerbations | - Increases lung function
52
Why should COPD patients get vaccinations?
Can decrease complications and death
53
What 2 vaccinations should COPD patients get?
- Seasonal flu every year | - Pneumococcal vaccine
54
What are AECOPDs?
Sustained worsening of symptoms that leads to increased use of medications
55
How often does the average COPD patient have exacerbations?
Twice per year
56
What cause the majority of COPD exacerbations?
Infections
57
What are other triggers besides infections of COPD exacerbations?
Congestive heart failure, exposure to allergens/irritants, and pulmonary embolism
58
What are the 4 steps of a therapeutic plan for a COPD patient?
1) Intensify bronchodilator therapy 2) Short course oral steroids to suppress acute inflammation 3) Antibiotics if pussy, coloured mucous 4) Oxygen therapy
59
COPD vs. Asthma -- age of onset
- Asthma -- usually younger than 40 | - COPD -- usually older than 40
60
COPD vs. Asthma -- smoking history
- Asthma -- not casual | - COPD -- usually more than 10 pack-years
61
COPD vs. Asthma -- primary symptoms
- Asthma -- cough, dyspnea, chest tightness, and wheezing | - COPD -- cough, dyspnea, mucous production, wheezing
62
COPD vs. Asthma -- sputum production
- Asthma -- infrequent (only in acute attacks) | - COPD -- often
63
COPD vs. Asthma -- reversible with beta-agonists?
- Asthma -- yes | - COPD -- little
64
COPD vs. Asthma -- allergies?
- Asthma -- often | - COPD -- infrequent
65
COPD vs. Asthma -- inflammation?
- Asthma -- yes (eosinophils, mast cells) | - COPD -- yes (neutrophils)
66
COPD vs. Asthma -- disease course
- Asthma -- stable (with exacerbations) | - COPD -- progressive worsening
67
COPD vs. Asthma -- spirometry results
- Asthma -- often normalizes | - COPD -- may improve but never normalizes
68
COPD vs. Asthma -- clinical symptoms
- Asthma -- intermittent and variable | - COPD -- persistent

Pathophysiology - Midterm (11 decks)

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