Pathophysiology of COPD

Question 1

Goal of therapy

Answer 1

reduce symptoms
prevent progression & exacerbation
reduce mortality

Question 2

Therapies

Answer 2

Smoking cessation - NRT
Exercise & diet changes
DRUG THERAPIES
Influenze & pneumococcal vaccination

Question 3

Drug therapy options

Answer 3

BRONCHODILATORS

ANTICHOLINERGICS

Question 4

SHORT ACTING BRONCHODILATORS

function

Answer 4

Ease INTERMITTENT COPD symptoms

Question 5

LONG ACTING BRONCHODILATORS

function

Answer 5

Prevent breathing problems

Step-up therapy for PERSISTENT symptoms

Question 6

ANTICHOLINERGICS

mechanism

Answer 6

M3 antagonists

- block Ach-M3 receptor binding

Question 7

ANTICHOLINERGICS

function

Answer 7

BRONCHODILATION
Prevent bronchospasm
reduce mucus production

Question 8

SHORT ACTING BRONCHODILATORS examples

Answer 8

Anticholinergics - ipratropium

B2-agonists - salbutamol

Question 9

LONG ACTING BRONCHODILATORS examples

Answer 9

Anticholinergics - tiotropium

B2-agonists - salmeterol

Question 10

B2 AGONISTS mechanism

Answer 10

Bind B2AR receptor (GPCR)

• Activate AC via Gs protein
• cAMP&raquo_space;
• PKA&raquo_space;
• PKA phosphorylates target proteins - BRONCHODILATION

Question 11

BRONCHODILATORS

Answer 11

ANTICHOLINERGICS & B2AR agonists

Question 12

COPD

Answer 12

persistent airflow limitation associated with enhanced chronic inflammation in the airways

Question 13

COPD symptoms

Answer 13

chronic & progressive dyspnoea, cough, sputum production

VARIABLE day-to-day

Question 14

Compare asthma & COPD daily variability

Answer 14

Asthma has more daily variability

Question 15

State COPD classifications

Answer 15

CHRONIC BRONCHITIS

EMPHYSEMA

Question 16

CHRONIC BRONCHITIS

+ Symptoms
+ Characteristics

Answer 16

chronic cough with sputum production

INFLAMMATION & EXCESS MUCUS
> Narrowed bronchioles

Question 17

EMPHYSEMA

+ Symptoms
+ characteristics

Answer 17

Chronic cough, SOB

INFLAMMATION
> alveolar membrane destruction
> reduced elasticity
> FEWER, ENLARGED ALVEOLI

Question 18

Risk factors

Answer 18

SMOKING, pollution, occupation

AAT deficiency

Question 19

Describe COPD pathogenesis following exposure to risk factors

Answer 19

Neutrophils & macrophages accumulate in alveoli

> release granules containing ELASTAASE & MMP

> Damage & elastic tissue destruction

Question 20

How smoking causes inflammation

Answer 20

CHEMOATTRACTANTS & ROS

Question 21

NEUTROPHIL ELASTASE effects

Answer 21

TISSUE DAMAGE

Question 22

Consequences of inflammation in the lungs:

Answer 22

Thickens bronchiole walls
Bronchioles collapse during expiration
Mucus&raquo_space; in lumen

> AIRWAY OBSTRUCTION

Question 23

AIR TRAPPING

Answer 23

During EXPIRATION
- lack of elasticity
ALVEOLAR CLOSURE
- DYSPNOEA 
<< exercise capacity

Question 24

Relate smoking & inflammatory effects

Answer 24

> > neutrophils, macrophages, cytokines, mediators & proteases

> > ELASTASES, MMP, ROS

&laquo_space;INFLAMMATION & TISSUE DAMAGE

Question 25

Common causes of COPD exacerbations

Answer 25

SMOKING

viral & bacterial infections

Question 26

Describe the process of a spirometry test

Answer 26

BRONCHODILATOR administered
> SPIROMETRY
> results compared to age-related normal parameters

Question 27

Limited airflow is indicated by post-bronchodilator FEV/FVC ___

Answer 27

FEV/FVC <0.7