11 - Chronic Obstructive Pulmonary Disease Flashcards Preview

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Flashcards in 11 - Chronic Obstructive Pulmonary Disease Deck (24)
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1
Q

COPD is mostly caused by ___ and ___.

A

Emphysema and chronic bronchitis

2
Q

Patients with asthma can be considered to have COPD if they have ___.

A

airway remodeling (leads to irreversible obstruction)

3
Q

What is the definition of emphysema?

A
  • abnormal permanent distal airspace enlargement (in respiratory bronchioles)
  • destructive changes of alveolar wall without obvious fibrosis
  • can be distal acinar, pan acinar, paraseptal, or subpleural
4
Q

What is the definition of chronic bronchitis?

A
  • Cough and sputum most days for a minimum of 3 months for 2 consecutive years
  • airflow obstruction may not be present
  • excess mucus secretion
5
Q

What are the risk factors for COPD?

A

Exposures

  • tobacco smoke
  • environmental tobacco smoke
  • occupational dust and chemicals
  • indoor/outdoor pollution
  • infection

Host factors

  • bronchial hyperreflexiveness (BHR)
  • bronchopulmonary dysplasia (BPD)
  • genetic
  • maternal smoking
  • childhood asthma
  • HIV
  • tuberculosis
  • decreased socioeconomic status
6
Q

What are the three mechanisms of disease in COPD?

A
  • chronic inflammation (lymphocytes, alveolar macrophages, neutrophils)
  • elastase/anti-elastase imbalance
  • oxidative stress
7
Q

What causes COPD to continue to progress after the precipitating factor is no longer present?

A
  • immune dysregulation/autoimmunity

- alveolar epithelial cell senescence

8
Q

In which lung disease is hyperinflation most common? Why?

A

Emphysema

Not as likely in other lung diseases because they are usually not associated with decreased elastic recoil or decreased radial traction

9
Q

What are the pathophysiologic explanations for signs and symptoms of COPD?

A
  • increased WOB, increased dead space, decreased respiratory muscle function, hypoxemia –> dyspnea and tachypnea
  • airflow obstruction –> wheeze, increased expiratory time
  • mucus gland and airway receptor stimulation –> cough and sputum
  • decreased food intake and systemic inflammation –> weight loss and peripheral weakness
  • hyperinflation and diaphragm dysfunction –> thoracoabdominal paradox, Hoover sign, accessorry muscle use
  • increased pulmonary vascular resistance –> pulmonary hypertension, cor pulmonale
10
Q

What PFT pattern is consistent with COPD?

A
  • decreased FEV1
  • decreased or normal FVC
  • decreased FEV1/FVC
  • increased TLC
  • decreased DLCO (if emphysema is present)
  • decreased MIP (if significant hyperinflation)
11
Q

What causes hypoxemia in COPD?

A

V/Q mismatch

12
Q

What causes hypercapnia in COPD?

A
  • increased dead space
  • decreased diaphragmatic capacity
  • abnormal control of breathing
  • smaller tidal volumes (leading to increased dead space fraction)
13
Q

Why might COPD patients breathe rapidly and shallowly?

A

Hyperinflation and increased elastic work of breathing –> fast, shallow breathing minimizes work on each breath

14
Q

At what PaO2 do you give supplemental oxygen to someone with COPD?

A

PaO2 ≤ 55 mmHg OR PaO2 ≤ 60 mmHg if there is also pulmonary hypertension

15
Q

What are the treatments for COPD?

A
  • smoking cessation
  • supplemental oxygen (in some cases)
  • short acting bronchodilators as needed
  • long acting bronchodilators and inhaled corticosteroids
  • pulmonary rehab
16
Q

What is the definition of COPD?

A
  • persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities
  • mixture of small airway disease and parenchymal destruction
17
Q

What are the known alpha-1 antitrypsin mutations? Which is the most common? Most severe?

A
  • PiZZ (most common and most severe)
  • PiSZ
  • PiMZ
  • PiSS
  • PiMM
18
Q

What does emphysema at an early age suggest?

A

Alpha-1 antitrypsin deficiency

19
Q

What part of the lungs does alpha-1 antitrypsin deficiency affect? What part of the lobe?

A

Lower lobes, panlobular/panacinar

20
Q

What is the proper treatment for someone with alpha-1 antitrypsin deficiency-induced emphysema

A
  • stop smoking, if applicable
  • replacement therapy
  • treat infections
21
Q

What small airway changes are seen in COPD?

A
  • thickening of airway wall
  • goblet cells
  • lymphoid follicles
  • loss of elasticity and disrupted alveolar attachments (airway-parenchymal interdependence)
  • lumen occlusion by mucus and inflammatory exudate
  • fibrosis
22
Q

What mechanisms in emphysema cause expiratory flow limitation? What mechanisms in chronic bronchitis cause expiratory flow limitation?

A

Emphysema:

  • loss of radial traction
  • loss of elastic recoil

Chronic bronchitis
- increased airway resistance (from edema, smooth muscle, mucus, and inflammation)

23
Q

How does hyperinflation affect work of breathing?

A

It increases it because there is reduced compliance

24
Q

At what PaO2 and SpO2 levels do you give someone with COPD supplemental oxygen?

A

PaO2 ≥ 55 mmHg or SpO2 ≥ 88%