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Flashcards in Chronic Obstructive Pulmonary Disease Deck (86)
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1

What is COPD characterized by?

What is it often accompianed by?

What are its major disorders? 4




What is the only thing that really helps in treating non reversible COPD?

Characterized by decreased airflow rate during expiration.
Often accompanied by elevated functional residual capacity resulting from trapped air.

Major Disorders:
1. COPD
2. Chronic Bronchitis
3. Emphysema
4. Bronchiectasis

Supplemental oxygen

2

Chronic bronchitis is defined by what?

a chronic productive cough for three months in each of two successive years in a patient in whom other causes of chronic cough have been excluded.
(They will fit the picture)

3

Emphysema is defined by what?
2

1. abnormal and permanent enlargement of the airspaces that are distal to the terminal bronchioles.

2. This is accompanied by destruction of the airspace walls, without obvious fibrosis (less muscus)

4

Bronchiectasis shares many clinical features with COPD, including what?
3

What infections are often associated with this?
2

1. inflamed and easily collapsible airways and
2. obstruction to airflow usually caused by infection.
3. (outpouchings with lots of mucus getting stuck in there)

1. pseudomonas
2. staff

5

WHO's defintion of COPD?
3


What does a heart sound like with COPD?

characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases.”

1. Not fully reversible
2. progressive
3. abnormal inflammatory response

Not much. Will have large AP area and a lot of air trapped in there. But they will probably have heart disease so you cant miss it.

6

AGAIN! What is COPD characterized by?

Periodic exacerbations are caused by what?
3

Slow, progressive irreversible airway obstruction due to chronic bronchitis and/ or emphysema


Periodic exacerbations with:
1. Increased dyspnea
2. Increased sputum (usually colorless)
3. Occasionally respiratory failure

7

Describe the onset of COPD?

What is the most frequent cause of COPD?

What will help us identify susceptible patients?

Takes years to become clinically significant.

Cigarette smoking is the most frequent cause, although fewer than 1 in 5 smokers will develop the disease.

Signs of airflow obstruction on PFT’s can identify susceptible patients.

8

Known Risk factors for COPD:
Agent? 2
Host? 1

1. Cigarette Smoke
2. Environmental/Occupational dusts and gases

1. Alpha 1 antitrypsin deficiency

9

Probable risk factors for COPD:
Agent? 5
Host? 4

1. Air pollution
2. Passive (involuntary) smoking
3. Respiratory viruses
4. Socioeconomic factors/living conditions
5. Alcohol

1. Age
2. Gender
3. Familial/genetic
4. Airway hyperresponsiveness

10

Where is the site of airway obstruction in COPD?

This results in peripheral airway resistance due to:
3

Muscus buildup occurs why?

in the smaller conducting airways ( less than 2mm in diameter)

1. Destruction of alveolar support
2. Loss of elastic recoil
3. Structural narrowing due to inflammation

outpuchings created by inflammation?

11

What volumes and capacities are increased in COPD? 3

What is reduced? 1
(What is this due to? 4)

1. Residual volume and
2. functional residual capacity are increased.
3. Total lung capacity may remain normal but is often increased.

1. Vital capacity is reduced:

1. Due to air trapping
2. Decrease in lung elastic recoil
3. Demands for increased minute volume may not allow the lungs to empty completely during the time available for expiration
4. end stage airway collapse

12

What process in the pathphysiology of COPD causes ventilation/perfusion mismatch? 3

What process stops perfusion and creates a physiological dead space? 3

Metabolic costs of breathing become excessive and cause?

1. Loss of surface area along with
2. bronchial obstruction and
3. altered distribution of ventilated air

1. Hyperinflation of the lungs, in which
2. alveolar pressure exceeds pulmonary artery pressure
3. stops perfusion and creates a physiologic dead space.

respiratory muscle fatigue

13

1. Structural changes ______ the work of breathing.

2. What kind of lung volumes put inspiratory muscles at a mechanical disadvantage?

3. Diaphragm is ______, _______ its ability to change intrathoracic volume.

4. Destruction of alveoli affects gas exchange how?

5. WHy are these important features?

6. Why do we want to treat aggressively?

1. increase

2. Larger

3. flattened
decreasing

4. decreases surface area for gas exchange.

5. They are easily recognizable on a chest X-ray


6. Because everytime they have an exacerbation they because even more immunocomprimised and it will happen more frequently

14

What is asthma characterized by?
5

1. variable and recurring symptoms,
2. airflow obstruction,
3. bronchial hyper-responsiveness and an
4. underlying inflammation.
5. Reversible

15

What are the three airway limitations in asthma patients?
3

What test will define whether its asthma or COPD?

What cells are affected in asthma (2) and which are affected in COPD (3)?

Bronchoconstrction
Airway hyperresponsiveness
Airway edema

Bronchodilator challenge

Asthma- CD4, eosinophils
CD8, macrophages and neutrophils are COPD

16

Describe what the following terms are:
Bronchoconstrction
Airway hyperresponsiveness
Airway edema

Bronchoconstriction
---Bronchial smooth muscle contraction in response to exposure to a variety of stimuli
Airway hyper-responsiviness
----Exaggerated bronchoconstrictor response to stimuli
Airway edema
----Edema, mucus hyper-secretion, formation of thickened mucus plugs

17

Chronic Bronchitis (blue bloaters)
is defined as?

The pathologic findings include the following. 3


What do the patients look like?

Defined as a persistent cough resulting in sputum production for more than 3 months in each of the past 2 years.

1. Goblet cell hyperplasia
2. Mucus plugging, excess mucus secretion
3. Fibrosis

Barrel chested, blue because there is so little oxygen. men usually

18

1. Pathological findings, along with loss of supporting alveolar, cause what?

2. Excessive bronchial secretions and airway obstruction cause what?

3. Blue bloaters are unable to maintain ______ by increasing their breathing effort.

4. ______, ______, and ________ develop earlier than emphysema

5. Have a greater chance of developing what?

1. airflow limitation due to airway wall deformities thus narrowing the airway lumen.

2. a ventilation/perfusion mismatch.

3. normal blood gases

4. Hypoxemia, hypercapnia and cyanosis







5. Cor Pulmonale

19

COPD
Chronic Bronchitis
Classic symptoms?
4

1. Increasingly productive cough
2. Dyspnea with a progressive decrease in exercise tolerance
3. Frequent and recurrent pulmonary infections
4. Weight gain

20

Defintion of Emphysema (pink puffers)?
4

1. Abnormal enlargement of the airspaces distal to the terminal bronchioles,
2. with destruction of the alveolar walls and capillary beds

3. Abnormal airspaces called Bullae compress surrounding area of more normal lung

4. Loss of lung elasticity

21

What are the most common causes of emphysema?


Whats the difference between pink puffers and blue bloaters?

1. cigarette smoking and
2. Alpha-1 Antitrypsin Deficiency.


pink puffers still have a equal match of perfusion and ventilation (fighters)
Blue bloaters can ventilate (non fighters)

22

Long history of progressive 1. ______ w/late onset of 2. _______ ______. Patients don’t realize they have it until well into later stages of the disease.

Initially, they are able to 3. _________ and maintain relatively normal blood gas levels until late in the disease.

The work of breathing makes 4. _____ difficult. Patients are usually 5. _____.


1. dyspnea
2. nonproductive cough

3. overventilate

4. eating
5. cachectic (little old lady who is wasted away/skinny because she isnt eating. cant breath)

23

Pursed lip breathing is helpful for COPD Emphysema. Why?
2

1. Increases resistance to the outflow of air
2. Helps to prevent airway collapse by increasing airway pressure

24

WHat will happen to the pulmonary vessels of COPD pats?

They will constrict. This will continue to narrow the blood supple and cause right side hypertrophy.

25

Most common early symtpom of COPD?

exertional dypsnea (will go through a cardiac workout to rule that out)

26

What are the two types of emphysema?

Centrilobular emphysema (CLE)‏
Panlobuar emphysema (PLE)‏

27

Why is the Alpha-1 Antitrypsin Deficiency pathogenic?

Alpha-1 Antitrypsin blocks the other kind of enzymes that are working to break down the alveoli. Without it they are not protected

28

1. WHats the most common type and what is it characterized by?

2. Seen mostly in who?

3. Most severe in what part of the lungs?

1. Centrilobular emphysema
Most common type
Characterized by focal destruction

2. Seen predominately in male smokers

3. Most severe in the upper lobes

29

What does Panlobular emphysema involve?

Where is it most severe?

Most commonly seen in what kind of pts?

Involves the entire alveolus distal to the terminal bronchiole

Most severe in the lower lung zones

Generally develops in patients with homozygous alpha1-antitrypsin (AAT) deficiency

30

What will we see in the specimen of an Emphysematus Lung?

large air spaces