Pathophys of COPD

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1

Difficult or uncomfortable breathing:

Dyspnea

2

Rapid breathing

Tachypnea

3

Cessation of breathing:

Apnea

4

COPD is a common preventable disease and is characterized by ________________________________________________________ that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles/gasses

persistent respiratory symptoms and airflow limitation

5

T/F: COPD is preventable, treatable, and fully reversible

False

6

List the 30 day readmission penalties:

  • Heart attack
  • Stroke
  • Pneumonia
  • HF
  • Total hip/knee replacement
  • COPD
7

What was COPD previously known as?

  • Chronic bronchitis
  • Emphysema
8

T/F: Most COPD pts demonstrates features of both chronic bronchitis and emphysema

True

9

Which "old terminology:"

  • Productive cough and sputum production for >3 mo during 2 consecutive years
  • Does not reflect primary airflow limitation in COPD

Chronic bronchitis

10

Which "old terminology:"

  • Only describes 1 of the structural abnormalities
  • Destruction of alveoli
  • Results in decreased gas exchange
  • Pt may have "barrel chest"

Emphysema

11

List factors that could cause COPD

  • Tobacco
  • Indoor air pollution
  • Occupational dusts and chemicals
  • Outdoor air pollution
  • Any factor that affects lung growth during gestation and childhood
12

Exposure risk factors:

  • Tobacco smoke
  • Air pollution
  • Occupational exposure
  • Infection
13

T/F: total burden of inhaled particles will increase the risk of COPD

True

14

Non-exposure risk factors:

  • Genetic predisposition
  • Age/gender
  • Airway hyper-responsiveness (2nd only to cigarette smoking)
  • Comorbidities
  • Lung growth and development
15

T/F: Males are more likely to have COPD than females

True

16

Example of a genetic disposition non-exposure risk factor:

alpha1 antitrypsin deficiency (AATD)

17

List the 3 cardinal symptoms of COPD

  • Dyspnea
  • Chronic cough
  • Chronic sputum production
18

Signs and sx of COPD

  • Dyspnea
  • Chronic cough
  • Chronic sputum production
  • Wheezing and chest tightness
19

T/F: COPD symptoms may vary day to day

True

20

Mild/moderate/severe:

1 cardinal symptom with at least one other sign/symptom

Mild (type 1)

21

Mild/moderate/severe:

2 cardinal symptoms

Moderate (type 2)

22

Mild/moderate/severe:

3 cardinal symptoms

Severe (type 3)

23

Define FEV1

forced expiratory volume in 1 second

24

T/F: a spirometry is required for a COPD diagnosis

True

25

Define FVC

Volume of air forcibly exhaled from the point of maximal inspiration

26

What does the FEV1/FVC ration tell us?

Airflow limitation (normal = 0.7 to 0.8 in adults)

27

________(pre/post) bronchodilator spirometry with a FEV1/FVC <____ confirms the diagnosis of persistent airflow limitation

Post; 0.7

28

T/F: Pre vs. post bronchodilator spirometry is no longer recommended

True

29

How does parenchymal destruction affect gas exchange?

Decreases

30

Extent of airflow limitation is determined by what 3 things?

  • Inflammation
  • Fibrosis
  • Exudate
31

Gas exchange abnormalities can result in:

  • Hypoxemia
  • Hypercapnia
32

T/F: COPD may lead to CO2 retention due to hyper inflation

True

33

T/F: A chronic productive cough is a feature of chronic bronchitis and develops in all patients

False

34

T/F: Mucus hypersecretion is always associated with airflow limitation

False

35

Inflammation upregulates mucus secretions due to secondary increases in ________ cells and __________ glands

goblet; submucosal

36

T/F: Studies have noted an association b/w mucus hypersecretion and increased FEV1 decline

True

37

When does pulmonary HTN occur during COPD?

Later stages

38

______________ results from hypoxic vasoconstriction of small pulmonary arteries

Pulmonary HTN

39

What conditions may pulmonary HTN lead to?

  • R ventricular hypertrophy
  • R-sided HF (cor pulmonale)
40

What triggers could exacerbate COPD?

  • Viral or bacterial pathogens
  • Air pollutants
41

What pathology could exacerbate COPD?

  • ↑ neutrophils and eosinophils
  • ↑ inflammatory mediators
  • ↑ air trapping and hyperinflation
42

What symptoms could exacerbate COPD?

  • ↑ dyspnea
  • ↑ hypoxemia
43

Does the following describe COPD, Asthma, or CHF?

  • Onset: mid-life
  • Slow progression of symptoms
  • Hx/o exposure to risk factors

COPD

44

Does the following describe COPD, Asthma, or CHF?

  • Early onset
  • Symptoms vary from day to day
  • Allergies, rhinitis, and/or eczema may be present
  • Family hx

Asthma

45

Does the following describe COPD, Asthma, or CHF?

  • Usual onset late mid-life
  • Presence of dilated heart seen on X-ray
  • Pulmonary fxn tests do not show airway limitation

CHF

46

Describe cells involved in COPD

  • Neutrophils
  • Large ↑ in macrophages
  • ↑ in CD8 and T lymphocytes
47

Describe cells involved in asthma

  • Eosinophils
  • Small ↑ in macrophages
  • ↑ in CD4 and Th2 lymphocytes
  • Activation of mast cells
48

Consequences of cells affected in COPD

  • Squamous metaplasia of epithelium
  • Parenchymal destruction
  • Mucus metaplasia
  • Glandular enlargement
49

Consequences of cells affected in asthma

  • Fragile epithelium
  • Thickening of basement membrane
  • Mucus metaplasia
  • Glandular enlargement
50

T/F: In asthma, glucocorticoids have variable effect while in COPD they inhibit inflammation

False

51

Which component is not associated with the pathophysiologic development and progression of COPD:

  1. Chronic inflammation
  2. Allergic hypersensitivity
  3. Protease/Antiprotease imbalance
  4. Oxidative stress

B

52

Goals for COPD assessment:

To determine level of airflow limitation and its impact on pts health status and risk of future events (i.e. exacerbations, hospitalizations, death)

53

COPD assessment must consider the following 4 points separately:

  1. Presence and severity of spirometric abnormality
  2. Current nature and magnitude of pts symptoms
  3. Exacerbation hx and future risk
  4. Comorbidities
54

Gold 1 FEV1:

≥ 80%

55

Gold 2 FEV1:

50-80%

56

Gold 3 FEV1:

30-50%

57

Gold 4 FEV1:

<30%

58

T/F: All Gold levels have FEV1/FVC of <70%

True

59

Which test is an 8 item test w/ scores ranging from 0-40 and is used to assess overall QoL of the pt?

COPD Assessment Test (CAT)

60

Which test just looks at breathlessness?

Modified British Medical Research Council questionnaire (mMRC)

61

On the mMRC, a score ≥ ____ indicates significant breathlessness

2

62

On the CAT, a score ≥____ indicates significant symptoms

10

63

An acute event characterized by a worsening of the pts respiratory symptoms that is beyond normal day-to-day variations and leads to a change in medication:

COPD exacerbation

64

T/F: Frequent COPD exacerbations are defined as having 2 or more each month

False

65

Examples of comorbidities that may influence mortality and hospitalizations:

  • CV dz
  • Osteoporosis
  • Depression/anxiety
  • Skeletal muscle dysfxn
  • Metabolic syndrome
  • Lung cancer
66

Which ABCD categories would someone who has a CAT < 10 or an mMRC of 0-1 fall under?

C, A

67

Which ABCD categories would someone who has a CAT > 10 or an mMRC of ≥2 fall under?

D, B

68

Which ABCD categories would someone who has an exacerbation history of ≥ 2 OR ≥1 leading to hospital admission fall under?

C, D

69

Which ABCD categories would someone who has an exacerbation history 0-1 not leading to hospital admission fall under?

A, B