Term
| What is used to treat mild COPD? |
|
Definition
| Short acting bronchodilators, LAAC, LABA |
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Term
| What is used to treat moderate COPD? |
|
Definition
| Addition of inhaled corticosteroid along with bronchodilators, LAAC, and LABA |
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Term
| What defines moderate COPD? |
|
Definition
| AECOPD less than 1 time per year |
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Term
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Definition
| They are anti parasympathetic nervous system. If you activate CN X to the heart and lungs, heart fails and airways are narrowed. LAAC blocks the PSNS, preventing narrowing of smooth muscle |
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Term
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Definition
| Activation receptors for SNS, activate relaxation pathway for airway smooth muscle. Block bronchonstriction to any source |
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Term
| What is lung volume reduction surgery? when is it used? |
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Definition
| Remove pieces of lung damaging to gas exchange, problematic due to gas trapping, hyperinflation, airway obstruction, sometimes used in COPD |
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Term
| What is the kaplan-meyer curve? |
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Definition
| Chance of surviving, comparing the number of AECOPD attacks and the probability of survival |
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Term
| What is spirometry, what does it measure? |
|
Definition
| Volume versus time, done to examine lung function in patients |
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Term
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Definition
| Forced vital capacity, taking in as much air as possible |
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Term
| What is the independant limb of a spirometric graph? |
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Definition
At a certain point, expiratory flow is independent of effort. Where additional effort is not matched by additional increase in flow
Max expiratory flow is at TLC, decreases as volume decreases |
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Term
| When is the max expiratory flow? |
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Definition
|
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Term
| Why is there a large expiratory flow reserve during quiet breathing? |
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Definition
| allows you to breath more quickly and increase expiratory flow if needed |
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Term
| What is normal FEV/FVC? what do people with COPD have? |
|
Definition
|
|
Term
|
Definition
| The amount of air you force out of you lung at FVC in 1s |
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Term
| What does hyperinflation affect? why are people with COPD hyperinflated? |
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Definition
| Increase the individual FRC, hyperinflation in an attempt to resist collapse of airways, to which they are susceptible because of destruction of parenchyma and tissue |
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Term
| Why does COPD have low inspiratory capacity? |
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Definition
| they have hyperinflated lungs, therefore they can't bring much more air to their lung because their FEV is low |
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Term
| How does exercise (in terms of spirometry) affect a normal person? |
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Definition
| Shifts their graph to the left, decreasing their lung volume, to increase their expiratory and inspiratory flow |
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Term
| What happens to a person with COPD during exercise? (related to spirometry) |
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Definition
| They have no way to move their graph to the let, their flow is already limited at rest. Rather, they try to hyperinflate to higher lung volume, this gives them a higher maximum expiratory flow (not efficient though) |
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Term
| What does the chest wall do during expiration? |
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Definition
| Pushes on the walls of the lung, creating positive pleural pressure |
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Term
| Where does pressure in airway drop to 0 (equivalent to external environment) |
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Definition
| preferably at end of mouth, so there is positive force pushing the air out of your lungs |
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Term
| What is dynamic compression? |
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Definition
| when trying to exhale, because the pressure around lung is bigger than pressure of airways, resistance will be completely altered. Extra effort goes to bending airways inwards, expiration will not increase |
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Term
| Why is dynamic compression so problematic in COPD? |
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Definition
| Dynamic compression is the pushing of the chest wall against everything near it, including alveoli and bronchiole. It helps to push stale out by pressing on the alvoeli, but in COPD with patients with fibrotic and disease bronchi, the pressure forces them to collapse. Because the collapse point is much lower, more stale air remains in the lungs, so forced expiratory volume is much smaller |
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Term
| What three factors affect dynamic compression? |
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Definition
| Peripheral resistance and pressure loss, reduced lung recoil (due to low lung volume, emphysema) and airway structural stiffness |
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Term
| What type of disorder is asthma |
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Definition
|
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Term
| What two symptoms typify asthma |
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Definition
| dysnpnea, chest tightness |
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Term
| what are all symptoms of asthma associated with? in comparison wtih copd |
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Definition
| variable flow limitation, vs. consistent flow limitation |
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Term
| What cells are caused in asthmatic bronchiol hyperresponsiveness? which are associated with sudden onset, and fatal exacerbations? |
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Definition
Mast cells, eosinophils, neutrophils, T lymphocytes, macrophages, epithelial cells
Neutrophils |
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Term
| What is the most common chronic respiratory disease of children? |
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Definition
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Term
| Why are females more susceptible for pulmonary disease/ |
|
Definition
| smaller airways and lungs than males |
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Term
| What is the cell the inflammatory response in asthma most directly linked to? |
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Definition
|
|
Term
| What four things happen during an asthma attack? |
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Definition
| Inflammation of mucosa with local edema, bronchoconstriction, mucus secretion, obstructed airways |
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Term
| What can severe asthma lead to? |
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Definition
| airway remodelling or permanent thickening of airway wall that reflects ongoing inflammation |
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Term
| Why is the mucus secretion in asthma especially bad? |
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Definition
| Adds to the problem of the already obstructed airway b/c of bronchoconstriction |
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Term
| What type of hypersensitivity is asthma? |
|
Definition
|
|
Term
|
Definition
| genetic tendencies to develop immediate allergic reactions to pollen, food, dander |
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Term
| When does intrinsic asthma onset? |
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Definition
|
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Term
| What stimulates intrinsic asthma? |
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Definition
| respiratory infections, cold air, exercise, aspirins, stress |
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Term
| What are three objective measurements of pulmonary function? |
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Definition
| Reversible airway obstruction, variable airflow limitations over time, airway hyperresponsiveness |
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Term
| When is asthma most likely to occur during the day? what is this cycle? |
|
Definition
driven by light dark cycle
Asthma is worse at night than in the morning |
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Term
| What treatments mainly exist for asthma? |
|
Definition
bronchodilators, corticosteroids
Work as cytokine inhibitors to reduce inflammation |
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Term
| What requirements are used to diagnose asthma? |
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Definition
| Less than 80% FEV/FVC for adults, 80-90% for children, expected 12% in FEV/FVC after bronchodilator therapy |
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Term
| What two challenges are used to test for asthma? |
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Definition
| MEtacholine challenge and exercise challenge |
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Term
| What is the metacholine challenge? |
|
Definition
If you are thought to have astham, we give you ACH and expect 20% decrease lung function in 1 sec (called PC20)
Problem with asthma is that hyperresponsiveness never levels out, you can limit your function until you die |
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Term
| What is the exercise challenge for asthma? |
|
Definition
| Perform exericse and examine reduciton in FEV1 post exercise |
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Term
| What are four ways to manage asthma? |
|
Definition
| Environmental control, have fast acting bronchodilators on demand, used inhaled corticosteroid, and LABA or increase ICS if it's very poor |
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Term
| Why is it important to avoide irritant allergic trigger? |
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Definition
| would lead to worsening asthma, therapy becomes less effective and results in worse exacerbations |
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Term
| Why are FABD used for mild intermittent asthma? |
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Definition
| It's inflammatory, they reduce inflammation |
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Term
| Why is inhaled corticosteroid used to treat asthma? |
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Definition
| It's the inital maintenance treatment of moderate to severe asthma |
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Term
| Where are Leukotriene receptors antagonists (LTRA) used? |
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Definition
| as a second line of defense if ICS are not working (but are less effective usually) |
|
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Term
| What ages of patients would use LABA vs. ICS? |
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Definition
|
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Term
| What a problematic possibility in chronic asthma? |
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Definition
| Leads to airway remodeling and chronic obstruction |
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Term
| What is end of life COPD associated with (a CVD)? |
|
Definition
| RV hypertorphy (due to hypoxia) |
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Term
| When are corticosteroids used in COPD? asthma |
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Definition
| ACute exacerbations, everyday therpay in astham |
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Term
| What do you use instead of corticosteroids for COPD? |
|
Definition
|
|
Term
| What are the three symptoms that define COPD physiologically? |
|
Definition
| Expiratory flow limitation, air trapping, hyperinflation |
|
|
Term
| What two conditions are manifested in COPD? |
|
Definition
Emphysema - permanent enlargement of airways distal to bronchioles with destruction of alveolar walls
Chronic bronchitis - productive cough for more than 3 months in 2 consecutive years |
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Term
| What physical changes happen to acinus during COPD? (3) |
|
Definition
| Destroys alevolar walls and septa, loss of parenchymal tissue, reduced gas exchange surface |
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|
Term
| What type of blood cell is elevated in COPD? what enzymes? |
|
Definition
Neutrophils
Elastase and proteases |
|
|
Term
| What is the problem with elevated proteases in COPD? |
|
Definition
| Leads to destruction of parenchyma of lungs |
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Term
| What possible genetic component exists in COPD? |
|
Definition
| genetic deficiency of alpha 1 antitrypsin inhibitor - protease inhibitor. too much protease leads to destruction of lungs tissue |
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|
Term
| Are alveoli larger or smaller during COPD? |
|
Definition
| larger, no integrity between them |
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|
Term
|
Definition
| abnormal outcopping with space 1cm of diameter or bigger, just dead lung tissue |
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Term
| why does loss of alveoli cause airway closure? |
|
Definition
| Alveoli are interdependant, so the destruction of parenchyma destroys tethering forces, pushing the lungs against the pleural space. destruction leads to less intraalveolar pressure, lower lung pressure therefore closure of airways |
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Term
| What is air trapping and hyperinflation? why does it happen in COPD? |
|
Definition
| The key aspect of COPD is impaired expiration, this is beacuse of the loss of alveolar tissue and elasticity. With damaged tissues, there is less intraalveolar pressure, leading to higher lunger volumes (hyperinflation) but less elastic recoil in tissues because of destruction leads to impaired expiration and gas exchange problems |
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Term
| What are the 4 pathophysiologic impacts of COPD? |
|
Definition
| loss of gas exchange area (alveoli), loss of pulmonary capillaries, matching of ventilation/perfusion and diffusion capacity, impact on oxygen delivery and Co2 elimination, loss of elastic fibres affect lung recoil. (leads to air trapping and hyperinflation) |
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|
Term
| what effect does loss of gas exchange area have? |
|
Definition
| mismatch of ventilation to perfusion, leads to reduced diffusion capacity for oxygen. Poor diffusion of oxygen, hypoxia |
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|
Term
| What has COPD shown in terms of trends over the last 32 years when compared to CVD and DM and stroke? |
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Definition
| CVD and stroke both have dropped significantly, while COPD is on the rise, similar to DM (greater rise) |
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|
Term
| Are more women or men diagnosed with COPD recently? |
|
Definition
|
|
Term
| Who dies more often of COPD (men/women)? |
|
Definition
| right now men, but it's pretty close. Women will overtake them slowly |
|
|
Term
| What is 4th leading cause of death in canada? |
|
Definition
|
|
Term
| How do doctors identify patients with COPD? |
|
Definition
| Coughing regularly, cough up phlegm regularly, simple chores make you short of breath, wheeze during night exertion, frequent colds? |
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|
Term
| What is the main form of diagnosis for COPD other than physiologic questioning? |
|
Definition
|
|
Term
| What is the definition of airway obstruction? |
|
Definition
| Post bronchodilator FEV/FVC less than 0.7 indicated airflow obstruction. Shows that COPD is only partially reversible, unlike asthma which would show change of 12% of FEV/FVC |
|
|
Term
| What is maximal inspiration,expiration values? |
|
Definition
| inspire to 6L volume, expire to 1.2L left in your lungs |
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|
Term
| What is tidal volume and it's value? What is Inspriatory reserve volume, expiratory reserve volume, residual volume? |
|
Definition
| Normal quiet breathing (500ml), IRV is what could be inspired above tidal breathing (3L), ERV is what could be let out above tidal breathing (1200ml) RV is what is always left in the lung (1200ml) |
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|
Term
|
Definition
| What volume in your lung you can expire from TLC (4800ml) |
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|
Term
| What is Functional residual capacity (FRC)? Inspiratory capacity? |
|
Definition
| What you usually have in your lungs after tidal expiration (2400ml), inspiratory capacity is what you can inhale after tidal expiration (3500ml) |
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|
Term
| What changes in lung volumes are seen in obstructive lung disorders and restrictive disorders? |
|
Definition
| obstructive - increase dramatically in RV (hyperinflation), decreased inspiratory capacity. Restrictive disorders show decresase in inspiratory capacity, but no increase in RV |
|
|
Term
| What is FEV/FVC? what's an average value? |
|
Definition
| The amount of the lung volume you can expire in 1s, after going to the forced vital capacity (FEV is forced expired volume). an average value is 80% |
|
|
Term
| Is COPD treatable at all stages? |
|
Definition
|
|
Term
| What grades differentiate mild, moderate and severe COPD? |
|
Definition
| 1,2 = mild, 3,4 = moderate, 5 = severe |
|
|
Term
| What categorizes severe COPD? moderate? mild? |
|
Definition
| too breathless to leave house or when dressing. walks slower than people of same age or stops for breath after waling 100 yards. Breathless with strenouuous exercise short of breath when hurrying on the level or walking up a slight hill |
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|
Term
| What's the hierarchy of COPD treatment (7 levels)? |
|
Definition
Smoking cessation (self management)
Short acting bronchodilators
Long acting bronchodilators
Pulmonary rehabilitation
Inhaled corticosteroid/ LABA
oxygen
Surgery |
|
|
Term
| What is the single most effect intervention to reduce risk of developing COPD? |
|
Definition
|
|
Term
| What are the 5's A of smoking cessation? |
|
Definition
| Ask, advise, assess, assist, arrange |
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|
Term
| Do self management education group show significant decreases in admissions? |
|
Definition
| yes, decreases in all admissions for both exacerbations, other reasons, other diseases etc.. |
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|
Term
| Why does IC increase in COPD post pharmacotherapy? |
|
Definition
| the LABA and Inhaled corticosteroid allow for decreased RV because they decrease bronchoconstriction and inflammation, (allow more exipiration) |
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