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16 Cards in this Set

  • Front
  • Back
COPD
Preventable and treatable disease characterized by airflow limitation that is NOT FULLY reversible

Progressive and associated with abnormal inflammatory response to noxious particles/gases (e.g., cigarette smoking)

Hyperinflation may occur

Includes: Chronic Bronchitis, Emphysema, and Bronchietasis but NOT asthma

Mixed picture of Emphysema & Chronic Bronchitis

Risk Factors: Tobacoo smoke, alpha 1 anti-trypsin deficiency, outdoor pollution, indoor pollution, and occupational dusts

PFT: FEV1/FVC < 0.7

Symptoms: Cough, sputum, dyspnea, exercise intolerance, wheeze and then spirometry & imaging
Chronic Bronchitis
Clinical Df: Productive cough for 3 months for 2 consecutive years

Pathology: Increased Reid Index (gland to bronchial wall thickness ratio) >50%

Gross: Bronchial wall thickening due to airway remodeling & glandular hypertrophy

"Blue Bloater"
Emphysema
Df: Enlargement of airspaces distal to the terminal bronchi with:
a) Destruction of alveolar walls, no fibrosis
b) Destruction of pulmonary capillaries
c) Increased compliance, loss of elastic recoil, hyperinflation and PEEPi
d) V/Q mismatching, reduced diffusion (DLCO) with ultimate hypoxia

Histology:
a) Centriacinar - Associated with cigarette smokers in upper and posterior lung lobules

b) Panacinar - Associated with alpha 1 anti-trypsin deficiency.

c) Distal Acinar - Young, tall, skinny persons with bullae and blebs with risk of spontaneous pneumothorax

"Pink Puffer"

Tx: Anticholinergic bronchodilators (ipratropium bromide) and oxygen, enzyme replacement (rare)
Bronchiectasis
Df. Chronic necrosis of bronchi with recurrent infections (focal pneumonia in America, TB worldwide)

Associated with CF, Kartagener's Syndrome (immotile cilia), HIV, or any immunocompromised state
Classification of COPD via GOLD Criteria
For all stages, FEV1/FVC < 0.7
Stage I: Mild FEV1 >= 80% predicted (no symptoms necessarily)

Stage II: Moderate 50% <= FEV1 < 80% predicted

Stage III: Severe 30% <= FEV1 <= 50% predicted

Stage IV: Very Severe FEV1 < 30% or <50% with chronic respiratory failure
COPD Pharmacotherapy
Short Acting Bronchodilators:
1st option Anticholinergics (Ipratropium bromide, Atrovent) have low side effects

Beta-2-agonists (Albuterol, Proventil, Ventolin)

Long Acting Bronchodilators (moderate disease):

Anticholinergic (Tiotropium Spirvia)

Beta-2 agonists (Fomoterol, Foradil, Salmeterol, Seravent)

Steroids NOT first line therapy, only severe cases due to side effects (cataracts, muscle weakness, HTN, osteoporosis, diabetes)

Methylxanthines (theophylline) high side effect profile (seizures)
Infections & COPD Exacerbations
Mild-moderate: S. pneumonia, H. influenzae, Moraxella catarrhalis, M. pneumoniae, and viruses

Severe: Pseudomonas spp., Gm(-) enteric bacilli
Surgery & COPD
Used in severe COPD (no clear guidelines)

Volume Reduction - decreases hyperinflation

Lung Transplantation - Done for CF, Pulmonary HTN, COPD, Emphysema, Interstial lung disease
Asthma
Df. Chronic inflammatory disorder of the airways associated with airway hyperresponsiveness, airflow limitation (reversible), and respiratory symptoms (wheeze, cough, tight chest)
Risk Factors for Asthma
Genetics & Environment
Asthma Epidemiology
37% 0-19 y, 30% 20-39 y, 21% 40-59 y, and 12% 60+ y
Asthma pathophysiology
Narrow bronchi, mucus plugs, curschmann spirals (sloughed epidermal cells due to plugs), charcot-leyden crystals (eosinophil debri), sub-mucosal glandular hyperplasia, hypertrophy of bronchial smooth muscle, eosinophils, mast cells, lymphocytes
Dutch Hypothesis
Chronic asthma leading to airways remodeling and eventual COPD if persists for an extended period of time
Astham dx
Bronchodilator response or adequate history (cough at night, cough associated with allergens, physical activity, etc.)
DDx for Wheezing
Tumor in vocal cord, aspiration of foreign body, asthma, airway obstruction

Differentiate via flow volume loop: "boxy" inspiration (with stridor) for tumor, delayed expiration for obstruction
Allergen testing in Asthma
Generally not done due to the early and late asthmatic response with difficulty in dosing the antigen; so, use methacholine test