COPD by Airi Kondo

2024-09-16 07:06:25 UTC

Definition

2024-09-16 07:06:55 UTC

Definition: A disease state characterised by airflow limitation that is not fully reversible
- The airflow limitation is usually both progressive & associated with an abnormal inflammatory response of the lungs to noxious particles or gases
Disease of the lower respiratory tract
Term to bring together variety of clinical syndromes associated with airflow obstruction & destruction of the lung parenchyma

636153ad — 2024-09-16 07:07:48 UTC

EMPHYSEMA

2024-09-16 07:10:03 UTC

Emphysema: abnormal, permanent enlargement of air spaces distal to terminal bronchiole, accompanied by destruction of walls without obvious fibrosis

Enlargement of distal air spaces (aka emphysema) is secondary result of small airway inflammation and destruction.
Different types are defined by site of damage.

2024-09-16 07:10:09 UTC

2024-09-16 07:10:36 UTC

types

airikondo3 — 2024-09-16 07:10:43 UTC

• Centri-acinar emphysema→

Centri-acinar emphysema

The central or proximal parts of the acini, formed by respiratory bronchioles, are affected, while distal alveoli are spared.

Both emphysematous and normal air spaces exist within the same acinus and lobule.

The lesions are more common and severe in the upper lobes, particularly in the apical segments.

In severe centriacinar emphysema the distal acinus also becomes involved,

and thus, the differentiation of cigarette smoking in people who do not have congenital deficiency of α1-antitrypsin.

• Pan-acinar emphysema

everything is affected, especially lower part. Acini are uniformly enlarged, from the level of the respiratory bronchiole to the terminal blind alveoli

It is the type of emphysema that occurs in α1-antitrypsin deficiency.

• Distal acinar emphysema

The proximal portion of the acinus is normal but the distal part is primarily involved.

Pneumothorax. Lung can rupture. Asymptomatic.

The emphysema is more striking adjacent to the pleura, along the lobular connective tissue septa, and at the margins

• Irregular emphysema

The acinus is irregularly involved, is almost invariably associated with scarring, such as that resulting from healed inflammatory diseases.

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2024-09-16 07:12:48 UTC

Definition of chronic bronchitis

airikondo3 — 2024-09-16 07:13:00 UTC

defined by the presence of a persistent productive cough for at least 3 consecutive

months in at least 2 consecutive years.

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airikondo3 — 2024-09-16 07:15:06 UTC

increased mucus, all irritants and chemicals will be stuck.

Less air can go through obstruction in bronchioles due to air trapping

airikondo3 — 2024-09-16 07:16:00 UTC

Inflammatory response. Chronic and acute cells.

CD8+ infiltrating.

Not only the lumen, but also the wall has response.

airikondo3 — 2024-09-16 07:16:53 UTC

Developed countries: 90% of people who have COPD are smokers.

Cigarette smoking is the most important underlying risk factor.

Chronic bronchitis is common among cigarette smoker and urban dwellers in smog-ridden cities.

Some studies indicate that 20% to 25% of men in the 40 to 65-year-old age group have the disease.

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airikondo3 — 2024-09-16 07:18:29 UTC

2024-09-16 07:19:08 UTC

structural changes in airways

airikondo3 — 2024-09-16 07:20:49 UTC

Left image: increased goblet cells produnig mucosa = purple dots

pink = mucus?

airikondo3 — 2024-09-16 07:21:41 UTC

- Air pollution

- Occupational exposures

- Biomes heating fuels

- Socioeconomic status

Cooking in poorly ventilated areas

cells involved in asthma vs COPD

2024-09-16 07:24:08 UTC

Reduced ratio of FEV1/FVC

airikondo3 — 2024-09-16 07:24:46 UTC

Patients with airflow obstruction related to COPD have a chronically reduced ratio of FEV₁/FVC.

airikondo3 — 2024-09-16 07:26:11 UTC

Smoking = most common cause
age
Alpha1-antitrypsin deficiency→proteinase inhibitor produced in liver. Seen in young COPD patients

Hyperinflation

airikondo3 — 2024-09-16 07:30:14 UTC

Increased RV, TLC / Air trapping→In COPD, there is often “air trapping” (increased residual volume and increased ratio of residual volume to total lung capacity) and progressive hyperinflation (increased total lung capacity) in more advanced disease.
- Hyperinflation of the lungs→ Hyperinflation of the thorax during tidal breathing preserves (maintain) maximum expiratory airflow, because as lung volume increases, elastic recoil pressure increases, and airways enlarge so that airway resistance decreases.

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airikondo3 — 2024-09-16 07:31:20 UTC

Elastase & anti elastase hypothesis

2024-09-16 07:34:55 UTC

BAL and biopsies (smoker airways): increased numbers of neutrophil granulocytes
- can release elastases and proteases —> may help cause emphysema
  - imbalance between protease and antiprotease activity causes the damage.
- α1-Antitrypsin = major serum antiprotease, can be inactivated by cigarette smoke

Infections

airikondo3 — 2024-09-16 07:35:43 UTC

promote use of antibiotics and routine vaccines against flu, COVID, and pneumococci

Elastases

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Emphysema

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airikondo3 — 2024-09-16 07:38:00 UTC

All these above leads to destroyed lung

airikondo3 — 2024-09-16 07:38:55 UTC

Excessive mucus secretion→beginning in the large airways

--> airway obstruction

2024-09-16 07:39:00 UTC

airikondo3 — 2024-09-16 07:39:51 UTC

shorter cilia, cleaning system is not working, excessive production of mucus.

CD8+ cell present to clean the imflammation.

Simple blood test shows evidence, biopsy not necessary.

airikondo3 — 2024-09-16 07:41:09 UTC

General Symptoms

2024-09-16 07:44:48 UTC

→ Productive cough with white or clear sputum

→ Wheeze

→ Breathlessness

→ Colds symptoms in chest

→ Symptoms can be worsened by cold, foggy weather and atmospheric pollution

→ Hypertension

→ Osteoporosis

→ Depression

→ Weight loss

→ Reduced muscle mass

→ General weakness

Symptoms

airikondo3 — 2024-09-16 07:44:49 UTC

productive cough
wheezing
breathlessness
hypertension
weight change

clubbed fingers

airikondo3 — 2024-09-16 07:45:54 UTC

enlargement of fingers or toes
proliferation of connective tissues
can he hereditary, with specific cause
associated with other disorders e.g.) cyanotic heart disease, COPD
Mainly due to hypoxia, lung conditions

2024-09-16 07:48:02 UTC

Diagnosis

airikondo3 — 2024-09-16 07:49:38 UTC

Multiple symptoms needed to diagnose
- Lung function test: assess airflow limitation
- Chest rays: used at any stage
- Arterial blood gases
- look for acidosis
- Look for Right ventricle hypertrophy: Cor pulmonale

ABCD & CAT

airikondo3 — 2024-09-16 07:51:29 UTC

Check for most recent GOLD classification

AB&E

See lecture

2024-09-16 07:51:34 UTC

Differential Diagnosis

airikondo3 — 2024-09-16 07:53:09 UTC

Variations of emphysema

compensentatory emphysema,
mediastinal emphysema

2024-09-16 07:53:33 UTC

etiennedemerson — 2024-09-16 07:54:31 UTC

airikondo3 — 2024-09-16 07:55:28 UTC

stop Smoking
Drug therapy: used both for short term managementt of exacerbations and for long term relief of symptoms.
Bronchodilators, including ß-adrenoreceptors, antimuscarinic drugs, and theophyllines
PDE4 inhibitors
Corticosteroids
Antibiotics, COVID, pneumococci, flu vaccines
Mucolytic agents

Oxygen

airikondo3 — 2024-09-16 07:56:32 UTC

Be careful with O2 as it can change pH levels and pressure of lung.

If O2 levels are too low, it can cause breathing mechanism to be confused --> slower breathing --> can stop breathing

CO: if patients have hypercapnia

CO2 insensitivity in blue bloaters

etiennedemerson — 2024-09-16 07:56:43 UTC

airikondo3 — 2024-09-16 07:58:31 UTC

Alpha1-antitrypsin replacement
Right sided heart failure
Kidney disease
Secondary polycythaemia→requires venesection (removing blood from the circulatory system through a cut) if packed cell volume is >55%
Sensation of breathlessness→short-acting sedation (administering sedating drugs) e.g. sublingual lorazepam/opiates are palliative (relieving pain) measure for intractable (uncontrollable) dyspnea. Others: breathing techniques and fan therapy
Harder to travel with airplanes

airikondo3 — 2024-09-16 08:01:03 UTC

2024-09-16 08:01:36 UTC

airikondo3 — 2024-09-16 08:02:55 UTC

younger patients are more likely to get lung transplant as they have longer life expectancy
Lung allocation score: A scoring system used to prioritize patients for lung transplants based on medical urgency and likelihood of transplant success. 1-100

comorbidities

airikondo3 — 2024-09-16 08:06:41 UTC

hypertension
diabetes
cor pulmonale
kidney disease

More failures, not possible to get lung transplant