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COPD
Overview
49
Pathology
5th Grade
02/20/2013

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Term
A common, preventable, treatable disease characterized by persistent airflow limitation that is usually progressive
Definition
Chronic Obstructive Pulmonary Disease
Term
"pink puffers"
Definition
Emphysema
Term
"blue bloaters"
Definition
Chronic bronchitis
Term
Emphysema
Definition
the presence of permanent enlargement of airspaces distal to the terminal bronchioles, with destruction of their walls, without fibrosis
Term
Chronic Bronchitis
Definition
Chronic productive cough for 3 months in each of 2 successive years after other causes of cough are ruled out
Term
COPD Pathophysiology
Definition
Inhalation of noxious particles/gases; Pathologic changes in 4 lung compartments; Physiologic abnormalities
Term
Inhalation of noxious particles/gases
Definition
Inflammation (diff. than asthma); imbalance of proteinases and anti-proteinases; oxidative stress; genetic component
Term
Pathologic changes in 4 lung compartments
Definition
Central airways, peripheral airways, lung parenchyma, pulmonary vasculature
Term
Central airways
Definition
goblet cell hypertrophy, enlarged submucosal glands, squamous metaplasia of epithelium
Term
Peripheral airways
Definition
airway wall thickening, peribronchial fibrosis, airway narrowing, inflammatory exudates
Term
Lung parenchyma
Definition
abnormal permanent enlargement of the airspaces distal to the terminal bronchiole, loss of alveolar attachments
Term
Pulmonary vasculature
Definition
intimal thickening, endothelial dysfunction, smooth muscle hypertrophy
Term
Physiologic abnormalities
Definition
mucous hypersecretion, ciliary dysfunction; Airflow limitation, hyperinflation; gas exchange abnormalities; pulmonary hypertension,; systemic effects
Term
Mucous hypersecretion, ciliary dysfunction
Definition
occur early in COPD
Term
Airflow limitation, hyperinflation
Definition
expiratory, largely irreversible, measured by spirometry, hallmark of COPD
Term
Gas exchange abnormalities
Definition
occur in advanced disease
Term
Pulmonary hypertension
Definition
occurs late in disease
Term
systemic effects
Definition
skeletal muscle wasting, systemic inflammation
Term
Airway remodeling, loss of elastic recoil, destruction of alveolar support, inflammatory exudates in airways, smooth muscle contraction, dynamic hyperinflation during exercise
Definition
Airflow limitation, hyperinflation
Term
Hypoxemia with/without hypercapnea, due to ventilation/perfusion alterations
Definition
gas exchange abnormalities
Term
hypoxic vasoconstriction, endothelial dysfunction, pulmonary arterial remodeling, loss of alveolar capillary bed, may lead to right ventricular hypertrophy and right heart failure (Cor Pulmonale)
Definition
Pulmonary hypertension
Term
general treatment principles
Definition
reduce symptoms, reduce risk
Term
Components of COPD Management
Definition
1) Assess and Monitor Disease
2) Reduce Risk Factors
3) Manage Stable COPD
4) Manage Exacerbations
Term
Diagnosis of COPD
Definition
Confirmed by an objective measure of airflow limitation-- spirometry; Post-bronchodilator FEV1/FVC less than 0.7 indicates airflow limitation that is not fully reversible
Term
progressive, persistent, worse with exercise
Definition
dyspnea
Term
may be intermittent and non-productive
Definition
chronic cough
Term
any pattern may indicate COPD
Definition
chronic sputum production
Term
tobacco smoke, occupational exposure, smoke from home cooking/heating oils
Definition
history of exposure
Term
FEV1 % predicted at least 80
Definition
Gold 1 - Mild
Term
FEV1 % predicted 50-80
Definition
Gold 2- Moderate
Term
FEV1 % predicted 30-50
Definition
Gold 3- Severe
Term
FEV1 % predicted <30
Definition
Gold 4- Very severe
Term
mMRC
Definition
breathlessness measurement using the modified British Medical Research Council questionnaire
Term
CAT
Definition
COPD assessment test, measure of health status impairment
Term
Exacerbation history
Definition
history of exacerbations is best predictor of future events
Term
Low risk, less symptoms (GOLD 1-2)
Definition
Category A; 1 or less exacerbations per year
Term
Low risk, more symptoms (Gold 1-2)
Definition
Category B; 1 or less exacerbations per year
Term
High risk, less symptoms (Gold 3-4)
Definition
Category C; 2 or more exacerbations per year
Term
High risk, more symptoms (Gold 3-4)
Definition
Category D; 2 or more exacerbations per year
Term
Category A
Definition
mMRC 0-1; CAT < 10
Term
Category B
Definition
mMRC at least 2; CAT at least 10
Term
Category C
Definition
mMRC 0-1; CAT < 10
Term
Category D
Definition
mMRC at least 2; CAT at least 10
Term
Additional diagnostic studies
Definition
chest x-ray; arterial blood gases, electrocardiogram; hemoglobin/hematocrit;alpha1 antitrypsin levels; bronchodilator/steroid reversibility testing
Term
Risk Factor Reduction
Definition
smoking cessation, minimize occupational exposures, indoor/outdoor air pollution, immunizations
Term
can reduce serious illness and death
Definition
influenza vaccination
Term
benefits less clear, decrease pneumonia
Definition
pneumococcal vaccine
Term
Persistent airflow limitation in COPD
Definition
vs. intermittent obstruction in asthma
Term
dramatic beta-agonist response in asthma
Definition
vs. moderate response in COPD
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