EMPHYSEMA AND CHRONIC BRONCHITIS (copy)

Chronic bronchitis is defined clinically by a chronic productive cough lasting for ________ in each of ________ , after excluding other causes of chronic productive cough.

3 months, 2 successive years

________ is defined pathologically as permanent enlargement of air spaces distal to the terminal bronchioles, with destruction of bronchiole walls and without obvious fibrosis.

Emphysema

COPD is a term for the simultaneous occurrence of ________ and ________.

chronic bronchitis, emphysema

The relative contribution of chronic bronchitis and emphysema in COPD is often difficult to determine, so they are treated as one ________ in clinical practice.

disease entity

• decrease surface area for gas exchange

• tend to collapse during expiration

• weakening and permanent enlargement of the air spaces distal to the terminal bronchioles and by destruction to the alveolar walls

anatomic alterations of the lungs associated with emphysema

• bronchial smooth muscle constriction

• bronchial irritation causes the submucosal bronchial glands to enlarge

• number of goblet cells to increase, resulting in excessive mucous production

• peripheral bronchi are often partially or totally occluded by inflammation and mucous plugs

• hyperinflated alveoli

anatomic alterations of the lungs associated with chronic bronchitis

________ emphysema involves abnormal weakening and enlargement of all alveoli distal to the terminal bronchioles, including respiratory bronchioles, alveolar ducts, alveolar sacs, and alveoli.

Paracinar

Panacinar emphysema is associated with ________ deficiency and is a more severe type of emphysema.

alpha1-antitrypsin

________ emphysema affects the proximal (central) portion of the acinus, leaving a rim of parenchyma relatively unaffected.

Centriacinar

Centriacinar emphysema is the most common form and is linked to ________ and chronic bronchitis.

cigarette smoking

Genetic factors such as ________ deficiency increase the risk of emphysema.

alpha1-antitrypsin

________ can break down connective tissue,

Neutrophil elastase

Normal alpha1-antitrypsin levels range between ________ mg/dL (1.5 to 3.5 g/L) when measured via radial immunodiffusion.

150 and 350

________ phenotype (homozygote) has normal alpha1-antitrypsin levels.

MM alpha1-antiytrypsin

________ phenotype is associated with severely low serum alpha1-antitrypsin concentrations.

ZZ alpha1-antitrypsin

MZ alpha1-antitrypsin phenotype results in an intermediate deficiency of alpha1-antitrypsin.

MZ alpha1-antitrypsin

________ smoking is a major risk factor for COPD.

Cigarette

Age increases the risk for COPD, and historically, COPD was more common in ________

men

Low birth weight and respiratory infections are risk factors related to lung growth and ________.

development

________ influences COPD risk through exposure to pollutants, crowding, poor nutrition, and infections.

Socioeconomic status

Asthma and ________ are risk factors for COPD.

bronchial hyperreactivity

Respiratory infections, such as ________, increase the risk for COPD.

tuberculosis

assessment of chronic bronchitis according to gold

over 40 years of age and who has dyspnea, chronic cough or sputum production, and a history of exposure to risk factors for the disease especially cigarette smoking and a family history of COPD

SPIROMETRY PARAMTERTS NEEDED

• FVC

• FEV1

• FVC/FEV1 ratio

SEVERITY ASSESSMENT OF CHRONIC OBSTRUCTIvE PULMONARY DISEASE

• airflow limitation

• symptoms

• exacerbation risk

• comorbidities

PFT measurements used to evaluate patient’s airflow limitation

• FEV1

• FEV1/FVC RATIO

GOLD 1

mild, FEV1 greater than or equal to 80% predicted

GOLD 2

moderate, FEV1 50-79% predicted

GOLD 3

severe, FEV1 30-49% predicted

GOLD 4

very severe, less than or equal to 29% or less than predicted

Assessment of Symptoms
“I only get breathless with strenuous exercise”

0

Assessment of Symptoms
“I get short of breath when hurrying on level ground or walking up a slight hill”

1

Assessment of Symptoms
“On level ground, I walk slower than people of the same age because of breathlessness or have to stop for breath when walking at my own pace”

2

Assessment of Symptoms

“I stop for breath after walking about 100 meters or after a few minutes on level ground”

3

Assessment of Symptoms
“I am too breathless to leave the house or I am breathless when dressing “

4

Mild COPD exacerbation is treated with ________ only.

short-acting bronchodilators (SABDs)

________ is treated with SABDs plus antibiotics and/or oral corticosteroids.

Moderate COPD exacerbations

________ requires a visit to the emergency room and/or hospitalization.

Severe COPD exacerbations

Severe exacerbations may also be associated with acute ________ failure.

ventilatory

The best predictor for future COPD exacerbations is the ________, including ________ .

patient history of exacerbations, hospitalizations

A history of ________ or more exacerbations per year indicates a high risk for further exacerbations.

two

Patients identified as ________ and ________ have a significantly higher risk for exacerbations.

GOLD 3 (severe), GOLD 4 (very severe)

________ may be helpful in detecting bronchiectasis or lung cancer in COPD patients.

Computed tomography scanning

Measurement of lung volumes and diffusing capacity (________) provides information on the functional impact of emphysema in COPD.

DLCO

Oximetry and arterial blood gas measurement are recommended when peripheral arterial oxygen saturation (SpO2) is <92%.

<92%

Exercise testing, such as cycle or treadmill ergometry, is useful for identifying coexisting or alternative conditions like ________.

cardiac disease

Alpha1-antitrypsin deficiency (AATD) screening should be considered for younger COPD patients (<________ years old) with a history and clinical indicators.

45

A serum concentration of alpha1-antitrypsin below ________% of normal is highly suggestive of emphysema caused by AATD.

15 to 20

ACUTE EXACERBATION IS ASSOCIATED WITH

• Increased airway inflammation

• increased mucous production

• significant alveolar hyperinflation

• increased dyspnea

key symptom of an acute exacerbation

increased dyspnea

GOAL OF CARE

• Achieving Airway Clearance

• Improving Breathing Patterns

• improving Activity Tolerance

• Monitoring and Managing Complications

• Promoting Home- and Community-Based Care

GOLD 2024 continues to recommend post-bronchodilator spirometry for COPD diagnosis, with a FEV1/FV ratio ________ confirming airflow limitation.

<0.7%

GOLD 2024 includes expanded information on ________ and introduces a section on ________.

preserved ration impaired spirometry (PRISm), hyperinflation

GOLD 2024 emphasizes reducing the carbon footprint of ________ .

inhalers

Smoking cessation recommendations in GOLD 2024 now focus on pharmacotherapies, discouraging ________ as a cessation tool.

vaping

________ recommendations for COPD patients have been updated in GOLD 2024.

vaccinations

GOLD 2024 discusses the ongoing debate about using ________ for COPD treatment.

biologics