Breathlessness Flashcards
What do we mean by breathlessness - clinically?
Refers to an uncomfortable need to breath - Often called dyspnoea
What are the most likely reasons someone is breathless?
- Problem with lungs
- Problems with the heart or circulation
- Problems with oxygen transport - blood
- Problems with acid-base balance
Decide whether each condition is likely to be acute, chronic or both
Difference between acute and chronic breathlessness?
Acute-means sudden onset, so something has changed quickly (few hours/few days)
Chronic breathlessness - persists over a long time - first described as breathlessness when patients exercise, which may eventually occur even at rest.
What is COPD?
Chronic obstructive pulmonary disease (COPD) is a lung disease characterised by persistent respiratory symptoms and airflow obstruction
COPD is a common cause of breathlessness and will increase in incidence over the coming years
COPD is most commonly the result of a combination chronic bronchitis and emphysema.
Chronic bronchitis - inflammaiton of the bronchi - cough and sputum production on most days for at least 3 months during the last two years.
Emphysema - characterised by large air-filled spaces - caused by the breakdown of the walls of the alveoli - aveolar wall collapse
How does COPD present clinically at the doctors?
- Breathlessness on exertion
- Cough
- Recurrent chest infections
What are the environmental risk factors for COPD?
- Smoking-accounts for 90-95%
- Environmental dusts, particulates, fumes - e.g. nitrogen dioxide
- Women more susceptible
- Asthma
Do people with COPD typcially have multi-morbidities?
Currently prevalence in Scotland ~4% of population
Yes, they often have other health conditions such as:
Peripheral vascular disease
Hypertension
Ischaemic heart disease
Heart failure
How is COPD diagnosed?
- History - breathlessness, cough and recurrent infection
- Investigations
a) Spirometry
b) Chest X-ray
What is spirometry?
Spirometry is a simple test used to help diagnose and monitor certain lung conditions by measuring how much air you can breathe out in one forced breath
It measures the volume and flow of air during inspiration and expiration - assessment of how effectively the lungs can be emptied and filled.
It can be used to assist the diagnosis of: Asthma, COPD, pulmonary fibrosis and cystic fibrosis.
What does FEV1 and FVC mean - spiromtery? How does this change in COPD patients?
Forced expiratory volume in the first second (FEV1) - volume of air that an individual can exhale during a forced breath in 1 second
Forced vital capacity (FVC) is the total amount of air exhaled during the FEV test.
Spirometry - what does FVC and FEV1 refer to? How do these values change in COPD patients?
FVC – Forced vital capacity - This is a measure of the maximum volume of air than can be exhaled
FEV1 – Forced expiratory volume in one second - volume expired during the first second of maximum expiration
Note - FEV1 expressed is normally expressed as a percentage relative to FVC - FEV/FVC - normally value ranges from 75%-80%
In COPD patients we typically observe both a reduced FEV1/FVC - takes longer to expire the air out of their lungs
Difference between obstructive and restrictive air flow?
What FEV1/FVC ratio is required for a COPD diagnosis and what are the FEV1 ranges used to differentiate severity?
Severity - comparing your FEV1 score to the predicted value of those individuals similar to you with healthy lungs.
What treatment is used for COPD?
General management
1. Most important - Stop smoking
2. Vaccinate against influenza and pneumococcus
3. Pulmonary rehabilitation- Exercise and education programme to cope with disease
4. Lose weight
5. Inhalers - Bronchodilator therapy a short-acting beta2-agonist (SABA) or short-acting muscarinic antagonist (SAMA) is first-line treatment
In patients with Asthmatic features/features suggesting steroid responsiveness - corticosteroids can be used
What is a pneumothorax? What is a primary, secondary, traumatic pneumothorax?
Pneumothorax is the presence of air in the pleural space, which can either occur spontaneously, or result from iatrogenic injury or trauma to the lung or chest wall
Basically, air will accumulate in the thoracic cavity resulting in collapsed lungs and impaired ventilation
- Primary spontaneous pneumothorax - occurs in patients with no history of lung disease
- Risk factors – smoking, tall stature and presence of apical subpleural blebs (air blisters) - Secondary pneumothorax - affects patients with pre-existing lung disease
- Traumatic - Iatrogenic (following thoracic surgery or biopsy) or chest wall injury
Describe the three main types of pneumthorax - open, closed and tension.
Open pneumthorax - occurs when an injury creates a hole in the chest wall that allows air from the environment to enter the pleural cavity.
Closed pneumthorax - refers to air that enters the pleural cavity from the lungs themselves - typically occurs due to a defect of or damage to the pulmonary parenchyma
Tension pneumthorax - in tension pneumothorax, the pleural injury acts as a one-way valve. As a result, the air can enter the pleural space during inspiration, but is unable to escape during expiration - with each inspiration more air is trapped - causes mediastinal displacement towards the opposite side
- Differs from open and closed as air is able to escape during expiration - allowing lungs to partiallly fill with air
What does clear, yellow, green, red/brown and pink sputum indicate?
Sputum - Phlegm
a) Clear (mucoid): COPD/bronchiectasis without current infection/rhinitis.
b) Yellow (mucopurulent): acute lower respiratory tract infection/asthma.
c) Green (purulent): current infection – acute disease or exacerbation of chronic disease, such as COPD.
d) Red/brown (rusty): pneumococcal pneumonia. Try to distinguish between rusty and frank red blood (see below).
e) Pink (serous/frothy): acute pulmonary oedema.
