Chronic Obstructive Pulmonary Disease Flashcards
What medication did he recently take for his chest infection?
Amoxicillin
What is his smoking history?
30 pack-year
What symptoms and signs does Mr Craven present with?
‘Catching his breath a bit over the last few months’
Finds climbing the stairs and running for more difficult
Slower pace when walking
What does the GP suggest?
Breathing test using spirometer
Set up meeting with stop smoking counsellor
What does the GP say is the best way to stop smoking?
Combination of medication and specialist support
What are the 4 main causes of breathlessness?
Lung conditions
Heart conditions
Anxiety
Being unfit
How can lung conditions cause breathlessness?
Cause airways to become inflamed and narrowed
Fill the airways with phlegm so it harder for air to move in and out of the lungs
Make the lungs stiff and less elastic so its harder for them to expand and fill with air
Give examples of lung conditions that can causes long-term breathlessness?
COPD Asthma Interstitial Lung disease (inc. pulmonary fibrosis) Bronchiectasis Industrial/Occupational e.g. asbestosis Lung cancer
What lung conditions cause acute breathlessness?
Asthma/COPD flare up Pulmonary embolism Pneumonia Tuberculosis Pneumothorax Collapsed lung Build up of fluid in lung or lining of lungs
How can chronic breathlessness be caused by heart conditions?
Problems with: Rhythm Valves Cardiac muscles Heart is unable to increase its pumping strength in response to exercise
When might heart failure due to breathlessness worsen?
Worse at night or when asleep
Which heart conditions can cause acute breathlessness?
Heart attack
Abnormal heart rhythm
(palpitations)
How can anxiety cause breathlessness?
Normal body response by your body to what you think is a stressful situation
Your body prepares for action
As you get more anxious you may start to breather faster and tense your breathing muscles
What is a panic attack?
When your body’s normal response is exaggerated
Rapid build up of physical responses
Body tries to take in more oxygen so heart beats faster and muscles tense
What are the symptoms of a panic attack?
Have a pounding heart Feel faint Sweat Feel sick Have shaky limbs Feel you're not connected to your body
Why might being unfit cause breathlessness?
Muscles get weaker
Weaker muscles need more oxygen to work
How can being an unhealthy weight make us feel breathless?
Underweight: Breathing muscles will be weaker
Overweight: More effort to breathe and move around
Having more weight in chest or abdomen restricts how much you lungs can move
What BMI value will mean you are more susceptible to breathlessness?
25
What can people who are severely overweight develop?
Obesity hypoventilation syndrome
Want is obesity hypoventilation syndrome?
Poor breathing leads to lower oxygen levels and high CO2 levels in their blood
What are the other reasons of chronic breathlessness?
Smoking
Conditions that affect how your muscles work
e.g. muscular dystrophy, MG and motor neurone disease
Postural conditions that alter the shape of your spine e.g. scoliosis and kyphosis
Anaemia
Kidney disease
Thyroid disease
What should someone experiencing breathlessness do when they go to see their doctor?
Think about how they’ll describe their breathlessness
Bring someone who can help
What is the MRC breathlessness scale?
Scale health professionals use to measure breathlessness
Shows what it stops you from doing
What does grade 1 on the MRC scale represent?
Not troubled by breathlessness except on strenuous exercise
What does grade 2 on the MRC scale represent?
Short pf breath when hurrying on the level or walking up a slight hill
What does grade 3 on the MRC scale represent?
Walks slower than most people on the level, stops after a mile or so, or stops after 15 minutes walking at own pace
What does grade 5 on the MRC scale represent?
Too breathless to leave the house, or breathless when undressing
What is important to tell your doctor?
what you used to be able to do that you can’t do any more
what people of your age around you do that you think you should be able to do
what your personal goals are for your day-to-day activity
What tests might a GP carry out?
No. of breaths per minute Listen to your chest Feel how your chest moves as you breathe Heart rate and rhythm Blood pressure and temperature Height, Weight, Waist and BMI Examine head/neck and armpits for swollen lymph glands Look at eyes, nails, skin and joints Blood oxygen levels
What may a GP refer a patient with breathlessness for?
Chest X-Ray Spirometry ECG Echocardiogram Blood tests
What could blood tests detect?
Anaemia
Allergies
Thyroid/ Liver/ Kidney/ Heart problems
What would you look for on chest radiography?
Signs of heart failure
Pulmonary pathology
What would you look for on a ECG?
Heart failure
Arrhythmia
Pulmonary embolism
What would you look for when performing a spirometry test?
Signs of obstructive airway disease
Restrictive pattern associated with interstitial lung disease
What would a U+E and a blood glucose test show?
Renal failure and diabetes as causes of metabolic acidosis and breathlessness
What could a thyroid function test detect?
Thyroid disease as a cause of breathlessness
How can you assess heart failure?
B-type natriuretic peptide test
What factors are characteristic of asthma?
A large response to bronchodilators
Significant diurnal or day-day variability of serial peak flow measurements
What should you do for patients with COPD?
arrange chest radiography to exclude other serious lung pathology (such as lung cancer) and check the full blood count to identify anaemia or polycythaemia
What is SOBOE?
Shortness of breath on exertion
What are the possible respiratory differential diagnosis for Mr Craven?
Asthma COPD Pulmonary fibrosis Lung cancer Pulmonary embolism Pneumothorax Lower respiratory tract infection
What are the possible cardiovascular/systemic differential diagnosis for Mr Craven?
Congestive heart failure Pulmonary oedema Valvular defects Acute coronary syndrome Anaemia Renal or liver failure Deconditioning