Clinical features of COPD Flashcards
What does prevelance mean?
No. people living with the disease (water in bath tub)
What is incidence?
Incidence = Number of new cases in a defined time period i.e. per year (information on risk of contracting the disease) (amount of new water being added to the bath tub)
Is COPD more common in men or women?
Men, but this is now plateauing.
Does the prevalence of COPD increase or decrease with social deprivation?
The prevalence of COPD increases with social deprivation; unclear whether this reflects exposure to cigarette smoke or to air pollutants, poor nutrition, crowding or other factors related to low socioeconomic status
Within which care system is COPD usually managed?
Primary Care
What is the no.1 cause of COPD
Smoking
In high- and middle-income countries tobacco smoke is the biggest risk factor, meanwhile in low-income countries exposure to indoor air pollution, such as the use of biomass fuels for cooking and heating, causes the COPD burden.
Also occupation can have an effect
An analysis of the large U.S. population-based National Health and Nutrition Examination Survey III survey of almost 10,000 adults aged 30-75 years estimated the fraction of COPD attributable to workplace exposures was 19.2% overall, and 31.1% among never-smokers. True or False?
True
What can predispose COPD?
Increasing age and female sex,low socio-economic status, pre-existing asthma, chronic bronchitis, recurrent childhood infection
What is Alpha-1 Antitrypsin Deficiency? What disease does it lead to and when?
Rare, inherited disease, presents with early onset COPD <45yrs
Where is Alpha-1 antitrypsin (AAT) made and what is it’s function?
Alpha-1 antitrypsin (AAT) is a protease inhibitor made in the liver.
Limits damage caused by activated neutrophils releasing elastase in response to infection/cigarette smoke.
What happens when there is low or absent amounts of Alpha-1 Antitrypsin?
alveolar damage and emphysema
What else can be affected by Alpha-1 Antitrypsin Deficiency?
Liver fibrosis or cirrhosis
basal predominance to emphysema
How can smoking in pregnancy affect the foetus?
may affect foetal lung growth and priming of the immune system
What % of smokers will develop COPD during their lifetime?
Less than 50%. After 25 years of smoking, at least 25% of smokers will have clinically significant COPD (stage 2 or worse)
True/false:
Smokers have…
a)Less respiratory symptoms and lung function abnormalities
b)Smaller annual rate of decline in FEV1 (Fletcher-Peto Curve)
c)Greater COPD mortality rate than non-smokers
a) false b)false c)true
Smokers have…
MORE respiratory symptoms and lung function abnormalities
GREATER annual rate of decline in FEV1 (Fletcher-Peto Curve)
Greater COPD mortality rate than non-smokers
Why could screening smokers’ lung function in early middle age, help to prevent severe or fatal COPD
The effect of quitting at age 45 can make the difference between a normal lifespan and premature death, because the subsequent rate of loss may revert to normal, extending the period of time before FEV1 is reduced to disabilitating or death. The screening may help to persuade those to stop smoking.
What is JVP and will it be raised in COPD?
Jugular Venous Pressure. Yes, it will be raised
What are the clinical signs of COPD?
Cyanosis Pursed lip breathing
Raised JVP Hyperinflated chest
Cachexia (severe weight loss) Use of accessory muscles
Wheeze Peripheral oedema
What are the criteria to diagnose COPD?
Typical symptoms
>35 years
Presence of risk factor (smoking or occupational exposure)
Absence of clinical features of asthma (lack of reversibility - demonstrated on post-bronchodilator challange)
AND
Airflow obstruction confirmed by post-bronchodilator spirometry
What are the FEV1% of values (of predicted value) for GOLD classification - spirometry: Stage 1 - mild Stage 2 -moderate Stage 3, severe Stage 4 very severe
Doesn’t always corroloate to how unwell they are.
FEV1/FVC <0.7 post bronchodilator
Demonstrates lack of reversibility
Only done as if working up ?COPD –
not routinely
Stage 1, mild — FEV1 80% of predicted value or higher. With these values, a diagnosis of COPD can only be made on the basis of respiratory symptoms.
◦Stage 2, moderate — FEV1 50–79% of predicted value.
◦Stage 3, severe — FEV1 30–49% of predicted value.
◦Stage 4, very severe — FEV1 less than 30% of predicted value.
Where is COPD mainly managed
Primary care
What clinical features could make you think of Alpha-1 Antitrypsin deficiency?
A young person presenting with COPD features, very basal predominance to their emphysema - usually emphysema goes to the tops of the lungs as it’s caused by inhalation toxicity from cigarettes. Liver fibrosis or cirrhosis.
What are the symptoms of COPD
Common: Cough Breathlessness Sputum Frequent chest infections Wheezing Other symptoms Weight loss Fatigue Swollen ankles
What is the mMRC Dyspnoea scale and what numbers does it go from?
Modified Medical Research Council - Dyspnoea (breathing difficulty) scale
0-4
0= no issues, ony strenuous exercise
1= short of breath hurryng on ground level/up a slight hill
2= Walk slower/ otherwise have to stop of breath every so often
3= stop for breath after about 100yrds on level ground
4 = too breathless to leave house. Breathless on dressing
Why does a chest X-ray help in the diagnosis of COPD?
Excludes other pathologies eg. lung cancer.
Can also see typical signs of COPD on x-ray:
Hyperinflation at the bottom of the lungs(more than 6 anterior or 10 posterior ribs showing
Flat diaphragm
Reduced lung markings at the top
Small heart (being squashed)
vascular hila (due to pulmonary hypertension)
Be wary of multiple conditions. Obese patients often have restrictive lung disease which can lead to a falsly good FEV1/FVC ratio, but still have bronchitis? true or false?
true
COPD: An increase/decrease in residual volume?
Increase/Decrease in total lung capacitty?
Residual vol/Total lung capacity greater than what?
Increase
Increase(emphysema??)
30% -pretty diagnostic of emphysema
What further diagnostic test can be done to help diagnose COPD?
High resolution Computed Tomography (HRCT) - High-res CT
Looking for centrilobular emphysema
Honeycombing, lung cysts and bronchiectasis and signet ring signs = other conditions
What are the signs of a sever exacerbation of COPD?
Resp rate more than 25/min Accessory muscles at rest Purse lip breathing Cyanosis (less than 92% O2 sats) Sig. Decrease in exercise tolerance Signs of sepsis (if caused by infection) Fluid retention Confusuon
Other tha infections (viral/bacterial, most common) what can cause exacerbatio ?
Change in air quality
Other complications of resp. Diseases eg pneumothorax
Blood clots
What is type 1 and type 2 respiratory failure?
Type 1 = hypoxic (low pO2)
Type 2 = ventilatory failure (low pO2 and high pCO2)
Will everyone with COPD develop type 2 resp failure?
No, not everyone but is possible. Usually only at end stage of the disease.
What are the signs of retained CO2 (hypercapnia)?
Drowsy
Flapping tremor
What is Secondary polycythaemia
The bodys responce to low O2, increase in erythropoitin, increase in rbc, increase in viscocity.
Is COPD a cause of finger clubbing?
no
What treatment givesyou the best value for money in QALY (quality-adjusted life-years)?
flu vaccination, smoking cessation and pulmonary rehabilitation. Non-pharmacological interventions in COPD are very effective and very important.
Is Terbutaline a short-acting beta agonist used as a reliever medication in asthma.
Yes
