Clinical Features of COPD Flashcards
What does COPD stand up for?
Chronic obstructory pulmonary disease
What is COPD characterised by?
Chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible
What is included in the diagnosis of COPD?
Chronic bronchitis and emphysema
What is COPD usually caused by?
Significant exposure to noxious particles or gases
What is the aetiology of COPD?
Smoking
Pollutants
Host factors
What is the patho-biology of COPD?
Impaired lung growth
Accelerated decline
Lung injury
Lung and systemic inflammation
What is pathobiology?
Branch of biology that deals with pathology with a greater emphasis on the biological than the medical aspects
What is the pathology of COPD?
Small airway disorders of abnormalities
Emphysema
Systemic effects
What are the clinical manifestations of COPD?
Symptoms
Exacerbations
Comorbidities
What are comorbidities?
Presence of one or more additional diseases co-occuring with a primary disease
What is the presence of one or more additional disease co-occurring with a primary disease called?
Comorbidities
What is pathology?
Medical specialty concerned with the diagnosis of diseases based on the laboratory analysis of bodily fluids
What is the primary cause of COPD?
Tobacco smoke
What predisposes COPD?
Increasing age and female sex
What does predisposes mean?
Makes someone liable to a specific condition
What can factors that affect lung growth during gestation and childhood affect?
Future risk of COPD
What deficiency is linked to early onset COPD?
Alpha-1-antitrypsin deficiency
What is the prevalence of alpha-1-antitrypsin deficiency?
Rare inherited disease
What is an early onset of COPD considered as?
Younger than 45 years old
What is alpha-1-antitrypsin?
Proteast inhibitor made in the liver which limits damage caused by activating neutrophils releasing elastase in response to infection/cigarette smoke
What does absent or low alpha-1-antitrypsin lead to?
Alveolar damage and emphysema
What are some common alpha-1-antitrypsin phenotypes?
PiMM (100% normal)
PiMS (80% normal serum levels)
PiSS (60% normal serum levels)
PiMZ (40% normal serum levels)
PiZZ (10-15% normal serum levels)
What serum levels is PiMM?
100%
What serum levels is PiMS?
80%
What serum levels is PiSS?
60%
What serum levels is PiMZ?
40%
What serum levels is PiZZ?
10-15%
What does A1AT stand for?
alpha-1-antitrypsin
What does alpha-1-antitrypsin (A1AT) lead to?
Liver fibrosis
Cirrhosis
What is cirrhosis?
Condition where the liver does not function properly due to long term damage
What do smokers have compared to non-smokers?
More respiratory symptoms and lung function abnormalities
Greater annual decline of FEV1
Greater COPD mortality rate
What percentage of smokers develop COPD in their lifetime?
<50%
After 25 years of smoking, how many smokers without initial disease will have significant COPD (stage 2 or worse) and how many will have any COPD?
25% will have stage 2 or worse COPD
30-40% will have any form of COPD
How can smoking cause COPD in people who do not smoke?
Environmental tobacco causes COPD (second hand smoke)
What does smoking during pregnancy affect?
Foetal lung growth and priming of the immune system
What curve is this?
Fletcher-peto curve
What level of FEV1 do clinical symptoms occur at?
About 50%
What is important to know about the initial presentation of COPD?
Initial presentation is varied
What are some typical symptoms of COPD?
Shortness of breath
Recurrent chest infections
Ongoing cough, not clearing up
Wheeze
Productive cough/sputum
What are some less common symptoms of COPD?
Weight loss (calorie consumption)
Fatigue
Decreased exercise tolerance
Ankle swelling (if causing heart failure)
What are some clinical features of COPD on examination?
Cyanosis
Raised jugular venous pressure (JVP)
Cachexia
Hyperinflated chest
Pursed lip breathing
Use of accessory muscles
Wheeze
Peripheral oedema
Acute exacerbations
What do the clinical features on examination depend on?
Severity
What does JVP stand for?
Jugular venous pressure
What is cachexia?
Weakness and wasting of the body due to severe chronic illness
What is weakness and wasting of the body due to severe chronic illness known as?
Cachexia
What is peripherial oedema?
Fluid collecting in cavities or tissues in the body
What is fluid collecting in cavities or tissues in the body known as?
Peripherial oedema
What can you say about a single diagnostic test for COPD?
No such thing exists
What should the criteria of someone be to make the COPD diagnosis?
>35 years old
Presence of risk factor
Presence of typical symptoms
Absence of clinical features of asthma
Airflow obstruction confirmed by post-bronchodilator spirometry
When does spirometry suggest COPD?
FEV`/FVC < 0.7 post bronchodilator suggests lack of reversibility which is COPD
What are the different stages of COPD?
Stage 1 (mild, FEV1 80% of predicted value or higher)
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)
What is stage 1 COPD?
Mild, FEV1 more than 80% of predicted value
What is stage 2 COPD?
Moderate, FEV1 50-79% of predicted value
What is stage 3 COPD?
Severe, FEV1 30-49% of predicted value)
What is stage 4 COPD?
Very severe, FEV1 less than 30% of predicted value
What is end stage COPD?
Not part of staging classification but is often used in practice
What are the 2 kinds of spirometry patterns (diseased)?
Obstructive
Restrictive
When is a spirometry pattern obstructive?
FEV1 reduced
FVC reduced to a lesser extent
FEV1/FVC ratio reduced (<0.7)
When is a spirometry pattern restrictive?
FEV1 reduced
FVC reduced
FEV1/FVC ratio normal (>0.7)
Which is obstructive and which is restrictive?
A is obstructive
B is restrictive
Is a chest X-ray part of the COPD diagnosis?
No, but may be used to exclude other pathology
What is hyperinflation?
More than 6 anterior or 10 posterior ribs in the mid-clavicular line at the lung diaphragm level
How many people live with a COPD diagnosis?
1.2 million (2%)
How common is COPD compared to other lung diseases?
2nd most common after asthma
What is the most common lung disease?
Asthma then COPD
Is the prevalence of COPD increasing or decreasing?
Increasing
How many people are diagnosed with COPD each year?
115,000 (diagnosis every 5 minutes)
Is the incidence of COPD increasing or decreasing?
Decreasing
Do more males or females have COPD?
Males
What is prevalence?
Number of people living with a disease
What is the number of people living with a disease called?
Prevalence
What is incidence?
Number of new cases in a defined time period
What is the number of new cases in a defined time period called?
Incidence
Is there a link between weath and COPD?
Yes, more poorer people have COPD
How do you differentiate between COPD and asthma?
Chronic respiratory symptoms + normal spirometry
Chronic respiratory symptoms preceding airflow limitations
Smokers with structural evidence of lung disease (emphysema, airway wall thickening and gas trapping) but no airflow limitations
History
What is the difference in smoking between COPD and asthma?
COPD nearly all smoke
Asthma smoking is possible
What is the difference in age (younger than 35) in COPD and asthma?
COPD is rare
Asthma is often
What is the difference in chronic productive cough in COPD and asthma?
COPD is common
Asthma is uncommon
What is the difference in breathlessness in COPD and asthma?
COPD is persistent and progressive
Asthma is variable
What is the difference btween nocturnal waking with breathlessness in COPD and asthma?
COPD is uncommon
Asthma is common
What is the difference in significant day to day variability of symptoms in COPD and asthma?
COPD is uncommon
Asthma is common
What should you do if you are unsure whether it is COPD or asthma?
Pulmonary function tests
What do pulmonary function tests test?
Lung volumes
Transfer factor
What lung volume changes are present in COPD?
Increased residual volume
Increased total lung capacity
RV/TLC > 30%
What transfer factor changes are present in COPD?
Reduced gas transfer
Decreased CLco (diffusion capacity of the lungs for carbon monoxide)
Decreased Kco (transfer factor for carbon monoxide)
If you are still unsure if it is COPD or asthma after pulmonary function tests what could you do?
Radiology
What does radiology show when its COPD?
Honeycombing
Traction bronchiectasis
Lungcysts
Centrilobular emphysema
Signet ring sign
What are worsening symptoms during exacerbations?
Shortness of breath
Wheeze
Chest tightness
Cough
Sputum
Unable to smoke
Systemic upset (eating, drinking)
Temperature (if infective)
Fatigue
What symptoms do severe exacerbations include?
Breathless (RR>25/min)
Accessory muscles used at rest
Purse lip breathing
Cyanosis (sats <92% o/a)
Significant decreased in exercise tolerance
Signs of sepsis (if caused by infection)
Fluid retention
Confustion
During severe exacerbations what is the breathing rate?
>25 breaths/min
What does the management of acute exacerbations involve?
Change in inhalers
Oral steroids
Antibiotics
What could a change in inhalers involve?
Technique
Device
Adding bronchodilator
Increase or add inhaled steroid
What may you have to do if the acute exacerbation is very severe?
Admit into hospital
What can acute exacerbations be triggered by?
Viral/bacterial infection (most common)
Seductive drugs
Pneumothorax
Trauma
What is the most common trigger of acute exacerbations?
Viral/bacterial infection
What does the treatment of acute exacerbations include?
Oxygen
Nebulised bronchodilator (B2 and anti-muscarinic)
Oral/IV corticosteroid
Antibiotic
What are some severe respiratory diseases?
Respiratory failure
Cor pulmonale
Secondary polycythaemia
Chronic bronchitis
Emphysema
What are the 2 types of respiratory failure?
Type 1 (decreased PO2)
Type 2 (increased PCO2)
What are the symptoms of cor pulmonale?
Tachycardiac
Oedematous
Congested liver
What is tachycardia?
Abnormally fast resting heart rate
What is abnormally fast resting heart rate known as?
Tachycardia
What is oedematous?
Excessive accumulation of fluid in extracellular space
What are the ECG features of cor pulmonale?
Right axis deviation
P pulmonale
T wave inversion
What is cor pulmonale?
Abnormal enlargement of the right side of the heart due to a disease of the lungs or pulmonary blood vessels
What are the symptoms of secondary polycythaemia?
Increased haemoglobin and haemocrit
What is seen in chronic bronchitis?
Cough for 3 months or more
Overweight and cyanotic
What is seen in emphysema?
Enlargement and destruction of airspaces
Older and thinner patient
How is emphysema and chonic bronchitis diagnosed?
Emphysema is a pathological diagnosis
Chronic bronchitis is a clinical diagnosis
What is the MRC dyspnoea scale?
Scale that measures respiratory disability
What does the MRC dyspnoea scale range from?
1 (least severe) to 5 (most severe)
What is used to measure respiratory disability?
MRC dyspnoea scale
What does 1 on the MRC dyspnoea scale mean?
Not troubled by breathlessness execpt during straneous exercise
What does 2 on the MRC dyspnoea scale mean?
Short of breath when hurrying or walking up a slight hill
What does 3 on the MRC dyspnoea scale mean?
Walks slower than contemporaries on the level because of breathlessness, or has to stop for breath when walking at own pace
What does 4 on the MRC dyspnoea scale mean?
Stops for breath after walking about 100m or after a few minutes on the level
What does 5 on the MRC dyspnoea scale mean?
Too breathless to leave the house, or breathless when dressing or undressing
What is the MRC dyspnoea scale used for?
COPD and other chronic conditions
What is seen in end of stage COPD?
Terminal illness
Unpredictable decline
Acute decline also possible
Palliation of symptoms
What respiratory diseases kill the most people each year?
1) Lung cancer
2) COPD
3) Pneumonia
What number of cause of emergency admissions is COPD?
Second largest
What percantage of people worldwide have COPD?
11.7%
Is smoking in young people increasing or decreasing?
Decreasing, going from 18% of 11-16 year olds in 2001 to 5% in 2014
