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2. Respiratory Medicine (Lectures) > Clinical Features of COPD > Flashcards

Clinical Features of COPD Flashcards

1
Q

What does COPD stand up for?

A

Chronic obstructory pulmonary disease

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2
Q

What is COPD characterised by?

A

Chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible

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3
Q

What is included in the diagnosis of COPD?

A

Chronic bronchitis and emphysema

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4
Q

What is COPD usually caused by?

A

Significant exposure to noxious particles or gases

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5
Q

What is the aetiology of COPD?

A

Smoking

Pollutants

Host factors

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6
Q

What is the patho-biology of COPD?

A

Impaired lung growth

Accelerated decline

Lung injury

Lung and systemic inflammation

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7
Q

What is pathobiology?

A

Branch of biology that deals with pathology with a greater emphasis on the biological than the medical aspects

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8
Q

What is the pathology of COPD?

A

Small airway disorders of abnormalities

Emphysema

Systemic effects

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9
Q

What are the clinical manifestations of COPD?

A

Symptoms

Exacerbations

Comorbidities

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10
Q

What are comorbidities?

A

Presence of one or more additional diseases co-occuring with a primary disease

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11
Q

What is the presence of one or more additional disease co-occurring with a primary disease called?

A

Comorbidities

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12
Q

What is pathology?

A

Medical specialty concerned with the diagnosis of diseases based on the laboratory analysis of bodily fluids

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13
Q

What is the primary cause of COPD?

A

Tobacco smoke

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14
Q

What predisposes COPD?

A

Increasing age and female sex

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15
Q

What does predisposes mean?

A

Makes someone liable to a specific condition

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16
Q

What can factors that affect lung growth during gestation and childhood affect?

A

Future risk of COPD

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17
Q

What deficiency is linked to early onset COPD?

A

Alpha-1-antitrypsin deficiency

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18
Q

What is the prevalence of alpha-1-antitrypsin deficiency?

A

Rare inherited disease

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19
Q

What is an early onset of COPD considered as?

A

Younger than 45 years old

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20
Q

What is alpha-1-antitrypsin?

A

Proteast inhibitor made in the liver which limits damage caused by activating neutrophils releasing elastase in response to infection/cigarette smoke

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21
Q

What does absent or low alpha-1-antitrypsin lead to?

A

Alveolar damage and emphysema

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22
Q

What are some common alpha-1-antitrypsin phenotypes?

A

PiMM (100% normal)

PiMS (80% normal serum levels)

PiSS (60% normal serum levels)

PiMZ (40% normal serum levels)

PiZZ (10-15% normal serum levels)

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23
Q

What serum levels is PiMM?

A

100%

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24
Q

What serum levels is PiMS?

A

80%

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25
Q

What serum levels is PiSS?

A

60%

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26
Q

What serum levels is PiMZ?

A

40%

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27
Q

What serum levels is PiZZ?

A

10-15%

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28
Q

What does A1AT stand for?

A

alpha-1-antitrypsin

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29
Q

What does alpha-1-antitrypsin (A1AT) lead to?

A

Liver fibrosis

Cirrhosis

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30
Q

What is cirrhosis?

A

Condition where the liver does not function properly due to long term damage

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31
Q

What do smokers have compared to non-smokers?

A

More respiratory symptoms and lung function abnormalities

Greater annual decline of FEV1

Greater COPD mortality rate

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32
Q

What percentage of smokers develop COPD in their lifetime?

A

<50%

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33
Q

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?

A

25% will have stage 2 or worse COPD

30-40% will have any form of COPD

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34
Q

How can smoking cause COPD in people who do not smoke?

A

Environmental tobacco causes COPD (second hand smoke)

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35
Q

What does smoking during pregnancy affect?

A

Foetal lung growth and priming of the immune system

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36
Q

What curve is this?

A

Fletcher-peto curve

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37
Q

What level of FEV1 do clinical symptoms occur at?

A

About 50%

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38
Q

What is important to know about the initial presentation of COPD?

A

Initial presentation is varied

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39
Q

What are some typical symptoms of COPD?

A

Shortness of breath

Recurrent chest infections

Ongoing cough, not clearing up

Wheeze

Productive cough/sputum

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40
Q

What are some less common symptoms of COPD?

A

Weight loss (calorie consumption)

Fatigue

Decreased exercise tolerance

Ankle swelling (if causing heart failure)

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41
Q

What are some clinical features of COPD on examination?

A

Cyanosis

Raised jugular venous pressure (JVP)

Cachexia

Hyperinflated chest

Pursed lip breathing

Use of accessory muscles

Wheeze

Peripheral oedema

Acute exacerbations

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42
Q

What do the clinical features on examination depend on?

A

Severity

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43
Q

What does JVP stand for?

A

Jugular venous pressure

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44
Q

What is cachexia?

A

Weakness and wasting of the body due to severe chronic illness

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45
Q

What is weakness and wasting of the body due to severe chronic illness known as?

A

Cachexia

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46
Q

What is peripherial oedema?

A

Fluid collecting in cavities or tissues in the body

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47
Q

What is fluid collecting in cavities or tissues in the body known as?

A

Peripherial oedema

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48
Q

What can you say about a single diagnostic test for COPD?

A

No such thing exists

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49
Q

What should the criteria of someone be to make the COPD diagnosis?

A

>35 years old

Presence of risk factor

Presence of typical symptoms

Absence of clinical features of asthma

Airflow obstruction confirmed by post-bronchodilator spirometry

50
Q

When does spirometry suggest COPD?

A

FEV`/FVC < 0.7 post bronchodilator suggests lack of reversibility which is COPD

51
Q

What are the different stages of COPD?

A

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)

52
Q

What is stage 1 COPD?

A

Mild, FEV1​ more than 80% of predicted value

53
Q

What is stage 2 COPD?

A

Moderate, FEV1​ 50-79% of predicted value

54
Q

What is stage 3 COPD?

A

Severe, FEV1​ 30-49% of predicted value)

55
Q

What is stage 4 COPD?

A

Very severe, FEV1​ less than 30% of predicted value

56
Q

What is end stage COPD?

A

Not part of staging classification but is often used in practice

57
Q

What are the 2 kinds of spirometry patterns (diseased)?

A

Obstructive

Restrictive

58
Q

When is a spirometry pattern obstructive?

A

FEV1 reduced

FVC reduced to a lesser extent

FEV1/FVC ratio reduced (<0.7)

59
Q

When is a spirometry pattern restrictive?

A

FEV1 reduced

FVC reduced

FEV1/FVC ratio normal (>0.7)

60
Q

Which is obstructive and which is restrictive?

A

A is obstructive

B is restrictive

61
Q

Is a chest X-ray part of the COPD diagnosis?

A

No, but may be used to exclude other pathology

62
Q

What is hyperinflation?

A

More than 6 anterior or 10 posterior ribs in the mid-clavicular line at the lung diaphragm level

63
Q

How many people live with a COPD diagnosis?

A

1.2 million (2%)

64
Q

How common is COPD compared to other lung diseases?

A

2nd most common after asthma

65
Q

What is the most common lung disease?

A

Asthma then COPD

66
Q

Is the prevalence of COPD increasing or decreasing?

A

Increasing

67
Q

How many people are diagnosed with COPD each year?

A

115,000 (diagnosis every 5 minutes)

68
Q

Is the incidence of COPD increasing or decreasing?

A

Decreasing

69
Q

Do more males or females have COPD?

A

Males

70
Q

What is prevalence?

A

Number of people living with a disease

71
Q

What is the number of people living with a disease called?

A

Prevalence

72
Q

What is incidence?

A

Number of new cases in a defined time period

73
Q

What is the number of new cases in a defined time period called?

A

Incidence

74
Q

Is there a link between weath and COPD?

A

Yes, more poorer people have COPD

75
Q

How do you differentiate between COPD and asthma?

A

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

76
Q

What is the difference in smoking between COPD and asthma?

A

COPD nearly all smoke

Asthma smoking is possible

77
Q

What is the difference in age (younger than 35) in COPD and asthma?

A

COPD is rare

Asthma is often

78
Q

What is the difference in chronic productive cough in COPD and asthma?

A

COPD is common

Asthma is uncommon

79
Q

What is the difference in breathlessness in COPD and asthma?

A

COPD is persistent and progressive

Asthma is variable

80
Q

What is the difference btween nocturnal waking with breathlessness in COPD and asthma?

A

COPD is uncommon

Asthma is common

81
Q

What is the difference in significant day to day variability of symptoms in COPD and asthma?

A

COPD is uncommon

Asthma is common

82
Q

What should you do if you are unsure whether it is COPD or asthma?

A

Pulmonary function tests

83
Q

What do pulmonary function tests test?

A

Lung volumes

Transfer factor

84
Q

What lung volume changes are present in COPD?

A

Increased residual volume

Increased total lung capacity

RV/TLC > 30%

85
Q

What transfer factor changes are present in COPD?

A

Reduced gas transfer

Decreased CLco (diffusion capacity of the lungs for carbon monoxide)

Decreased Kco (transfer factor for carbon monoxide)

86
Q

If you are still unsure if it is COPD or asthma after pulmonary function tests what could you do?

A

Radiology

87
Q

What does radiology show when its COPD?

A

Honeycombing

Traction bronchiectasis

Lungcysts

Centrilobular emphysema

Signet ring sign

88
Q

What are worsening symptoms during exacerbations?

A

Shortness of breath

Wheeze

Chest tightness

Cough

Sputum

Unable to smoke

Systemic upset (eating, drinking)

Temperature (if infective)

Fatigue

89
Q

What symptoms do severe exacerbations include?

A

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

90
Q

During severe exacerbations what is the breathing rate?

A

>25 breaths/min

91
Q

What does the management of acute exacerbations involve?

A

Change in inhalers

Oral steroids

Antibiotics

92
Q

What could a change in inhalers involve?

A

Technique

Device

Adding bronchodilator

Increase or add inhaled steroid

93
Q

What may you have to do if the acute exacerbation is very severe?

A

Admit into hospital

94
Q

What can acute exacerbations be triggered by?

A

Viral/bacterial infection (most common)

Seductive drugs

Pneumothorax

Trauma

95
Q

What is the most common trigger of acute exacerbations?

A

Viral/bacterial infection

96
Q

What does the treatment of acute exacerbations include?

A

Oxygen

Nebulised bronchodilator (B2 and anti-muscarinic)

Oral/IV corticosteroid

Antibiotic

97
Q

What are some severe respiratory diseases?

A

Respiratory failure

Cor pulmonale

Secondary polycythaemia

Chronic bronchitis

Emphysema

98
Q

What are the 2 types of respiratory failure?

A

Type 1 (decreased PO2)

Type 2 (increased PCO2)

99
Q

What are the symptoms of cor pulmonale?

A

Tachycardiac

Oedematous

Congested liver

100
Q

What is tachycardia?

A

Abnormally fast resting heart rate

101
Q

What is abnormally fast resting heart rate known as?

A

Tachycardia

102
Q

What is oedematous?

A

Excessive accumulation of fluid in extracellular space

103
Q

What are the ECG features of cor pulmonale?

A

Right axis deviation

P pulmonale

T wave inversion

104
Q

What is cor pulmonale?

A

Abnormal enlargement of the right side of the heart due to a disease of the lungs or pulmonary blood vessels

105
Q

What are the symptoms of secondary polycythaemia?

A

Increased haemoglobin and haemocrit

106
Q

What is seen in chronic bronchitis?

A

Cough for 3 months or more

Overweight and cyanotic

107
Q

What is seen in emphysema?

A

Enlargement and destruction of airspaces

Older and thinner patient

108
Q

How is emphysema and chonic bronchitis diagnosed?

A

Emphysema is a pathological diagnosis

Chronic bronchitis is a clinical diagnosis

109
Q

What is the MRC dyspnoea scale?

A

Scale that measures respiratory disability

110
Q

What does the MRC dyspnoea scale range from?

A

1 (least severe) to 5 (most severe)

111
Q

What is used to measure respiratory disability?

A

MRC dyspnoea scale

112
Q

What does 1 on the MRC dyspnoea scale mean?

A

Not troubled by breathlessness execpt during straneous exercise

113
Q

What does 2 on the MRC dyspnoea scale mean?

A

Short of breath when hurrying or walking up a slight hill

114
Q

What does 3 on the MRC dyspnoea scale mean?

A

Walks slower than contemporaries on the level because of breathlessness, or has to stop for breath when walking at own pace

115
Q

What does 4 on the MRC dyspnoea scale mean?

A

Stops for breath after walking about 100m or after a few minutes on the level

116
Q

What does 5 on the MRC dyspnoea scale mean?

A

Too breathless to leave the house, or breathless when dressing or undressing

117
Q

What is the MRC dyspnoea scale used for?

A

COPD and other chronic conditions

118
Q

What is seen in end of stage COPD?

A

Terminal illness

Unpredictable decline

Acute decline also possible

Palliation of symptoms

119
Q

What respiratory diseases kill the most people each year?

A

1) Lung cancer
2) COPD
3) Pneumonia

120
Q

What number of cause of emergency admissions is COPD?

A

Second largest

121
Q

What percantage of people worldwide have COPD?

A

11.7%

122
Q

Is smoking in young people increasing or decreasing?

A

Decreasing, going from 18% of 11-16 year olds in 2001 to 5% in 2014

2. Respiratory Medicine (Lectures) (50 decks)

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