Clinical Features of COPD

Question 1

What does COPD stand for?

Answer 1

Chronic Obstructive Pulmonary Disease

Question 2

Is COPD reversible?

Answer 2

No.

Question 3

COPD is an umbrella term for which two diseases?

Answer 3

Emphysema
Chronic bronchitis

Question 4

What is chronic bronchitis?

Answer 4

Long-term inflammation of the airway

Question 5

What is emphysema?

Answer 5

Damage to the alveoli in the lungs

Question 6

What must you have had in order to be diagnosed with chronic bronchitis?

Answer 6

Cough and sputum for at least three months, present in two consecutive years,

Question 7

What is the main cause of COPD?

Answer 7

Smoking

Question 8

In developing countries, what can contribute to the development of COPD?

Answer 8

Biomass fuel cooking and heating

Question 9

What are the non-modifiable factors which contribute to COPD?

Answer 9

Increase in age
Female
Lower socioeconomic status
Asthma / airway hyper-reactivity
Chronic bronchitis
Childhood infection

Question 10

What is Alpha-1 Antitrypsin Deficiency?

Answer 10

Rare, inherited disease, presents with early onset COPD <45yrs

Question 11

What is alpha-1 antitrypsin?

Answer 11

Protease inhibitor made in the liver

Question 12

What does alpha-1 antitrypsin do?

Answer 12

Limits damage caused by activated neutrophils releasing elastase in response to infection/cigarette smoke

->neutrophils engulf toxins from smoking

Question 13

How does smoking impact the foetus of pregnant women?

Answer 13

May affect foetal lung growth and priming of the immune system

Question 14

What are the main symptoms of COPD?

Answer 14

Cough
Breathlessness
Sputum
Frequent chest infections
Wheezing

Question 15

What are some other, less common, symptoms of COPD?

Answer 15

Weight loss
Fatigue
Swollen ankles

Question 16

List some examination findings of individuals with COPD.

Answer 16

Cyanosis (blue discolouration of hands/lips)
Raised JVP
Cachexia
Wheeze
Hyperinflated chest
Use of accessory muscles
Peripheral oedema
Pursed lip breathing

Question 17

What scale helps to quantify breathlessness?

Answer 17

mMRC scale

Question 18

What does a grade 0 on the mMRc scale mean?

Answer 18

Only breathless after strenuous exercise

Question 19

What does a grade 4 on the mMRC scale mean?

Answer 19

Breathless when dressing
Too breathless to leave the house

Question 20

What diagnostic test is required to confirm diagnosis of COPD?

Answer 20

Post-bronchodilator spirometry

Question 21

What post-bronchodilator spirometry value suggests COPD?

Answer 21

FEV1/FVC <0.7

Question 22

What should be carried out in any smoker complaining of respiratory symtoms?

Answer 22

Chest xray to screen for malignancies

Question 23

In Xrays, what is shwon in hyperinflation?

Answer 23

More than 6 anterior ribs showing or more than 10 anterior ribs showing

Question 24

Describe the breathlessness of COPD compared to asthma

Answer 24

COPD-continuous and progressive
Asthma- variable

Question 25

Describe common results of pulmonary function tests in individuals with emphysema.

Answer 25

Lung volumes: ↑ residual volume ↑ total lung capacity RV/TLC > 30%

Question 26

What type of radiography can be helpful in diagnosing COPD?

Answer 26

High resolution CT

Question 27

What part of the lungs is emphysema more common in?

Answer 27

Upper part as it is an inhalation injury to the lungs.

Question 28

What are some of the triggers of acute exacerbation?

Answer 28

Viral/bacterial infection (most common) Sedative drugs, pneumothorax, trauma

Question 29

What tests may be taken if in hospital w an acute exacerbation?

Answer 29

Chest xray Blood gases FBC U&E (kidney function) Sputum culture Viral throat swab

Question 30

What is the severe endpoint for those with COPD?

Answer 30

Respiratory failure

Question 31

Describe ventilation and perfusion in COPD.

Answer 31

Reduction in both ventilation and perfusion

Question 32

What can happen to individuals if they retain CO2?

Answer 32

Become drowsy, develop a flapping tremour

Question 33

What can severe ventilation problems lead to?

Answer 33

Reduced sensitivity of CO2 chemoreceptors in medulla therefore some COPD patients develop a “hypoxic drive"

Question 34

What is cor pulmonare?

Answer 34

Right sided heart failure due to lung disease

Question 35

How does cor pulmonare come about?

Answer 35

From smoking or hypoxia

Question 36

What can happen to haemoglobin levels in those with COPD?

Answer 36

Raised levels of haemoglobin. Body produces more erythropoietin in response to low O2

Question 37

Name some public health measures which can reduce the numbers of COPD.

Answer 37

1. Increasing age of buying tobacco products raised from 16 to 18 2. Picture warnings included on cigarette packaging 3. Ban on smoking in cars carrying children