Clinical Features of COPD Flashcards
What does COPD stand for?
Chronic Obstructive Pulmonary Disease
Is COPD reversible?
No.
COPD is an umbrella term for which two diseases?
Emphysema
Chronic bronchitis
What is chronic bronchitis?
Long-term inflammation of the airway
What is emphysema?
Damage to the alveoli in the lungs
What must you have had in order to be diagnosed with chronic bronchitis?
Cough and sputum for at least three months, present in two consecutive years,
What is the main cause of COPD?
Smoking
In developing countries, what can contribute to the development of COPD?
Biomass fuel cooking and heating
What are the non-modifiable factors which contribute to COPD?
Increase in age
Female
Lower socioeconomic status
Asthma / airway hyper-reactivity
Chronic bronchitis
Childhood infection
What is Alpha-1 Antitrypsin Deficiency?
Rare, inherited disease, presents with early onset COPD <45yrs
What is alpha-1 antitrypsin?
Protease inhibitor made in the liver
What does alpha-1 antitrypsin do?
Limits damage caused by activated neutrophils releasing elastase in response to infection/cigarette smoke
->neutrophils engulf toxins from smoking
How does smoking impact the foetus of pregnant women?
May affect foetal lung growth and priming of the immune system
What are the main symptoms of COPD?
Cough
Breathlessness
Sputum
Frequent chest infections
Wheezing
What are some other, less common, symptoms of COPD?
Weight loss
Fatigue
Swollen ankles
List some examination findings of individuals with COPD.
Cyanosis (blue discolouration of hands/lips)
Raised JVP
Cachexia
Wheeze
Hyperinflated chest
Use of accessory muscles
Peripheral oedema
Pursed lip breathing
What scale helps to quantify breathlessness?
mMRC scale
What does a grade 0 on the mMRc scale mean?
Only breathless after strenuous exercise
What does a grade 4 on the mMRC scale mean?
Breathless when dressing
Too breathless to leave the house
What diagnostic test is required to confirm diagnosis of COPD?
Post-bronchodilator spirometry
What post-bronchodilator spirometry value suggests COPD?
FEV1/FVC <0.7
What should be carried out in any smoker complaining of respiratory symtoms?
Chest xray to screen for malignancies
In Xrays, what is shwon in hyperinflation?
More than 6 anterior ribs showing or more than 10 anterior ribs showing
Describe the breathlessness of COPD compared to asthma
COPD-continuous and progressive
Asthma- variable
Describe common results of pulmonary function tests in individuals with emphysema.
Lung volumes:
↑ residual volume
↑ total lung capacity
RV/TLC > 30%
What type of radiography can be helpful in diagnosing COPD?
High resolution CT
What part of the lungs is emphysema more common in?
Upper part as it is an inhalation injury to the lungs.
What are some of the triggers of acute exacerbation?
Viral/bacterial infection (most common)
Sedative drugs, pneumothorax, trauma
What tests may be taken if in hospital w an acute exacerbation?
Chest xray
Blood gases
FBC
U&E (kidney function)
Sputum culture
Viral throat swab
What is the severe endpoint for those with COPD?
Respiratory failure
Describe ventilation and perfusion in COPD.
Reduction in both ventilation and perfusion
What can happen to individuals if they retain CO2?
Become drowsy, develop a flapping tremour
What can severe ventilation problems lead to?
Reduced sensitivity of CO2 chemoreceptors in medulla therefore some COPD patients develop a “hypoxic drive”
What is cor pulmonare?
Right sided heart failure due to lung disease
How does cor pulmonare come about?
From smoking or hypoxia
What can happen to haemoglobin levels in those with COPD?
Raised levels of haemoglobin.
Body produces more erythropoietin in response to low O2
Name some public health measures which can reduce the numbers of COPD.
- Increasing age of buying tobacco products raised from 16 to 18
- Picture warnings included on cigarette packaging
- Ban on smoking in cars carrying children
