Clinical Features of COPD

Question 1

What is the definition of COPD?

Answer 1

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

Slowly progressive disorder

Airflow obstruction doesn’t change much over several months

Question 2

Why does obstruction of the airways occur?

Answer 2

Small-airway narrowing - worsened by inflammation and mucus

Leads to progressive breathlessness on exertion, coughing, wheezing

Question 3

What causes luminal occlusion?

Answer 3

Secretion of mucus and inflammatory exudate

Thickening of airway wall

Question 4

What happens to the airway wall?

Answer 4

Thickens

Question 5

What is ACOS

Answer 5

Asthma, COPD, overlap syndrome

Symptoms of Asthma and COPD

Question 6

What happens to elasticity and alveolar attachments?

Answer 6

Loss of elasticity and disrupted alveolar attachments

Question 7

What causes COPD (apart from smoking?)

Answer 7

Passive smoking

Maternal smoking (Reduces FEV1 and increases respiratory illness)

Air pollution

Occupation (jobs exposing to dusts, vapours, fumes)

Question 8

What are the examinations for COPD?

Answer 8

No diagnostic tests

May be normal in early stages

Reduced chest expansion

Prolonged expiration/Wheeze

Hyperinflated chest

Respiratory failure

Question 9

What is the effect of alpha 1 antitrypsin ?

Answer 9

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

Deficiency leads to breakdown on self lung tissue

Question 10

What percentage of smokers develop clinically significant COPD?

Answer 10

20%

Question 11

What is a normal pack year?

Answer 11

Over 20

Question 12

What is a pack year?

Answer 12

1 pack year = 1 pack a day for a year

Question 13

What is the rate of decline of FEV1?

Answer 13

Non-smoker - 30 ml/yr

SMOKER - 50 ml/yr

Question 14

What is your typical COPD patient?

Answer 14

• Typical symptoms
• >35 years
• Smoking or occupational exposure
• Absence of clinical features of asthma

Question 15

What are the differential diagnosis for COPD?

Answer 15

COPD

Asthma

Lung cancer

Left ventricular failure

Fibrosing alveolitis

Bronchiectasis Rarities

TB

Recurrent pulmonary emboli

Question 16

What separates COPD from asthma?

Answer 16

Asthma has variable airflow obstruction and reversible

COPD gradually worsens over time

Question 17

What are the symptoms of COPD?

Answer 17

Breathlessness

Cough with Sputum

Wheeze

Weight loss

Peripheral oedema

Question 18

What is sputum like?

Answer 18

Clear or mucoid sputum

Question 19

What does haemoptysis suggest rather than COPD?

Answer 19

Lung cancer/TB/bronchiectasis

Question 20

What does weight loss indicate?

Answer 20

Severe disease, TNF alpha

Question 21

What does peripheral oedema cause

Answer 21

Cor pulmonale (right heart failure secondary to lung disease), severe disease, respiratory failure

Question 22

What is typical past medical history?

Answer 22

Asthma as child

Adolescence Respiratory diseases

Ischaemic heart disease

Question 23

What are the signs of COPD?

Answer 23

• Cyanosis
• Raised JVP
• Cachexia
• Wheeze
• Pursed lip breathing
• Hyperinflated chest (Barrel chest- pectus excavatum)
• Use of accessory muscles
• Peripheral oedema

Question 24

What is the interpretation of FEV1 of

Answer 24

Question 25

What is the purpose of full pulmonary function testing?

Answer 25

Loking for emphysema

Question 26

What is the effect of Gas trapping on lung volumes?

Answer 26

Increase in residual volume Increase in total lung capacity RV/TLC is greater than 30%

Question 27

What is the response to oral corticosteroids and bronchodilators?

Answer 27

Minimal

Question 28

What does significant bronchodilator/steroid response suggest?

Answer 28

asthma

Question 29

What will a chest radiograph indicate?

Answer 29

Hyperinflated lung fields Flattened diaphragms Lucent lung fields Bullae (Can rule out bronchogenic carcinoma, interstitial disease, left ventricular failure)

Question 30

What are the different type of blood gas measurements likely to be found?

Answer 30

Type 1: ↓ pO₂ Type 2: ↓ pO₂ and ↑ pCO_{2 (ventilatory failure)}

Question 31

What can a full blood count be indicative of?

Answer 31

Secondary polycthaemia Body produces ↑ erythropoietin in response to low O₂ ↑ Haemoglobin ↑ Haematocrit ↑ bloody viscosity

Question 32

What does an ECG tell you?

Answer 32

Right axis deviation P pulmonale (right atrial enlargement) T wave inversion

Question 33

What does sputum analysis indicate?

Answer 33

MC and S (Mucous culture and sensitivites) - S pneumoniae, H influenzae, M catarrahlis

Question 34

What can be the cause of an acute exacerbation?

Answer 34

Usually by viral and bacterial infection Consider sedative drugs, pneumothorax, trauma

Question 35

What are the symptoms of an acute exacerbations?

Answer 35

Confusion cyanosis severe breathless flapping tremor drowsy pyrexial wheeze “tripod” position

Question 36

What is the management for Acute exacerbations?

Answer 36

Oxygen Nebulised bronchodilator B2 anti-muscurinic Oral/iv corticosteroid +/-antibiotic IV aminophylline