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respiratory > Clinical Features of COPD > Flashcards

Clinical Features of COPD Flashcards

1
Q

What is the definition of COPD?

A

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

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2
Q

Why does obstruction of the airways occur?

A

Small-airway narrowing - worsened by inflammation and mucus

Leads to progressive breathlessness on exertion, coughing, wheezing

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3
Q

What causes luminal occlusion?

A

Secretion of mucus and inflammatory exudate

Thickening of airway wall

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4
Q

What happens to the airway wall?

A

Thickens

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5
Q

What is ACOS

A

Asthma, COPD, overlap syndrome

Symptoms of Asthma and COPD

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6
Q

What happens to elasticity and alveolar attachments?

A

Loss of elasticity and disrupted alveolar attachments

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7
Q

What causes COPD (apart from smoking?)

A

Passive smoking

Maternal smoking (Reduces FEV1 and increases respiratory illness)

Air pollution

Occupation (jobs exposing to dusts, vapours, fumes)

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8
Q

What are the examinations for COPD?

A

No diagnostic tests

May be normal in early stages

Reduced chest expansion

Prolonged expiration/Wheeze

Hyperinflated chest

Respiratory failure

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9
Q

What is the effect of alpha 1 antitrypsin ?

A

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

Deficiency leads to breakdown on self lung tissue

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10
Q

What percentage of smokers develop clinically significant COPD?

A

20%

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11
Q

What is a normal pack year?

A

Over 20

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12
Q

What is a pack year?

A

1 pack year = 1 pack a day for a year

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13
Q

What is the rate of decline of FEV1?

A

Non-smoker - 30 ml/yr

SMOKER - 50 ml/yr

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14
Q

What is your typical COPD patient?

A
  • Typical symptoms
  • >35 years
  • Smoking or occupational exposure
  • Absence of clinical features of asthma
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15
Q

What are the differential diagnosis for COPD?

A

COPD

Asthma

Lung cancer

Left ventricular failure

Fibrosing alveolitis

Bronchiectasis Rarities

TB

Recurrent pulmonary emboli

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16
Q

What separates COPD from asthma?

A

Asthma has variable airflow obstruction and reversible

COPD gradually worsens over time

17
Q

What are the symptoms of COPD?

A

Breathlessness

Cough with Sputum

Wheeze

Weight loss

Peripheral oedema

18
Q

What is sputum like?

A

Clear or mucoid sputum

19
Q

What does haemoptysis suggest rather than COPD?

A

Lung cancer/TB/bronchiectasis

20
Q

What does weight loss indicate?

A

Severe disease, TNF alpha

21
Q

What does peripheral oedema cause

A

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

22
Q

What is typical past medical history?

A

Asthma as child

Adolescence Respiratory diseases

Ischaemic heart disease

23
Q

What are the signs of COPD?

A
  • Cyanosis
  • Raised JVP
  • Cachexia
  • Wheeze
  • Pursed lip breathing
  • Hyperinflated chest (Barrel chest- pectus excavatum)
  • Use of accessory muscles
  • Peripheral oedema
24
Q

What is the interpretation of FEV1 of

A
25
Q

What is the purpose of full pulmonary function testing?

A

Loking for emphysema

26
Q

What is the effect of Gas trapping on lung volumes?

A

Increase in residual volume

Increase in total lung capacity

RV/TLC is greater than 30%

27
Q

What is the response to oral corticosteroids and bronchodilators?

A

Minimal

28
Q

What does significant bronchodilator/steroid response suggest?

A

asthma

29
Q

What will a chest radiograph indicate?

A

Hyperinflated lung fields

Flattened diaphragms

Lucent lung fields

Bullae

(Can rule out bronchogenic carcinoma, interstitial disease, left ventricular failure)

30
Q

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

A

Type 1: ↓ pO2

Type 2: ↓ pO2 and ↑ pCO2 (ventilatory failure)

31
Q

What can a full blood count be indicative of?

A

Secondary polycthaemia

Body produces ↑ erythropoietin in response to low O2

↑ Haemoglobin

↑ Haematocrit

↑ bloody viscosity

32
Q

What does an ECG tell you?

A

Right axis deviation

P pulmonale (right atrial enlargement)

T wave inversion

33
Q

What does sputum analysis indicate?

A

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

34
Q

What can be the cause of an acute exacerbation?

A

Usually by viral and bacterial infection

Consider sedative drugs, pneumothorax, trauma

35
Q

What are the symptoms of an acute exacerbations?

A

Confusion

cyanosis

severe breathless

flapping tremor

drowsy

pyrexial

wheeze

“tripod” position

36
Q

What is the management for Acute exacerbations?

A

Oxygen

Nebulised bronchodilator

B2 anti-muscurinic

Oral/iv corticosteroid +/-antibiotic

IV aminophylline

respiratory (30 decks)

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