Clinical Features of COPD Flashcards
What is COPD? - give examples
Chronic Obstructive Pulmonary Disease characterised by chronic obstruction of lung airflow that interferes with normal breathing and is NOT FULLY REVERSIBLE.
E.g. Chronic bronchitis and emphysema
What are the causes of COPD
- Smoking!!!!
- Occupation
- Air pollution
- Female sex
- Increase in age
- 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
Alpha-1 antitrypsin (AAT) is a protease inhibitor made in the liver
- Limits damage caused by activated neutrophils releasing elastase in response to infection/cigarette smoke
When absent/low -> alveolar damage and emphysema
What are common clinical features of COPD?
- Cough
- Breathlessness
- Sputum
- Frequent chest infections
- Wheezing
What are less common symptoms of COPD?
- Weight loss
- Fatigue
- Swollen ankles
What must be considered when diagnosing COPD?
- AGE
- SMOKING HISTORY
- ONSET/PROGRESSION
What will be the examination findings of COPD
Cyanosis Pursed lip breathing
Raised JVP Hyperinflated chest
Cachexia Use of accessory muscles
Wheeze Peripheral oedema
Whats the criteria for COPD?
- Typical symptoms
- > 35 years
- Presence of risk factor (smoking or occupational exposure)
- Absence of clinical features of asthma
AND
Airflow obstruction confirmed by post-bronchodilator spirometry
Compare the clinical features of COPD vs asthma
COPD
- most likely smoker
- rare under 35
- common chronic productive cough
- breathlessness persistent and progressive
- Uncommon night time waking with breathlessness and/or wheeze
- Uncommon significant diurnal or day to day variability of symptoms
VS THE OPPOSITE FOR ASTHMA
What should be carried out if unsure to diagnose COPD?
Pulmonary function tests:
- Lung volumes: ↑ residual volume
↑ total lung capacity RV/TLC > 30% - Transfer factor: Reduced gas transfer
↓ DLco ↓ Kco - Radiology - HRCT
Acute exacerbation COPD - primary care
Worsening symptoms:
SOB Unable to smoke
Wheeze Systemic upset – eating, drinking, ADLs
Chest tightness Temperature (if infective)
Cough Fatigue
Sputum – purulence / volume
SEVERE exacerbation COPD
Breathless (RR>25/min) Significant decrease in exercise tolerance
Accessory muscle use at rest Signs of sepsis (if exacerbation caused by infection)
Purse lip breathing Fluid retention
Cyanosis (Sats <92% o/a) Confusion
Management of acute acute/exacerbation COPD
- Change in inhalers (technique, device, add bronchodilator, increase or add inhaled steroid)
- Oral steroids (Prednisolone tablets)
- Antibiotics
- Self management for select patients
What triggers acute exacerbation - secondary care
- Viral/bacterial infection (most common)
Sedative drugs, pneumothorax, trauma
Treatment for acute exacerbation - secondary care
- Oxygen
- Nebulised bronchodilator
- (b2 & anti-muscarinic)
- Oral/IV corticosteroid +/- antibiotic
(IV aminophylline, respiratory stimulant, NIV)
Measuring severity
- Spirometry
- Nature and magnitude of symptoms (slide 19)
- MRC breathlessness scale + COPD Assessment Tool
- History of moderate and severe exacerbations and future risk
- Number per year, hospitalisation?
- Presence of co-morbidity
- Heart Disease, Atrial Fibrillation, Obesity …
End stage COPD
- Terminal illness
- what does this mean for patients?
- unpredictable decline
- acute decline also possible
- Palliation of symptoms - breathlessness, anxiety in particular
- Social aspects - care? housebound? oxygen at home?
