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Medicine 1 - Respiratory > Clinical Features Of COPD > Flashcards

Clinical Features Of COPD Flashcards

1
Q

Describe COPD according to WHO definition.

A

COPD is a lung disease characterized by chronic obstruction lung airflow, interfering with normal breathing and is not fully reversible.

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2
Q

Define chronic bronchitis and emphysema in the context of COPD.

A

Chronic bronchitis is defined as having cough and sputum for at least three months, present in two consecutive years, whereas emphysema refers to the structural changes in the alveoli causing them to disintegrate.

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3
Q

How does COPD differ from a smoker’s cough?

A

COPD is not just a smoker’s cough, it is a disease process involving chronic obstruction of lung airflow and not fully reversible.

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4
Q

Do chronic bronchitis and emphysema fall under the umbrella term of COPD?

A

Yes, chronic bronchitis and emphysema are encompassed by the umbrella term COPD.

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5
Q

Describe the main cause of COPD.

A

The main cause of COPD is significant exposure to noxious particles or gases, with smoking being the primary contributor.

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6
Q

What is the difference between prevalence and incidence in the context of COPD?

A

Prevalence refers to the number of cases in a population at any specific point in time, while incidence is the new number of cases being diagnosed within a defined time period.

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7
Q

How does the prevalence of COPD vary with age?

A

COPD is more common the older a person gets, as shown by the graph from the British Lung Foundation.

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8
Q

Describe the relationship between the prevalence of COPD and socio-economic background.

A

The prevalence of COPD seems to be related to underlying socio-economic background, with the least deprived people having the least amount of COPD, as indicated by the graph.

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9
Q

What are the main symptoms of COPD according to the Global Initiative for Chronic Obstructive Lung Disease?

A

The main symptoms are breathlessness, cough, plus or minus sputum, and persistent respiratory symptoms as well as air flow limitations.

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10
Q

the main modifiable cause of COPD.

A

The main modifiable cause of COPD is smoking, which is globally the most common cause of the condition.

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11
Q

Define Alpha-1 antitrypsin deficiency and its impact on COPD.

A

Alpha-1 antitrypsin deficiency is a rare inherited condition that presents with early onset of COPD in people under 45 years of age. It is a protease inhibitor made in the liver, and its waning amounts due to the deficiency can lead to early onset loss of lung function, especially when combined with smoking.

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12
Q

How does childhood disadvantage factor into the risk of developing COPD?

A

Factors affecting lung growth during gestation and childhood have the potential to increase an individual’s risk of getting COPD. Childhood disadvantage factors seem to be as important as heavy smoking in predicting lung function in adult life.

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13
Q

Describe the impact of occupational exposure on COPD.

A

Occupational exposure to dust, fumes, and other workplace exposures are said to have a small effect on the development of COPD.

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14
Q

Do all smokers develop COPD?

A

No, not all smokers go on to develop COPD. Less than 50% of smokers develop COPD during their lifetime, and at least a quarter of those who smoked for 25 years had significant COPD.

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15
Q

What are the non-modifiable risk factors for COPD?

A

Non-modifiable risk factors for COPD include female sex, increase in age, pre-existing asthma, small lung size, chronic bronchitis, recurrent childhood infection, and genetic conditions like Alpha-1 antitrypsin deficiency.

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16
Q

Describe the impact of low socio-economic status on the risk of developing COPD.

A

Having low socio-economic status seems to be a risk factor for developing COPD, indicating that social deprivation may contribute to the prevalence of the condition.

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17
Q

How does air pollution relate to COPD?

A

Air pollution has geographical and temporal associations with COPD symptoms, indicating that it is one of the environmental factors that can impact the development of the condition.

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18
Q

Define the role of Hampden Park in illustrating the healthcare burden of COPD.

A

Hampden Park, which can hold about 50,000 people in Glasgow, is used to illustrate the number of GP consultations per year for COPD, emphasizing the significant healthcare burden the condition places on GP practices.

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19
Q

Describe the impact of smoking on lung function and COPD development.

A

Smoking accelerates the rate of lung function loss, making individuals more susceptible to COPD. Even though lung function cannot be fully regained after quitting smoking, the rate of loss reduces, potentially increasing healthy lifespan.

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20
Q

What are the main symptoms of COPD?

A

The main symptoms of COPD include cough, breathlessness, sputum production, frequent chest infections, wheezing, weight loss, fatigue, and swollen ankles.

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21
Q

Define barrel chest and its association with COPD.

A

Barrel chest is a chest wall deformity characterized by an increased anterior-posterior distance due to chronic breathlessness and hyperinflation of the chest from the loss of alveoli in emphysema, often seen in patients with COPD.

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22
Q

How does pursed lip breathing help individuals with COPD?

A

Pursed lip breathing is a technique used by individuals with COPD to splint their airways open, increasing end expiratory pressure and improving gas exchange.

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23
Q

Describe the signs of late-stage COPD.

A

Late-stage COPD may present with peripheral edema, raised jugular venous pressure, and cachexia, which refers to severe weight loss often associated with cancer but can also be seen in COPD patients.

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24
Q

What is the impact of smoking cessation on COPD development?

A

Quitting smoking can reduce the rate of lung function loss, potentially increasing healthy lifespan and making a difference between a normal lifespan and premature death, even if individuals quit at a later age.

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25
Q

Do individuals with COPD typically know they have the condition?

A

Most people with COPD do not realize they have the condition and it may be picked up incidentally during a visit to the GP for another reason, making awareness and early detection crucial.

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26
Q

Describe the impact of age and smoking history on COPD symptoms.

A

COPD symptoms tend to worsen over time, particularly breathlessness, and are often seen in individuals over 35 years old with a history of smoking, emphasizing the importance of early intervention and smoking cessation.

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27
Q

How does hypoxia manifest in individuals with COPD?

A

Hypoxia in individuals with COPD may manifest as cyanosis or bluish discoloration of the lips, tongue, and peripherally, indicating reduced oxygen in the blood.

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28
Q

What are the potential clinical features of COPD on physical examination?

A

On physical examination, patients with COPD may exhibit barrel chest, pursed lip breathing, cyanosis, wheezing upon chest auscultation, and signs of late-stage disease such as peripheral edema and raised jugular venous pressure.

29
Q

Describe the modified medical research council Dyspnoea scale.

A

It is a helpful way of quantifyinglessness, ranging from zero to four, and is used in clinical practice to put a number on breathlessness and relate it to exercise capacity.

30
Q

How is COPD investigated and diagnosed?

A

It involves a combination of symptoms, history, lung function tests, and spirometry, with a key aspect being the demonstration of airflow obstruction confirmed on lung function testing.

31
Q

Define obstructive spirometry defect in COPD.

A

It is characterized by reduced forced expiratory volume in one second (FEV1) less than 80% predicted, a slightly reduced forced vital capacity, and a ratio of FEV1 to FVC less than 0.7.

32
Q

Describe the difference between obstructive and restrictive defects in spirometry.

A

Obstructive defects in COPD show a ratio of FEV1 to FVC less than 0.7, while restrictive defects have a ratio of more than 0.7.

33
Q

What is the significance of spirometry in COPD diagnosis?

A

It helps to categorize the severity of the disease, but does not always correlate with how clinically unwell a person is.

34
Q

Do lung function tests in COPD always correlate with the severity of the disease?

A

No, a person with severe airflow obstruction on spirometry may be very fit and active, while someone with mild spirometric abnormality may have a lot of symptoms.

35
Q

Describe the features that can be noticed on a chest x-ray in COPD.

A

A chest x-ray may show hyperinflation, with more than six anterior ribs or more than 10 posterior ribs showing, flat diaphragms, and reduced lung markings at the top due to emphysema.

36
Q

How is the phrase ‘end-stage COPD’ used in clinical assessment?

A

It is a global assessment of the patient and does not specifically correlate with a particular FEV1 value, serving as a helpful physiological way of categorizing the severity of the disease.

37
Q

Describe the differences between asthma and COPD in terms of symptoms and patient demographics.

A

Asthma is associated with allergies, variable breathlessness, and wheezing, while COPD patients are older, have a more persistent cough, and less variability in symptoms.

38
Q

How can obesity affect the diagnosis of COPD?

A

Obesity can cause a restrictive lung disease or spirometry, which can mask COPD and artificially raise the FEV1/FVC ratio.

39
Q

Define the key questions that can help differentiate between COPD and other lung conditions during a patient history.

A

Key questions include asking about cough patterns, response to steroids, sputum production, breathlessness, allergies, childhood respiratory problems, smoking history, and occupational exposures.

40
Q

What are the differences in pulmonary function tests between COPD and other lung conditions?

A

In COPD, lung volume testing may show an increase in residual volume and total lung capacity, and a ratio of residual volume to total lung capacity of more than 30 percent is diagnostic of emphysema. Additionally, reduced gas transfer may be observed due to the loss of alveoli.

41
Q

Do patients with COPD tend to complain of waking up overnight with breathlessness or wheeze?

A

No, patients with COPD tend to have persistent breathlessness rather than variable symptoms and are less likely to complain of waking up overnight with breathlessness or wheeze.

42
Q

Describe the impact of occupational exposures on the differentiation between asthma and COPD.

A

Occupational exposures can worsen COPD, and keeping an eye out for occupational asthma is important in differentiating between the two conditions.

43
Q

Describe the appearance of centrilobular emphysema on a CT scan.

A

Centrilobular emphysema appears as little ground glass foci in the middle with a lack of lung tissue around it.

44
Q

What are some common symptoms of acute exacerbations of COPD?

A

Common symptoms include increased breathlessness, wheeziness, chest pain or tightness, increased coughing, and changes in the amount and color of sputum.

45
Q

Define the tripod position in the context of COPD exacerbation.

A

The tripod position is when individuals lean forwards and brace themselves on a table or on their knees, struggling for breath.

46
Q

How does emphysema typically present in the upper zones of the lungs in smokers?

A

Emphysema is more pronounced in the upper zones of the lungs in smokers due to inhalational injury, where most of the damage takes place.

47
Q

Describe the signs that would indicate a severe exacerbation of COPD.

A

Signs of severe exacerbation include increased respiratory rate, use of accessory muscles, cyanosis, confusion, rapid onset, inability to complete sentences, and changes on an X-ray.

48
Q

What are some factors that can trigger exacerbations of COPD?

A

Exacerbations can be triggered by factors such as infection (bacterial or viral), changes in air quality, air pollution, pneumothorax, blood clots, or changes in medication.

49
Q

Do patients with fairly mild symptoms of COPD exacerbation generally require investigations?

A

Patients with fairly mild symptoms of COPD exacerbation generally do not require investigations and can be treated at home.

50
Q

How can GPs and nurses in the community determine whether a COPD patient can be treated at home or needs to be admitted to the hospital?

A

GPs and nurses can assess the need for hospital admission based on factors such as the patient’s ability to cope at home, level of breathlessness, cyanosis, oxygen saturation, confusion, rapid onset, and ability to manage alone.

51
Q

Describe the common investigations done in a hospital for COPD patients.

A

Common investigations include chest-ray, arterial blood gases, full blood count, kidney function tests, sputum culture, and viral throat swab.

52
Q

Define severity assessment methods for COPD.

A

Severity assessment methods for COPD include spirometry, COPD Assessment Tool, MRC breathlessness scale, exacerbation rate, and presence of comorbidities.

53
Q

How does COPD lead to respiratory failure?

A

COPD leads to respiratory failure due to reduced ventilation and perfusion, increased physiological dead space, and destruction of alveoli, resulting in a matched reduction in both ventilation and perfusion.

54
Q

Describe the pathophysiology of type one and type two respiratory failure in COPD.

A

Type one respiratory failure in COPD is hypoxic only, while type two respiratory failure involves reduced oxygen and increased carbon dioxide levels due to ventilatory failure, occurring in severe COPD.

55
Q

Do all COPD patients develop ventilatory failure?

A

No, ventilatory failure occurs only in very severe COPD and not all COPD patients will develop it.

56
Q

Define hypercapnia and its key signs in COPD patients.

A

Hypercapnia is the retention of carbon dioxide, and its key signs in COPD patients include drowsiness, flapping tremor, and twitching when holding the wrists back for 15 seconds.

57
Q

Describe the impact of hypernia on the centralemo-receptors in the Medulla.

A

Hypercapnia can lead to decreased of the central chemo-receptors in the Medulla to the increase in carbon dioxide, resulting in reduced ventilation.

58
Q

Define Cor Pulmonale and its association with severe COPD.

A

Cor Pulmonale refers to right-sided heart failure due to lung disease, often caused by smoking and hypoxia in severe COPD.

59
Q

How does high flow oxygen affect patients with severe COPD?

A

High flow oxygen can worsen the condition of patients with severe COPD as it can reduce the rate and depth of breathing, exacerbating ventilatory failure.

60
Q

Describe the physiological compensatory response to chronic hypoxia in severe COPD.

A

Chronic hypoxia in severe COPD can lead to secondary Polycythaemia, where the body increases red blood cell production in response to low oxygen levels in the blood.

61
Q

Do patients with severe COPD rely on a hypoxic drive for breathing?

A

Yes, patients with severe COPD may rely on a hypoxic drive, where chemo-receptors in the carotid body and aortic arch detect a drop in oxygen levels to drive their breathing.

62
Q

What are the recommended oxygen saturation levels for COPD patients?

A

For COPD patients, it is recommended to aim for lower oxygen saturations between 88 and 92%, rather than higher saturations of 94 to 98% to avoid exacerbating their condition.

63
Q

Describe the clinical course of COPD.

A

The clinical course of COPD involves a gradual decline in lung function, punctuated by exacerbations, and a general downward trend in lung function.

64
Q

Define the criteria for diagnosing COPD using spirometry.

A

COPD is diagnosed using obstructive spirometry, which requires a ratio of FEV1 to FVC of less than 0.7.

65
Q

How does smoking impact the progression of COPD?

A

Smoking is the number one factor that patients can modify to slow the progression of COPD.

66
Q

Describe the burden of COPD on society.

A

COPD imposes a huge global burden on the cost of the disease to society, and it is one of the most expensive conditions treated by the NHS.

67
Q

Do patients with COPD have a cure for their condition?

A

No, COPD is an incurable, lifelong illness punctuated with variable exacerbations.

68
Q

What are the preventive measures for COPD?

A

Public health measures, especially smoking bans, have gone some way to reducing the development of COPD in the future.

69
Q

Describe the prevalence and expected trend of COPD in the developing world.

A

COPD has an increasing prevalence in the developing world, and its prevalence is expected to rise over the next 30 years.

Medicine 1 - Respiratory (23 decks)

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