Clinical features of COPD

Question 1

What factors increase risk of COPD

Answer 1

Places of deprivation have higher rates

Smokers

Increasing age

Female sex

Question 2

What is alpha-1 antitrypsin deficiency

Answer 2

Rare inherited disease - presents with early COPD <45 yrs old

Alpha-1 antitrypsin is a protease inhibitor made in liver - limits damage caused by activated neutrophils releasing elastase in response to smoking or infection

Question 3

What are the symptoms of COPD

Answer 3

Cough
Breathlessness
Sputum
Frequent chest infections
Wheezing
Weight loss
Fatigue
Swollen ankles

Question 4

What examination findings can be found in COPD

Answer 4

Central cyanosis

Raised JVP

Cachexia - loss of skeletal muscle and fat

using accessory muscles when breathing

Wheeze

Peripheral oedema

Question 5

What criteria needs to be met to diagnose COPD

Answer 5

> 35 years
Smoking history or occupation w certain chemicals
Airflow obstruction confirmed by post- bronchodilator spirometry

Question 6

Describe the spirometry stages of COPD

Answer 6

Stage 1 - mild - FEV1 80% predicted value

Stage 2 - moderate - FEV1 50-79%

Stage 3 - severe - FEV1 30-49% of predicted value

Stage 4 - very severe - FEV1 less than 30% of predicted value

Question 7

What spirometry value shows obstruction

Answer 7

FEV1/FVC <0.7

Question 8

What are the characteristic features seen in a chest Xray in a COPD patient

Answer 8

Hyperinflation
Flat diaphragm
Small heart
Bulla
Vascular hila

Question 9

Describe hyperinflation seen on Xray

Answer 9

More than 6 anterior or 10 posterior ribs seen in the mid clavicular line at the lung diaphragm level

Question 10

What is the main differences between COPD and asthma presentation

Answer 10

COPD: usually always a smoker, older than 35 yrs usually, productive cough, persistent breathless and no diurnal or variability throughout the day

Asthma: possibility of being a smoker, usually under 35 yrs, variable breathlessness, variability during the day and wheeze

Question 11

Describe type 1 respiratory failure

Answer 11

Decrease pO2

Question 12

What 2 diseases make up COPD

Answer 12

Chronic bronchitis and emphysema

Question 13

Describe type 2 respiratory failure

Answer 13

Decrease in pO2 and an increase in pCO2

Question 14

What happens when the body is exposed to chronically increased CO2 over a great period of time

Answer 14

The central chemoreceptors in the medulla detect the CO2 but lose sensitivity over time, therefore developing a hypoxic drive to respiration driven by the peripheral chemoreceptors in the carotid body and aortic arch

Question 15

Describe the features of cor pulmonale

Answer 15

Tachycardia

Oedematous

Raised JVP

congested liver

Question 16

Describe the ECG features of cor pulmonale

Answer 16

Right axis deviatiom and T wave inversion V1-4

Question 17

Describe secondary polycythemia following COPD

Answer 17

Body produces increased erythropoietin in response to the low O2 - this increases haemoglobin and haematocrit as well as the blood viscosity

Question 18

Describe how COPD leads to cor pulmonale

Answer 18

Damage to the pulmonary vasculature due to low levels of O2 and smoking

Back pressure leading to pulmonary arterial hypertension and RH failure - the Right ventricle enlarges which reduces LV function and reduces circulating volume

This activates the RAAS system which leads to fluid retention

Question 19

Signs of chronic bronchitis severe

Answer 19

Overweight and cyanotic

Elevated haemoglobin

Peripheral oedema

Ronchi and wheezing

Question 20

Signs of emphysema severe

Answer 20

Older and thin

Severe dyspnoea

Quiet chest

Hyperinflation with flattened diaphragm on X ray