Clinical features of COPD Flashcards
What are the defining features of COPD?
COPD (Chronic Obstructive Pulmonary Disease) is characterized by chronic airflow limitation, primarily due to emphysema and chronic bronchitis. Features include progressive dyspnea, chronic cough, sputum production, and reduced lung function that is not fully reversible.
What is the epidemiology of COPD?
COPD is a leading cause of morbidity and mortality worldwide, affecting millions of people. It primarily affects people over the age of 40, with higher prevalence in those who have a history of smoking or exposure to air pollution. It is more common in males, though the gap is narrowing.
What are the aetiological factors of COPD?
The most significant aetiological factor is smoking (active and passive), which is responsible for up to 85-90% of COPD cases. Other factors include environmental pollutants, genetic factors (e.g., alpha-1 antitrypsin deficiency), respiratory infections, and occupational exposures to dusts and chemicals.
What are the major pathological features of asthma, chronic bronchitis, and emphysema?
Asthma: Airway inflammation, bronchoconstriction, and hyperresponsiveness.
Chronic Bronchitis: Chronic inflammation of the bronchi with mucus hypersecretion and productive cough.
Emphysema: Destruction of alveolar walls and loss of elastic recoil, leading to air trapping and hyperinflation.
What are the complications of asthma, chronic bronchitis, and emphysema?
Asthma: Acute exacerbations, airway remodeling, hypoxemia, and hypoxic cor pulmonale in severe cases.
Chronic Bronchitis: Recurrent respiratory infections, hypoxemia, cor pulmonale, and respiratory failure.
Emphysema: Pulmonary hypertension, hypoxemia, cor pulmonale, and pneumothorax.
What are the main causes of wheezing illness?
Main causes include asthma, COPD, acute bronchitis, pneumonia, foreign body aspiration, and pulmonary edema. Wheezing is typically caused by airway obstruction or narrowing.
What are the symptoms, signs, and clinical patterns of COPD?
Symptoms: Chronic cough, sputum production, and progressive dyspnea.
Signs: Wheezing, prolonged expiration, decreased breath sounds, and cyanosis in advanced stages.
Clinical patterns: Symptoms worsen progressively over time, with exacerbations and recurrent infections.
What specific features should be included in the clinical history of COPD?
Key features include smoking history, occupational exposure, exposure to air pollutants, chronic cough, sputum production, family history of respiratory diseases, and history of frequent respiratory infections.
What investigations are used to diagnose COPD?
Spirometry: To confirm the diagnosis (FEV1/FVC ratio <0.7).
Chest X-ray: To rule out other causes of symptoms and check for signs of emphysema.
CT scan: To assess the extent of emphysema or other complications.
Arterial blood gases (ABG): To assess oxygenation and carbon dioxide retention.
How is the severity of acute and chronic COPD assessed?
Acute COPD exacerbations: Severity is assessed using ABG analysis (hypoxemia, hypercapnia), pulse oximetry, and clinical assessment (dyspnea, respiratory rate).
Chronic COPD: Severity is assessed using spirometry (FEV1), the modified Medical Research Council (mMRC) dyspnea scale, and COPD Assessment Test (CAT).
What are the similarities and differences between asthma and COPD?
Similarities: Both are obstructive lung diseases with symptoms of wheezing and dyspnea. Both involve airway inflammation and bronchoconstriction.
Differences:
Asthma is usually reversible, triggered by allergens or irritants, and often presents with episodic symptoms.
COPD is irreversible, primarily caused by smoking, and has a progressive course with chronic symptoms.
What is the natural history of COPD and how does it relate to realistic medicine?
COPD typically has a progressive decline in lung function, with exacerbations leading to further deterioration. Realistic medicine emphasizes individualized care, considering a patient’s age, comorbidities, and goals of treatment to balance symptom control, quality of life, and avoiding overtreatment in advanced stages.
