Clinical Features of COPD Flashcards
What is COPD?
Chronic obstructive pulmonary disease is a lung disease characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible.
What is chronic bronchitis?
having cough and sputum for three months present in two consecutive years.
Thickening and irritation of the bronchi and this causing mucus and hyperproduction.
Causes obstruction to air going in and out
What is emphysema?
structural changes in the alveoli causing them to disintegrate.
Leading to gas trapping
What are the modifiable causes of COPD?
smoking - main cause
biomass fuel cooking and heating- other countries
air pollution
exposure to dust for e.g.
What are the non modifiable risk factors of COPD?
female sex
increase in age
lower socioeconomic status
pre existing asthma
childhood infection
What is Alpha-1 Antitrypsin deficiency?
rare, inherited disease, presents with early onset COPD <45 years
AAT is a protease inhibitor made in the liver
-limits damage caused by activated neutrophils releasing elastase in response to infection/ cigarette smoke
Effects of alpha-1 antitrypsin deficiency?
causes very early onset loss of lung function
What things might trigger you to think about alpha-1- antittrypsin?
someone young with COPD features
basal predominance to emphysema
liver fibrosis or cirrhosis
What are the symptoms of COPD?
cough
breathlessness
sputum
frequent chest infections
wheezing
other symptoms:
weight loss
fatigue
swollen ankles
main clues if someone may have COPD?
age -over 35
smoking history
onset / progression
(breathlessness gets worse over time)
Examination of patient with COPD findings?
breathlessness
chest wall deformities
pursed lip breathing
cyanosis (reduced oxygen in blood)
wheeze
late stage disease:
peripheral oedema
raised JVP
cachexia (severe weight loss)
How is COPD diagnosed?
diagnose if :
typical symptoms
over 35
smoker or occupational exposure
absense of clinical features of asthma
airflow obstruction confirmed by post bronchodilator spirometry
What is a scale used to give severity of breathlessness a number?
mMRC Dyspnoea scale
0-4
0- only w strenous exercise
1- hurrying on level ground or slight hill
2- walk slower and stop for breath on level
3- stop for breath after walking 100 yards or after a few mins
4- too breathless to leave house and when dressing
How do obstructive and restrictive defects differ in spirometry?
Obstructive- reduced FEV1 (<80% predicted normal) FVC reduced but to a lesser extent (<80% predicted normal)
FEV1/FVC ratio reduced (<0.7)
Restrictive
FEV1 reduced
FVC reduced
FEV1/FVC ratio normal (>0.7)
What are the stages of severity of spirometry?
stage 1 - FEV1 80% of predicted value or higher
stage 2 -50-79%
stage 3 30-49%
stage 4 - FEV1 less than 30%
End stage COPD
Why is it important to a chest x ray in any smoker that complains of resp symptoms?
exclude alternate pathology and screen for malignancy
Questions to ask in history about COPD?
tell me about cough? -worse at night?
-sputum?
-variation?
response to steroids?
triggers? (exercise)
breathlessness -intermittent, resolves?
gradually worsening?
anyone in family have allergies, hayfever, eczema?
childhood chest problems
-asthmal
-recurrent bronchitis
-whooping cough
-pneumonia
- tb
Exposure history?
-smoking
-occupation
Clinical features differentiating COPD from asthma?
COPD?
smokes or smoked? majority
symptoms <35? rare
chronic productive cough? common
breathlessness? persistent and progressive
night time waking with breathless and / or wheeze? uncommon
significant diurnal or day to day variability of symptoms? uncommon
asthma?
possibly
often
uncommon
variable
common
common
If unsure , what are further tests and their possible findings and meanings?
lung volume tests
-increase in residual volume
-increase in total lung capacity
RV/TLC >30% - emphysema
transfer factor
reduced gas transfer
-indicates emphysema and therefore points more towards COPD
Name of emphysema depending on where it is in lungs?
Centrilobular emphysema- in lungs
paraseptal emphysema- goes around edges of the lungs
Describe an acute exacerbation of COPD?
feeling more breathless
more wheezy
sometimes pain or tightness in their chest
coughing more
change in sputum and volume
unable to smoke
systemic upset
temperature
fatigue
What are signs of a severe exacerbation?
breathlessness (RR>25/min)
accessory muscle use at rest
purse lip breathing
cyanosis (sats<92% o/a)
significant decrease in exercise tolerance
signs of sepsis (if exacerbation caused by infection)
fluid retention
confusion
What could be cause of acute exacerbation?
non infective or infective, airpollution , pneumothorax, blood clots (change in mediation)
Investigations for Acute COPD?
treated at home
