Clinical features of COPD 2

Question 1

After 25 years of smoking, how many smokers without initial disease will have significant COPD (stage 2 or worse) and how many will have any COPD?

Answer 1

25% will have stage 2 or worse COPD30

40% will have any form of COPD

Question 2

How can smoking cause COPD in people who do not smoke?

Answer 2

Environmental tobacco causes COPD (second hand smoke)

Question 3

What does smoking during pregnancy affect?

Answer 3

Foetal lung growth and priming of the immune system.

Question 4

What curve is this?

Answer 4

Fletcher-peto curve

Question 5

What level of FEV1 do clinical symptoms occur at?

Answer 5

About 50%

Question 6

What is important to know about the initial presentation of COPD?

Answer 6

Initial presentation is varied

Question 7

What are some typical symptoms of COPD?

Answer 7

Shortness of breath

Recurrent chest infections

Ongoing cough, not clearing up

Wheeze

Productive cough/sputum

Question 8

What are some less common symptoms of COPD?

Answer 8

Weight loss

Fatigue

Decreased exercise tolerance

Ankle swelling

Question 9

What are some clinical features of COPD on examination?

Answer 9

Cyanosis

Raised jugular venous pressure (JVP)

Cachexia

Hyperinflated chest

Pursed lip breathing

Use of accessory muscles

Wheeze

Peripheral oedema

Acute exacerbations

Question 10

What do the clinical features on examination depend on?

Answer 10

Severity

Question 11

What is cachexia?

Answer 11

Weakness and wasting of the body due to severe chronic illness

Question 12

What is peripheral oedema?

Answer 12

Fluid collecting in cavities or tissues in the body

Question 13

What can you say about a single diagnostic test for COPD?

Answer 13

No such thing exists

Question 14

What should the criteria of someone be to make a COPD diagnosis?

Answer 14

> 35 years old

Presence of risk factor

Presence of typical symptoms

Absence of clinical features of asthma

Airflow obstruction confirmed by post-bronchodilator spirometry

Question 15

When does spirometry suggest COPD?

Answer 15

FEV/FVC <0.7 post bronchodilator suggests lack of reversibility which is COPD

Question 16

What is stage 1 COPD?

Answer 16

Mild, FEV1 more than 80% of predicted value

Question 17

What is stage 2 COPD?

Answer 17

Moderate, FEV1 50-79% of predicted value

Question 18

What is stage 3 COPD?

Answer 18

Severe, FEV1 30-49% of predicted value

Question 19

What is stage 4 COPD?

Answer 19

Very severe, FEV1 less than 30% of predicted value

Question 20

What is end stage COPD?

Answer 20

Not part of the staging classification but is often used in practice

Question 21

What are the 2 kinds of spirometry patterns (diseased)

Answer 21

Obstructive and Restrictive

Question 22

When is spirometry pattern obstructive?

Answer 22

FEV1 reduced

FVC reduced to a lesser extent

FEV1/FVC ratio reduced (<0.7)

Question 23

When is a spirometry pattern restrictive?

Answer 23

FEV1 reduced

FVC reduced

FEV1/FVC ratio normal (>0.7)

Question 24

Which is obstructive and which is restrictive?

Answer 24

A is obstructive

B is restrictive

Question 25

Is a chest X-ray part of the COPD diagnosis

Answer 25

No, but may be used to exclude other pathology

Question 26

What is hyperinflation?

Answer 26

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

Question 27

How many people live with a COPD diagnosis?

Answer 27

1.2 million (2%)

Question 28

How common is COPD compared to other lung diseases?

Answer 28

2nd most common after asthma

Question 29

is the prevalence of COPD increasing or decreasing?

Answer 29

Increasing

Question 30

How many people are diagnosed with COPD each year?

Answer 30

115,000 (diagnosis every 5 minutes)