Clinical features of COPD 3 Flashcards
is the incidence of COPD increasing or decreasing?
Decreasing
Do more males or females have COPD?
Males
What is prevalence?
Number of people living with a disease
What is incidence?
Number of new cases in a defined time period
Is there a link between wealth and COPD?
Yes, more poorer people have COPD
How do you differentiate between COPD and asthma?
Chronic respiratory symptoms + normal spirometry
Chronic respiratory symptoms preceding airflow limitations
Smoker with structural evidence of lung disease (emphysema, airway wall thickening and gas trapping) but no airflow limitations
History
What should you do if you are unsure whether it is COPD or asthma?
Pulmonary function tests
What do pulmonary function tests test?
Lung volumes
Transfer factor
What lung volume changes are present in COPD?
Increased residual volume
Increased total lung capacity
RV/TLC > 30%
What transfer factor changes are present in COPD?
Reduced gas transfer
Decreased CLco (diffusion capacity of the lungs for carbon monoxide)
Decreased Kco (transfer factor for carbon monoxide)
If you are still unsure if it is COPD or asthma after pulmonary function tests what could you do?
Radiology
What does radiology show when its COPD?
Honeycombing traction bronchiectasis
Lung cysts
Centrilobular emphysema
Signet ring sign
What are worsening symptoms during exacerbations?
Shortness of breath
Wheeze
Chest tightness
Cough sputum
Unable to smoke
Systemic upset (eating, drinking)
Temperature (if infective)
Fatigue
What symptoms do severe exacerbations include?
Breathless (RR>25/min)
Accessory muscles used at rest
Purse lip breathing
Cyanosis (sats <92% o/a)
Significant decreased in exercise tolerance
Signs of sepsis (if caused by infection)
Fluid rentention
Confusion
During severe exacerbations what is the breathing rate?
> 25 breaths/min
What does the management of acute exacerbations involve?
Change in inhalers
Oral steroids Antibiotics
What could a change in inhalers involve?
Technique device adding
Bronchodilator increase or add inhaled steroid
What may you have to do if the acute exacerbation is very severe?
Admit into hospital
What can acute exacerbations be triggered by?
Viral/bacterial infection (most common)
Seductive drugs
Pneumothorax trauma
What does the treatment of acute exacerbations include?
Oxygen nebulised bronchodilator (B2 and anti-muscarinic)
Oral/IV corticosteroid antibiotic
What are some severe respiratory diseases?
Respiratory failure
Cor pulmonale
Secondary polycythaemia
Chronic bronchitis
Emphysema
What are the 2 types of respiratory failure?
Type 1 (decreased PO2)
Type 2 (Increased PCO2)
What are the symptoms of cor pulmonale?
Tachycardiac
Oedematous
Congested liver
What is tachycardia?
Abnormally fast resting heart rate
What is oedematous?
Excessive accumulation of fluid in extracellular space
What are the ECG features of cor pulmonale?
Right axis deviation
P pulmonale
T wave inversion
What is cor pulmonale?
Abnormal enlargement of the right side of the heart due to a disease of the lungs or pulmonary blood vessels
What are the symptoms of secondary polycythaemia?
Increased haemoglobin and haemocrit
What is seen in chronic bronchitis?
Cough for 3 months
More overweight
Cyanotic
What is seen in emphysema?
Enlargement and destruction of air spaces
Older and thinner patient
