Clinical Features of COPD Flashcards

1
Q

What is the definition of COPD?

A

Chronic, slowly progressive disorder characterised by airflow obstruction that does not change markedly over several months. Most of the the lung function impairment is fixed, although some reversibility can be produced by bronchodilator (or other) therapy.

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2
Q

What does the definition of COPD not mention?

A

NO mention of symptoms NO mention of bronchitis or emphysema NO mention of smoking

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3
Q

Why does obstruction of the airways occur?

A

Small-airway narrowing - and can be worsened by inflammation and mucus, leading to progressive breathlessness on exertion, along with coughing and wheezing.

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4
Q

What causes luminal occlusion?

A

Secretion of mucus and inflammatory exudate. Thickening of airway wall

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5
Q

What happens to the airway wall?

A

Thickens

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6
Q

ACOS?

A

Asthma, COPD, overlap syndrome

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7
Q

What happens to elasticity and alveolar attachments?

A

Loss of elasticity and disrupted alveolar attachments

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8
Q

What causes COPD (apart from smoking?)

A

Passive smoking Maternal smoking (Reduces FEV1 and increases respiratory illness) Air pollution Occupation (jobs exposing to dusts, vapours, fumes)

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9
Q

What are the two genotypes for alpha 1 antitrypsin deficiency? (75 variants)

A

Normal (86% UK) - PiMM Troublesome genotype (PiZZ)

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10
Q

What is the effect of alpha 1 antitrypsin ?

A

Neutralises enzymes released by neutrophils.

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11
Q

What percentage of smokers develop clinically significant COPD?

A

20%

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12
Q

What is a normal pack year?

A

Over 20

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13
Q

What is a pack year?

A

1 pack year = 1 pack a day for a year

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14
Q

What is the rate of decline of FEV1?

A

Non-smoker - 30 ml/yr SMOKER - 50 ml/yr

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15
Q

What is your typical COPD patient?

A

Patient 40+ years, smoker/ex-smoker, breathless on exertion, cough

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16
Q

What are the differential diagnosis for COPD?

A

COPD Asthma Lung cancer Left ventricular failure Fibrosing alveolitis Bronchiectasis Rarities: TB, recurrent pulmonary emboli

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17
Q

What separates COPD from asthma?

A

Asthma has variable airflow obstruction COPD, gradually worsens over the years

18
Q

What are the symptoms of COPD?

A

Breathlessness Cough and Sputum Wheeze Weight loss Peripheral oedema

19
Q

What is sputum like?

A

Clear or mucoid sputum

20
Q

What does haemoptysis suggest rather than COPD?

A

Lung cancer/TB/bronchiectasis

21
Q

What does weight loss indicate?

A

Severe disease, TNF alpha

22
Q

What does peipheral oedema

A

Cor pulmonale (right heart failure secondary to lung disease), severe disease, respiratory failure

23
Q

What is typical past medical history?

A

Asthma as a child, adolescence Respiratory diseases Ischaemic heart disease

24
Q

What are the signs of COPD?

A

Breathless walking in to clinic, undressing

Pursed lip breathing, accessory muscles

Cyanosis CO2 flap, Tremor (beta-agonists), Effects of steroids: tissue skin, bruising, Cushingoid

Hyperexpanded chest

Laryngeal descent

Paradoxical movement of ribs and abdomen

Decrease cardiac dullness to percussion

Decreases in breath sounds (no crackles) Prolonged expiration with wheeze

Palpable liver

Cor pulmonale: increased jugular venous pressure, hepatomegaly, ascites, oedema

25
Q

What is the interpretation of FEV1 of

A
26
Q

What is the purpose of full pulmonary function testing?

A

Loking for emphysema

27
Q

What is the effect of Gas trapping on lung volumes?

A

Increase in residual volume

Increase in total lung capacity

RV/TLC is greater than 30%

28
Q

What are the findings in carbon monoxide gas transfer?

A

Decreased gas transfer

(decreased TLCO which is the diffusing capacity for carbon monoxide)

Decreased KCO (KCO measures the integrity of the blood–gas barrier)

29
Q

What are the tests involved in the full pulmonary funciton testing?

A

Lung volumes

Carbon monoxide gas transfer

30
Q

What is the response to oral corticosteroids and bronchodilators?

A

Minimal

31
Q

What does significant bronchodilator/steroid response suggest?

A

asthma

32
Q

What will a chest radiograph indicate?

A

Hyperinflated lung fields

Flattened diaphragms

Lucent lung fields

Bullae

(Can rule out bronchogenic carcinoma, interstitial disease, left ventricular failure)

33
Q

What are the different type of blood gas measurements likely to be found?

A
34
Q

What can a full blood count be indicative of?

A

Secondary polycthaemia

35
Q

What does an ECG tell you?

A

Right axis deviation

P pulmonale (right atrial enlargement)

T wave inversion

36
Q

What does sputum analysis indicate?

A

MC and S (Mucous culture and sensitivites) - S pneumoniae, H influenzae, M catarrahlis

37
Q

What can be the cause of an acute exacerbation?

A

Usually precipitated by viral and bacterial infection

But consider sedative drugs, pneumothorax, trauma

38
Q

What are the symptoms of an acute exacerbations?

A

Increase cough, sputum, sputum purulence, shortness of breath, wheeze, unable to sleep, increase oedema, confusion, drowsiness, cyanosis, breathless, flapping tremor, pyrexial

39
Q

What is the management for Acute exacerbations?

A

Nebulised bronchodilator beta 2 and anti-muscarinic, O2, Oral/iv corticosteroid, antibiotic, diuretic, iv aminophyline, respiratory stimulant, NIV

40
Q
A