Clinical Features of COPD Flashcards
What is the definition of COPD
chronic, slowly progressive disorder characterised by airflow obstruction
Majority of lung function impairment is fixed but how can some reversibility be obtained?
Bronchodilators
What is the common death rate for COPD worldwide
5th most common death worldwide
What is the aetiologies of COPD
smoking = 85% Chronic asthma air pollution occupation age
What is the morphology of COPD
Loss of elasticity by alveolar attachments
Thickening or airway walls due to fibrosis
Goblet cells now present produce mucous
Lymphoid follicles in severe diseases
What causes of inflammation in COPD
neutrophilic
How does alpha 1-antitrypsin work in the lungs
made in the liver neutralises neutrophil enzymes and regulates elastase
What are the genetics of alpha 1-antitrypsindeficiency and what does it do
Genotype abnormal Z-AT
and is a Recessive condition passed on by both parents
prevents the regulation of elastase decreasing elasticity of the alveoli and causing inflammation by neutrophilic recruitment = COPD
What is a pack year measure by
How many pack years would you roughly need before you develop COPD
1 pack of cigarets a day for a year
20 pack years
What does smoking do to your lungs
accelerates the loss of lung function by preventing the action of alpha 1-antitrypsint increasing elastase production
and causes inflamation in the lungs further triggering elastase production
Which destroy the alveoli walls
What is the rate of FEV1 decline in smokers and no smokers
non smokers - 30ml/yr
smokers - 50ml/yr (some 80)
What differential diagnosis can be made with the symptoms of COPD
Asthma Lung cancer Left ventricular failure Fibrosing alveolitis Bronchiectasis Rarities: TB, recurrent pulmonary emboli
Symptoms of COPD
breathlessness
cough and sputum
Wheeze
weight loss - bad
peripheral
oedema - bad
when the symptom of haemopytis what further diagnosis can be made
Lung cancer
TBbronchiectasis
What information is needed in making the diagnosis
past medical history e.g. asthma as a child
drugs
personal and social - smoking
what is the signs of COPD
Hyperinflation of the chest
(loss of recoil, push out and diaphragm be pushed down)
Reduced chest expansion
cardiac dulness on percussion
NO crackles
Prolonged expiration wheeze
Respiratory distress
(pursued lip breathing and using accessory muscles)
What is the investigations
spirometry
Peak expiratory flow rate
Past medical History
Lung volumes
Test reversibility:
Bronchodilator - salbutamol 15 minutes
steroid - predisalone 2 weeks
Chest X ray
Blood gasses
Full blood count
ECG
Sputum
Pulmonary function test:
CO gas transfer
Do the tests predict the response to the treatment
no
What is acute exacsberation of COPD and the signs and symptoms present
worsening conditions
confusion
cyanosis
breathlessness
CO2 flapping tremor
pyrexial
Hypotension
Low oxygen saturation
Tachypnoea
When is a wheeze most typical with COPD
on exertion
In gas trapping what percentage of residual volume shows that COPD is present
when the residual volume is above 30%
What is the interpretation if there is a insignificant bronchodilator/steroid response
Its COPD and not asthma
What do you look our for in a chest x ray
Hyperinflated lung fields (> 10 posterior ribs)
Flattened diaphragms
Lucent lung fields
Bullae
A full blood count can show secondary polycythaemia what is this
increased erythropoietin (EPO) production either in response to chronic hypoxia (low blood oxygen level) or from an erythropoietin secreting tumor
What is the usual causes for COPD exasperation
viral/bacterial infection - common
sedative drugs
pneumothorax
trauma
