Clinical Features of COPD

Question 1

What is the definition of COPD

Answer 1

chronic, slowly progressive disorder characterised by airflow obstruction

Question 2

Majority of lung function impairment is fixed but how can some reversibility be obtained?

Answer 2

Bronchodilators

Question 3

What is the common death rate for COPD worldwide

Answer 3

5th most common death worldwide

Question 4

What is the aetiologies of COPD

Answer 4

smoking = 85%
Chronic asthma 
air pollution 
occupation 
age

Question 5

What is the morphology of COPD

Answer 5

Loss of elasticity by alveolar attachments
Thickening or airway walls due to fibrosis
Goblet cells now present produce mucous
Lymphoid follicles in severe diseases

Question 6

What causes of inflammation in COPD

Answer 6

neutrophilic

Question 7

How does alpha 1-antitrypsin work in the lungs

Answer 7

made in the liver neutralises neutrophil enzymes and regulates elastase

Question 8

What are the genetics of alpha 1-antitrypsindeficiency and what does it do

Answer 8

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

Question 9

What is a pack year measure by

How many pack years would you roughly need before you develop COPD

Answer 9

1 pack of cigarets a day for a year

20 pack years

Question 10

What does smoking do to your lungs

Answer 10

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

Question 11

What is the rate of FEV1 decline in smokers and no smokers

Answer 11

non smokers - 30ml/yr

smokers - 50ml/yr (some 80)

Question 12

What differential diagnosis can be made with the symptoms of COPD

Answer 12

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

Question 13

Symptoms of COPD

Answer 13

breathlessness

cough and sputum

Wheeze

weight loss - bad
peripheral

oedema - bad

Question 14

when the symptom of haemopytis what further diagnosis can be made

Answer 14

Lung cancer

TBbronchiectasis

Question 15

What information is needed in making the diagnosis

Answer 15

past medical history e.g. asthma as a child
drugs
personal and social - smoking

Question 16

what is the signs of COPD

Answer 16

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)

Question 17

What is the investigations

Answer 17

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

Question 18

Do the tests predict the response to the treatment

Answer 18

no

Question 19

What is acute exacsberation of COPD and the signs and symptoms present

Answer 19

worsening conditions

confusion

cyanosis

breathlessness

CO2 flapping tremor

pyrexial

Hypotension

Low oxygen saturation

Tachypnoea

Question 20

When is a wheeze most typical with COPD

Answer 20

on exertion

Question 21

In gas trapping what percentage of residual volume shows that COPD is present

Answer 21

when the residual volume is above 30%

Question 22

What is the interpretation if there is a insignificant bronchodilator/steroid response

Answer 22

Its COPD and not asthma

Question 23

What do you look our for in a chest x ray

Answer 23

Hyperinflated lung fields (> 10 posterior ribs)
Flattened diaphragms
Lucent lung fields
Bullae

Question 24

A full blood count can show secondary polycythaemia what is this

Answer 24

increased erythropoietin (EPO) production either in response to chronic hypoxia (low blood oxygen level) or from an erythropoietin secreting tumor

Question 25

What is the usual causes for COPD exasperation

Answer 25

viral/bacterial infection - common
sedative drugs
pneumothorax
trauma