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Systems: Respiratory AB > Clinical Features of COPD > Flashcards

Clinical Features of COPD Flashcards

1
Q

What is COPD purely defined by?

A

Airflow obstruction

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2
Q

What is their not mention of when defining COPD?

A
  • Symptoms
  • Bronchitis or emphysema
  • Smoking
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3
Q

What causes airway obstruction?

A

Occurs due to small-airway narrowing

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4
Q

What can make airway obstruction worse?

A

Inflammation and mucus

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5
Q

What can worsened airway obstruction lead to?

A

Progressive breathlessness on exertion, along with coughing and wheezing

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6
Q

Who is treated for COPD?

A

Those who are symptomatic

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7
Q

What are the trends in prevalence of COPD?

A
  • Male predominance
  • Increasing prevalence
  • More prevalent in the less educated
  • More prevalent amongst lower income households
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8
Q

Where does COPD rank in the UKs mortality tables?

A

6th most common cause of death

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9
Q

How does COPD impact the NHS?

A
  • Increasing burden on NHS
  • Hospital admissions
  • Beds
  • GP visits
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10
Q

What must be paid for with each COPD patient?

A
  • Inpatient hospitalisation
  • Treatment
  • Scheduled GP and specialist care
  • Unscheduled GP and emergency department care
  • Laboratory tests
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11
Q

What aspects of patients lives does COPD impact?

A
  • Climbing stairs
  • Gardening
  • Housework
  • Dressing
  • Sleep disturbances
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12
Q

What is 85% of smoking attributable to?

A

Smoking

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13
Q

Apart from smoking, what other causes of COPD are there?

A
  • Chronic asthma
  • Passive smoking
  • Maternal smoking
  • Air pollution
  • Occupation
  • a1 antitrypsin deficiency
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14
Q

How does maternal smoking contribute to COPD?

A

Reduces FEV1 and increases respiratory illness

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15
Q

What occupations are thought to be associated with COPD?

A
  • Coal mining
  • Hard rock mining
  • Tunnel working
  • Concrete manufacturing
  • Construction
  • Farming
  • Foundry working
  • Plastics
  • Textiles
  • Rubber
  • Leather
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16
Q

What does a1 antitrypsin do?

A

Neutralises enzymes released by neutrophils

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17
Q

What is the normal genotype and troublesome genotypes regarding a1 antitrypsin?

A
  • Normal: PiMM

- Troublesome: PiZZ

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18
Q

What is important in tobacco related COPD?

A

Total tobacco consumption

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19
Q

What is 1 pack year equivalent to?

A

1 pack a day for a year

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20
Q

What does the BTS guidelines suggest is normal in smoking related COPD?

A

> 20 pack year smoking history

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21
Q

How does FEV1 differ with age?

A

It falls continuously and smoothly

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22
Q

What is the differential diagnosis for COPD?

A
  • Asthma
  • Lung cancer
  • Left ventricular failure
  • Fibrosing alveolitis
  • Bronchiectasis
  • TB
  • Recurrent pulmonary emboli
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23
Q

What is the typical COPD patient?

A

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

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24
Q

How should someone with COPDs symptoms present?

A

Insidious, gradually worsening over the years

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25
Q

What should be done before making the diagnosis of COPD.

A

Exclude other possible diagnosis

26
Q

What symptoms will COPD patients not have?

A

The features of variable airflow obstruction of asthma

27
Q

What symptoms might a COPD patient present with?

A
  • Breathlessness
  • Cough and sputum
  • Wheeze
  • Weight loss
  • Peripheral oedema
28
Q

When might a COPD patient be breathless?

A
  • It will have little variation and a gradual onset
  • Climbing hills, stairs with loads or while hurrying
  • Walking on the flat with contemporaries
  • Gardening
  • Housework
  • Dressing and washing
  • At rest
29
Q

How might the cough and sputum of a COPD patient present?

A
  • Long history of smokers cough
  • Clear or mucoid sputum
  • Early morning winter months
  • All day winter months
  • All day and all year
30
Q

If there is haemoptysis, what should be considered?

A
  • Lung cancer
  • TB
  • Bronchiectasis
31
Q

When do COPD patients typically present with wheeze?

A

Typically on exertion

32
Q

What does weight loss indicate?

A

Severe disease

33
Q

What does peripheral oedema suggest?

A
  • Cor pulmonale
  • Severe disease
  • Respiratory failure
34
Q

What might be found in the past medical history of someone with COPD?

A
  • Asthma as a child
  • Respiratory diseases
  • Ischaemic heart disease
35
Q

What must you ask about in relation to drugs when taking a history?

A
  • List of current inhalers and the doses

- Previous medications and effects on breathing

36
Q

What is important to ask about in personal and social history?

A
  • Occupation

- Smoking history

37
Q

What signs might be present in a COPD patient?

A
  • Breathlessness when entering clinic or undressing
  • Pursed lip breathing
  • Use of accessory muscles
  • Cyanosis
  • CO2 flap
  • Effects of steroids (tissue skin, bruising, Cushingoid)
38
Q

What might you find on examination of a COPD patient?

A
  • Barrel chest, decreased expansion
  • Laryngeal descent
  • Paradoxial movement of ribs and abdomen
  • Decreased cardiac dullness to percussion
  • Decreased breath sounds
  • Prolonged expiration with wheeze
  • Palpable liver
  • Cor pulmonale
39
Q

What investigations should be conducted before diagnosing COPD?

A
  • Spirometry
  • Full pulmonary function testing
  • Lung volumes
  • Carbon monoxide gas transfer
  • Reversibility to bronchodilators and oral corticosteroids
40
Q

What investigations are useful in diagnosing COPD?

A
  • Chest radiograph
  • Blood gases
  • Full blood count
  • ECG
  • Sputum
41
Q

In spirometry results what does a normal FEV1 indicate?

A

Effectively rules out COPD

42
Q

What spirometry results would indicate COPD?

A

FEV1 <80% predicted with FEV1/FVC ratio <70%

43
Q

What are you looking for when carrying out full pulmonary function testing?

A

Emphysema

44
Q

What does lung volumes involve in pulmonary function testing?

A
  • Gas trapping
  • Increased residual volume
  • Increased total lung capacity
  • RV/TLC >30%
45
Q

What does carbon monoxide gas transfer involve in pulmonary function testing?

A
  • Decreased gas transfer
  • Decreased TLCO
  • Decreased KCO (tissue destruction)
46
Q

What can de demonstrated by spirometry?

A

Fixed airflow obstruction

47
Q

How should a COPD patient respond to bronchodilators?

A

Minimal reversibility

48
Q

How should a COPD patient respond to oral corticosteroids?

A

Minimal response

49
Q

What is the method used when testing response to oral corticosteroids?

A
  • 30-40mg Prednisolone daily for 2 weeks (0.6mg/kg)
  • Measure baseline and final FEV1
  • Increasing trend not to do trials of steroids though
50
Q

What does significant bronchodilator/steroid response suggest?

A

Asthma or asthmatic component

51
Q

What does response to bronchodilator/steroids not suggest?

A

Does not predict symptomatic benefit from long term use

52
Q

What may be observed on a chest radiograph?

A
  • Hyperinflated lung fields
  • Flattened diaphragms
  • Lucent lung fields
  • Bullae
53
Q

What are chest radiographs useful in?

A
  • Bronchogenic carcinoma
  • Interstitial disease
  • Left ventricular failure
54
Q

What might abnormal blood gas results suggest?

A
  • Decreased PaO2 Type I respiratory failure

- Decreased PaO2 and increased PaCO2 Type II respiratory failure

55
Q

What might a full blood count show?

A

Secondary polycythaemia

56
Q

What might be identified on an ECG?

A
  • Right axis deviation
  • P pulmonale
  • T wave inversion V1-V4
57
Q

What might be found on a MC&S sputum test?

A
  • S pneumoniae
  • H influenzae
  • M catarrahalis
58
Q

What can precipitate an acute exacerbation of COPD?

A
  • Viral/bacterial infection
  • Sedative drugs
  • Pneumothorax
  • Trauma
59
Q

How might a patient present with an acute exacerbation of COPD?

A
  • Increased cough
  • Increased sputum
  • Increased sputum purulence
  • Increased shortness of breath
  • Increased wheeze
  • Unable to sleep
  • Increased oedema
  • Confusion
  • Drowsiness
  • Cyanosis
  • Flapping tremor
  • Pyrexial
  • Signs of COPD
60
Q

What investigations are useful in diagnosing an acute exacerbation of COPD?

A
  • Chest radiograph
  • Blood gases
  • FBC
  • U&E
  • Sputum culture
61
Q

How should acute exacerbations of COPD be managed?

A
  • Nebulised bronchodilator B2 and anti muscarinic
  • O2
  • Oral/iv corticosteroid
  • Antibiotics
  • Diuretic
  • IV aminophylline
  • Respiratory stimulant
  • NIV

Systems: Respiratory AB (39 decks)

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