Clinical Features of COPD Flashcards

1
Q

Define COPD

A

A chronic slowly progressive airflow obstruction that shows little change over months. Most impairment is fixed but some can be reversed with bronchodilators

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2
Q

How does COPD relate to Chronic Bronchitis & emphysema?

A

Most people with COPD have it as a result of chronic bronchitis & emphsema. Some also have Asthma.

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3
Q

What obstructs the airways in COPD?

A
  • Fibrosis thickens the airway walls
  • Mucuous & inflammatory exudate blocks the airway
  • Lymphoid follicles in severe disease
  • Loss of eleasticity due to broken alveolar attachments.
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4
Q

Why defines chronic bronchitis?

A

Coughing up sputum almost every day for 4 or more months of the year for 2 or more years

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5
Q

What are the common causes for COPD?

A
  • Smoking ~85%
  • Chronic Asthma
  • Maternal Smoking
  • Air pollution
  • Occupation
  • Genetics
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6
Q

What occupations can lead to COPD?

A

Mining/tunneling
Construciton
Work with plastics, leather, textiels

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7
Q

What genetic conditions can lead to COPD?

A

Enzyme deficiencies,

Specifically Alpha1-antitrypsin deficiency results in emphysema.

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8
Q

What does alpha1-antitrypsin normally do?

A

Neutralises the enzymes released by neutrophils so they dont damage the tissue or cause inflammation

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9
Q

What level of smokin is indicative of COPD?

A

> 20 pack years

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10
Q

How does FEV1 decline in a normal person and a smoker?

A

~30ml/yr

In a smoker more like 50-80ml/yr

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11
Q

How do we rule out asthma when diagnosisng a patient?

A

If the symptoms are constant then its not asthma

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12
Q

When would we consider lung cancer or bronchiecstasis over COPD?

A

If there is harmoptysis

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13
Q

What is smoker’s cough?

A

Coughing up clear or mucoi sputum, gradually becomes more regular over time.
(almost all resolve if they stop smoking)

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14
Q

What are the common symptoms of COPD?

A
Wheeze
Weight loss in severe disease
Peripheral Oedema (due to cor pulmonale via respiratory failure)
SOBOE
Cough
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15
Q

What illnesses do you look for in a history when diagnosing COPD?

A

Childhood Asthma
Respiratory Disease
Ischaemic heart failure

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16
Q

Why would you ask about the effect of previous breathing meds?

A

To see if theyre effects correlate with what youd expect form COPD. As opposed to asthma etc

17
Q

What signs might you see in the clinic?

A
Breathless with pursed lips and accessory muscle involvement.
Cyanosis
CO2 tremor
Hyperinflated chest
Larygeal descent
Slow expiration
Palapable Liver
18
Q

How do we treat a CO2 trmor?

A

With a B-agonist

19
Q

How far can the larynx descend?

A

As far as the manubrium

20
Q

What FEV1 & FEV1/FVC valuse are expected in COPD?

A
  • FEV1 < 80% of predicted

- FEV1/FVC < 70% of predicted

21
Q

What are the grades of airflow obstruction as measured by FEV1?

A

80% or above - Fine
50-79% - Moderate AFO
30-49% - Severe AFO
<30% - Very Severe AFO

22
Q

What is the point of pulmonary function tests?

A

To detect evidence of emphysema