Clinical features of COPD

Question 1

What 2 conditions is COPD comprised of?

Answer 1

Emphysema + Chronic bronchitis

Question 2

What is chronic bronchitis?

Answer 2

Chronic neutrophilic inflammation in the bronchi/bronchioles, causing mucus hypersecretion and bronchospasms

Question 3

What is emphysema?

Answer 3

Enlarged air spaces distal to terminal bronchioles, leading to destruction of alveolar walls

Question 4

COPD is a chronic, slowly progressive disorder characterised by

Answer 4

Airflow obstruction

Question 5

COPD does not change markedly over

Answer 5

several months

Question 6

In COPD, most of the lung function impairment is…

Answer 6

Fixed, however some reversibility can be produced by bronchodilator (or other) therapy

Question 7

What causes the obstruction of the airways and what worsens it?

Answer 7

Obstruction of the airways occurs due to small-airway narrowing and can be worsened by inflammation and mucus

Question 8

What does this obstruction and inflammation lead to?

Answer 8

Breathlessness on exertion, coughing and wheezing

Question 9

What FEV1 value would you expect from someone with COPD?

Answer 9

Less that 80% [of normal ?]

Question 10

What would the FEV1/FVC ratio be expected for a COPD case?

Answer 10

Less than 0.7

Question 11

Usually, can batients have COPD and asthma?

Answer 11

No, either one or the other

Question 12

Is COPD reversible?

Answer 12

Not really, can have a small element of reversibility but mostly not

Question 13

Usual age of COPD onset?

Answer 13

> 35 years

Question 14

What else can majorly contribute to COPD?

Answer 14

Active or passive smoking

Pollution related

Question 15

“COPD is favoured by…” (what I think this means is COPD is shown by)

Answer 15

Chronic dyspnea

Sputum production

Miniminal diurnal or day to day FEV1 variation

Question 16

What is chronic dyspnea

Answer 16

shortness of breath that lasts more than one month

Question 17

What is chronic bronchitis defined as CLINICALLY?

Answer 17

Sputum production on most days for 3 months of 2 consecutive years

Question 18

When do chronic bronchitis symptoms improve?

Answer 18

When patient stops smoking

Question 19

Are chronic bronchitis and emphysema indicative of COPD?

Answer 19

No

Question 20

Is asthma a cause of COPD?

Answer 20

No - increases likelihood of developing COPD but is not a cause

Question 21

Other than smoking, what are the common causes of COPD?

Answer 21

Maternal smoking
Air pollution
Occupational

Question 22

How does maternal smoking cause COPD?

Answer 22

Causes the baby to be born with small lungs and reduced lung function (Reduces FEV1 and increases respiratory illness) from the start of life, therefore more likely to develop COPD

Question 23

What is a rare cause of COPD?

Answer 23

Alpha-1-antitrypsin deficiency

Question 24

What is the function of alpha-1-antitrypsin?

Answer 24

Neutralises enzymes released by neutrophils

Question 25

In susceptible smokers with COPD, stopping smoking will not restore the lost FEV1 but it may

Answer 25

Revert the subsequent rate of loss to normal

Question 26

What procedure could help to prevent severe or fatal COPD if individuals with reduced lung function could stop smoking?

Answer 26

Screening smokers lung function in early middle age

Question 27

What is the progression of symptoms of COPD?

Answer 27

Symptoms are insidious and gradually worsen over years

Question 28

In diagnosing COPD, what features should be confirmed about breathlessness experienced by the patient?

Answer 28

Gradual onset and little variation of breathlessness

Question 29

In diagnosis COPD, what features of cough and sputum should be present?

Answer 29

Long history of ‘smokers cough Clear or mucoid sputum Cough persistant all day & all year

Question 30

A patient with COPD will typically produce a wheeze on...

Answer 30

Exertion

Question 31

What symptoms indicate severe COPD?

Answer 31

Weigh loss | Peripheral oedema

Question 32

What else can a peripheral oedema indicate?

Answer 32

Cor pulmonale and respiratory failure

Question 33

In smokers, what information is important to acquire when making a diagnosis?

Answer 33

Cigarettes smoked per day, pack years

Question 34

What childhood condition increases the likelihood of developing COPD?

Answer 34

Asthma

Question 35

What other past medical conditions make it likely to get COPD?

Answer 35

Respiratory diseases | Ischaemic heart disease

Question 36

What should you look out for in the history when making a diagnosis?

Answer 36

Drugs - list of inhalers, doses Previous meds and effects on breathing - steriods Personal and social - occupation, smoking histor and age stared/stopped, cigs per day and pack years

Question 37

What muscles might be being used that is a sign of COPD?

Answer 37

Accessory muscles

Question 38

What symptom is a sign of CO2 retention and may also be a sign of COPD?

Answer 38

Flapping tremor

Question 39

What are some other signs of COPD?

Answer 39

Breathlessness upon walking into clinic Cyanosis Effects of steroids on skin - bruising

Question 40

What symptoms would a patient with moderate COPD have?

Answer 40

Cough - SOBOE moderate exertion - FEV1 50-79%

Question 41

What test method would be used to demonstrate fixed airflow obstruction when investigating possible COPD?

Answer 41

Spirometry

Question 42

What is the point in investigating full pulmonary function testing?

Answer 42

Looks for emphysema

Question 43

If it is COPD, will bronchodilators and oral cortisteroids have a massive impact?

Answer 43

No, hence why we test it to see if its asthma or COPD

Question 44

Does testing bronchodilators and steroids rule out not having any symptomatic benefit from these drugs in the long run?

Answer 44

No

Question 45

What treatment when taken long term can improve COPD symptoms?

Answer 45

Long term bronchodilator Steroid inhalation

Question 46

What might show up on a chest radiograph which could be useful in diagnosing COPD?

Answer 46

Hyperinflated lung fields Flattened diaphragms Lucent lung fields Bullae

Question 47

What investigatory test would show patients who were chronically hypoxic?

Answer 47

Full blood count

Question 48

Acute exacerbation of COPD are usually precipitated by...

Answer 48

Viral/bacterial infections

Question 49

What else can cause acute exacerbation of COPD?

Answer 49

Sedative drugs Pneumothorax Trauma

Question 50

Acute exacerbation of COPD will increase what symptoms?

Answer 50

``` Cough Sputum production Sputum purulence Short of breath Wheeze Oedema Confusion Drowsiness Unable to sleep ```