Clinical features of COPD Flashcards
What 2 conditions is COPD comprised of?
Emphysema + Chronic bronchitis
What is chronic bronchitis?
Chronic neutrophilic inflammation in the bronchi/bronchioles, causing mucus hypersecretion and bronchospasms
What is emphysema?
Enlarged air spaces distal to terminal bronchioles, leading to destruction of alveolar walls
COPD is a chronic, slowly progressive disorder characterised by
Airflow obstruction
COPD does not change markedly over
several months
In COPD, most of the lung function impairment is…
Fixed, however some reversibility can be produced by bronchodilator (or other) therapy
What causes the obstruction of the airways and what worsens it?
Obstruction of the airways occurs due to small-airway narrowing and can be worsened by inflammation and mucus
What does this obstruction and inflammation lead to?
Breathlessness on exertion, coughing and wheezing
What FEV1 value would you expect from someone with COPD?
Less that 80% [of normal ?]
What would the FEV1/FVC ratio be expected for a COPD case?
Less than 0.7
Usually, can batients have COPD and asthma?
No, either one or the other
Is COPD reversible?
Not really, can have a small element of reversibility but mostly not
Usual age of COPD onset?
> 35 years
What else can majorly contribute to COPD?
Active or passive smoking
Pollution related
“COPD is favoured by…” (what I think this means is COPD is shown by)
Chronic dyspnea
Sputum production
Miniminal diurnal or day to day FEV1 variation
What is chronic dyspnea
shortness of breath that lasts more than one month
What is chronic bronchitis defined as CLINICALLY?
Sputum production on most days for 3 months of 2 consecutive years
When do chronic bronchitis symptoms improve?
When patient stops smoking
Are chronic bronchitis and emphysema indicative of COPD?
No
Is asthma a cause of COPD?
No - increases likelihood of developing COPD but is not a cause
Other than smoking, what are the common causes of COPD?
Maternal smoking
Air pollution
Occupational
How does maternal smoking cause COPD?
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
What is a rare cause of COPD?
Alpha-1-antitrypsin deficiency
What is the function of alpha-1-antitrypsin?
Neutralises enzymes released by neutrophils
In susceptible smokers with COPD, stopping smoking will not restore the lost FEV1 but it may
Revert the subsequent rate of loss to normal
What procedure could help to prevent severe or fatal COPD if individuals with reduced lung function could stop smoking?
Screening smokers lung function in early middle age
What is the progression of symptoms of COPD?
Symptoms are insidious and gradually worsen over years
In diagnosing COPD, what features should be confirmed about breathlessness experienced by the patient?
Gradual onset and little variation of breathlessness
In diagnosis COPD, what features of cough and sputum should be present?
Long history of ‘smokers cough
Clear or mucoid sputum
Cough persistant all day & all year
A patient with COPD will typically produce a wheeze on…
Exertion
What symptoms indicate severe COPD?
Weigh loss
Peripheral oedema
What else can a peripheral oedema indicate?
Cor pulmonale and respiratory failure
In smokers, what information is important to acquire when making a diagnosis?
Cigarettes smoked per day, pack years
What childhood condition increases the likelihood of developing COPD?
Asthma
What other past medical conditions make it likely to get COPD?
Respiratory diseases
Ischaemic heart disease
What should you look out for in the history when making a diagnosis?
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
What muscles might be being used that is a sign of COPD?
Accessory muscles
What symptom is a sign of CO2 retention and may also be a sign of COPD?
Flapping tremor
What are some other signs of COPD?
Breathlessness upon walking into clinic
Cyanosis
Effects of steroids on skin - bruising
What symptoms would a patient with moderate COPD have?
Cough - SOBOE moderate exertion - FEV1 50-79%
What test method would be used to demonstrate fixed airflow obstruction when investigating possible COPD?
Spirometry
What is the point in investigating full pulmonary function testing?
Looks for emphysema
If it is COPD, will bronchodilators and oral cortisteroids have a massive impact?
No, hence why we test it to see if its asthma or COPD
Does testing bronchodilators and steroids rule out not having any symptomatic benefit from these drugs in the long run?
No
What treatment when taken long term can improve COPD symptoms?
Long term bronchodilator Steroid inhalation
What might show up on a chest radiograph which could be useful in diagnosing COPD?
Hyperinflated lung fields Flattened diaphragms
Lucent lung fields
Bullae
What investigatory test would show patients who were chronically hypoxic?
Full blood count
Acute exacerbation of COPD are usually precipitated by…
Viral/bacterial infections
What else can cause acute exacerbation of COPD?
Sedative drugs
Pneumothorax
Trauma
Acute exacerbation of COPD will increase what symptoms?
Cough Sputum production Sputum purulence Short of breath Wheeze Oedema Confusion Drowsiness Unable to sleep
