Clinical features of COPD

Question 1

Define chronic obstructive lung disease

Answer 1

Chronic slowly progressive disorder characterised by fixed airflow obstruction that does not change markedly over several months. Most of the lung function impairment is fixed, although some reversibility can be produced by bronchodilators or other therapy

Question 2

What causes airway obstruction in COPD?

Answer 2

Narrowing of the small airways
Inflammation and mucus causing luminal occlusion
Loss of elasticity and disrupted alveolar attachments
Thickening of airway walls

Question 3

What is ACOS?

Answer 3

Asthma COPD overlap syndrome

Question 4

What is the 6th most common cause of death in the UK?

Answer 4

COPD

Question 5

What is the 6th most common cause of death in the world?

Answer 5

COPD

Question 6

Describe the impact of COPD on patient QOL

Answer 6

Climbing stair difficult
Gardening diffiult
Housework difficult
Dressing difficult
Disturbed sleep
Social isolation and dependency 
Anxiety and depression

Question 7

List some causes of COPD

Answer 7

Smoking (85% of cases)
Chronic asthma
Passive smoking
Maternal smoking
Occupation
Air pollution
a1-antitrypsin deficiency
Age

Question 8

What is the function of antitrypsin?

Answer 8

Neutralises enzymes including elastase released by neutrophils. If missing, these aren’t neutralised and elastase breaks down elastin around alveoli

Question 9

What % of COPD cases are linked to smoking?

Answer 9

85%

However only 20% smokers have COPD
30% have subclinical obstruction
50% have no obstruction

Question 10

What is the average rate of decline of FEV1 in non-smokers?

Answer 10

30ml/yr

Question 11

What is the average rate of decline of FEV1 in smokers?

Answer 11

50ml/yr

Question 12

What is the typical COPD patient?

Answer 12

> 40yo
Smoker/ex-smoker
Breathless on exertion
Cough

Question 13

What could be some differential diagnoses of COPD?

Answer 13

Asthma
Lung cancer
Left ventricular failure
Fibrosing alveolitis
Bronchiectasis
TB
Recurrent pulmonary emboli

Question 14

What are the symptoms of COPD?

Answer 14

Breathlessness
Cough and sputum
Wheeze, typically on exertion
Weight loss
Peripheral oedema
PMH of childhood asthma, IDH, resp disease

Question 15

What are the clinical signs of COPD?

Answer 15

Breathless, undressing, leaning forward
Pursed lip breathing, accessory muscles
Cyanosis
Flapping tremor
Effects of steroids
Hyperexpanded barrel chest
Decreased chest expansion
<3 fingers between manubrium and larynx
(Laryngel descent)
Decreased cardiac dullness to percussion
Decreased breath sounds
Prolonged expiration with wheeze
Palpable liver - hepatomegaly
Cor pulmonale
JVP 
Ascites
Oedema

Question 16

What are some investigations you could carry out in patients with suspected COPD?

Answer 16

Spirometry: FEV1 <80%, ratio <70%
Full pulmonary function test
Lung volumes
Carbon monoxide gas transfer
Irreversibility to bronchodilators/corticosteroids
CXR: hyperinflated lungs, flat diaphragm
Blood gases
Full blood count
ECG - P pulmonale, T wave inversion V1-4
Sputum analysis for MC&amp;S

Question 17

What increase in FEV1 suggest significant reversibility to bronchodilators?

Answer 17

FEV1 >200ml
FEV1 >15% baseline

If reaches this, not COPD, probably asthma

Question 18

What are 3 common infectious agents in RTIs?

Answer 18

Streptococci pneumoniae
Haemophilus influenzae
Mycobacterium catarrhalis

Question 19

What symptoms suggest an acute exacerbation of COPD?

Answer 19

Increased cough/sputum/purulence
Increased SOB and wheeze
Oedema
Confusion
Drowsiness
Inability to sleep
Cyanosis
Flapping tremor
Pyrexia

Question 20

How do you manage acute exacerbations of COPD?

Answer 20

Oral/IV corticosteroids
Antibiotics
Diuretics
IV aminophylline - bronchodilator
Non-invasive ventilation (NIV)