Clinical Features of COPD

Question 1

COPD

Answer 1

Chronic, slowly progressive disorder characterised by airflow obstruction that does not change markedly over several months. Lung function impairment mostly fixed but some reversibility can be produced by a bronchodilator or some other therapy

Question 2

Obstruction of the airways

Answer 2

Occurs due to small-airway narrowing and can be worsened by inflammation and mucus

Question 3

Emphysema

Answer 3

Alveolar damage

Question 4

Chronic bronchitis

Answer 4

Recurrent cough for 2/3 years

Question 5

Causes of COPD (excluding smoking)

Answer 5

Chronic asthma (from when asthma treatment was unavailable - variable airflow obstruction has become fixed)
Passive smoking
Maternal smoking
Air pollution
Occupation
Alpha 1-antitrypsin deficiency - neutralises enzymes released by neutrophils, however, not enough antitrypsin so neutrophils cause tissue destruction

Question 6

Symptoms

Answer 6

Breathlessness - worse over time
gradual onset, little variation
Cough and sputum - in morning/winter
Wheeze (typically on exertion)
Weight loss
Peripheral oedema
Pursed lip breathing
Hyperexpanded (barrel) chest

Question 7

Haemoptysis

Answer 7

Blood in sputum - not a symptom of COPD - lung cancer/TB etc

Question 8

FEV1

Answer 8

> 80% - “at risk”
50-79% - moderate
30-49% - severe
<30% - very severe

Question 9

Blood gases

Answer 9

Decreased PaO2 - type 1 respiratory failure

Decreased PaO2, increased PaCO2 - type 2 respiratory failure