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Respiratory system > clinical features of copd > Flashcards

clinical features of copd Flashcards

1
Q

what is COPD?

A

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

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2
Q

what are the characteristics of COPD in aiways?

A
  • goblet cell hyperplasia leading to luminal occlusion by mucous
  • thickening of airway wall
  • fibrosis
  • loss of elasticity and disrupted alveolar attachments
  • luminal occlusion by secretions of mucous and inflammatory exudate
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3
Q

what sort of inflammation occurs in COPD?

A

neutrophilic airway inflammation

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4
Q

how many sufferes of COPD in uk?

A

1.2 million diagnosed but this is only estimated to be half of real number

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5
Q

how many deaths are there from COPD per year?

A

30000

6th most common cause in UK

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6
Q

what is the percentage of COPD cases attributable to smoking?

A

85%

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7
Q

what are some other causes of COPD that aren’t smoking?

A
  • passive smoking
  • maternal smoking
  • air pollution
  • occupation
  • alpha1-antitrypsin deficiency
  • chronic asthma
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8
Q

which jobs can causes COPD?

A

those where people are esposed to dust vapours and fumes. eg. coal mining, hard rock mining, farming, working with plastics, textiles, rubber and leather.

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9
Q

what percentage of smokers develop COPD?

A

20%

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10
Q

what percentage of smoker develop significant but subclinical airflow obstruction?

A

30%

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11
Q

what percentage of smokers never develop significant airflow obstruction?

A

50%

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12
Q

what is a 1 pack year?

A

1 pack of cigarettes a day for a year

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13
Q

how many pack years is typical of a COPD patient?

A

> 20

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14
Q

what is a typical patient with COPD?

A

40+ years, smoker/ex-smoker, breathless on exertion, cough

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15
Q

which conditions must you consider when diagnosing a 40+ years patient who smokes or has done in the past, is breathless on exertion and has a cough?

A 
COPD
Asthma
Lung cancer
Left ventricular failure
Fibrosing alveolitis
Bronchiectasis
Rarities: TB, recurrent pulmonary emboli
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16
Q

what are the symptoms of COPD?

A

-breathlessness
-cough and sputum
-wheeze on exertion
-weight loss
peripheral oedema

symptoms will have persisted over a long time and will gradually be getting worse.

17
Q

describe the breathlessness that comes with COPD?

A

occurs on exertion at first with little variation and has a gradual onset. It worsens until the patient is breathless at rest

18
Q

describe the cough and sputum that comes with COPD?

A
  • long history of smokers cough
  • clear or mucoid sputum
  • moves from early morning in winter months to all day in winter to all day all year
19
Q

if there is haemoptysis, is it COPD?

A

no, it could be lung cancer, TB or bronchiectasis

20
Q

describe the wheeze associated with COPD?

A

a minor symptom (not as important as in asthma) it is typical on exertion

21
Q

describe the weight loss associated with COPD?

A

only occurs in severe cases

22
Q

what causes peripheral oedema in COPD?

A

Cor pulmonale, severe disease or respiratory failure

23
Q

what is the past medical history of someone with COPD?

A

childhood asthma
respiratory disease
ischaemic heart disease

24
Q

what in the personal and social history of a COPD patient?

A

occupation

smoking history, age started, stopped smoking, cigarettes/day, pack years

25
Q

what are the signs of COPD that are observable on the patient?

A
  • breathlessness walking into clinic/ undressing
  • pursed lips
  • using accessory muscles to breath
  • cyanosis
  • CO2 flap or tremor form beta agonists
  • effects of steroids: tissue skin, bruising, cishingoid
  • hyperexpanded chets with decreased expansion and <3 finger widths between manubrium and larynx
  • laryngeal descent
  • paradoxical movement of ribs & abdomen
  • decreases cardiac dullness to percussion
  • decreased breath sounds (no crackles)
  • prolonged expiration with wheeze
  • palpable liver
  • cor pulminale
26
Q

what symptoms come with cor pulminale?

A

increases jungular venous pressure, hepatomegaly (large liver), ascites ( accumulation of fluid in the abdomen), oedema

27
Q

when testing lung volumes what happens to residual volume and total lung capacity with COPD?

A

they increase, indication gas trapping

28
Q

when carrying out a carbon monoxide gas transfer test on a COPD patient what are the results?

A

gas transfer decreases

29
Q

how can you tell the difference between COPD and asthma with full pulmonary function testing?

A
  • in both gas trapping increases so lung volumes increase.

- however gas transfer is only compromised in COPD so results of carbon monoxide transfer will only be lower in COPD

30
Q

how can you demonstrate fixed airflow obstruction, indicating it is COPD and not asthma?

A
  • minimal bronchodilaor reversibilty

- minimal response to oral corticosteroids

31
Q

what is the method for bronchodilator reversibilty test and what are the results for COPD?

A

method:
baseline taken, then reading taken 15 mins post nebulised 2.5-5mg of salbutamol
or
Baseline, 30 minutes post neb 2.5-5mg salbutamol + 500micrograms ipratropium

results: change in FEV1<200ml, change in FEV1 <15% of baseline
(insignificant change)

32
Q

what is the method for the oral corticosteroid test and what are the results for COPD?

A

30-40mg prednisolone daily for 2 weeks (0.6mg/kg)
measure baseline and final FEV1

results: change in FEV1<200ml, change in FEV1 <15% of baseline
(insignificant change)

33
Q

what can a chest radiograph be useful to look for in COPD?

A
  • Hyperinflated lung fields (> 10 posterior ribs)
  • Flattened diaphragms
  • Lucent lung fields
  • Bullae
34
Q

what results on an ECG are associated with COPD?

A

Right axis deviation
P pulmonale
T wave inversion V1-V4

35
Q

what can cause AECOPD?

A

viral/bacterial infection
sedative drugs
pneumothorax
trauma

36
Q

what are the signs of AECOPD?

A

increase in :

  • cough
  • sputum
  • sputum purulence
  • shortness of breath
  • wheeze
  • oedema
  • unable to sleep
  • confusion
  • drowsiness
  • cyanosis
  • flapping tremor
  • pyrexia
37
Q

what tests should be carried out for AECOPD?

A

Chest radiograph, blood gases, FBC, U&E (urea and electrolytes), sputum culture

38
Q

what is the management of COPD?

A
  • nebulised bronchodilator Beta2 & anti-muscarinic
  • O2
  • oral/iv corticosteroid
  • antibiotic
  • diuretic (promotes the production of urine)
  • iv aminophylline
  • respiratory stimulant
  • NIV (non-invasive ventilation)

Respiratory system (38 decks)

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