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Respiratory System > Clinical Features of COPD > Flashcards

Clinical Features of COPD Flashcards

1
Q

What is COPD?

A

Chronic slowly progressive disorder charcaterised by; fixed airflow obstruction that gets worse over time

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2
Q

Is COPD reversible?

A

for the most part, however to some degree by a bronchodilator or other therapy form

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3
Q

How does airway obstruction occur?

A

small-airway narrowing and can be worsened by inflammation and mucus

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4
Q

How does inflammation worsen airflow obstruction

A

Neutrophilic airway inflammation;

  • release of proteolytic enzymes
  • loss of alveolar lung,
  • therefore loss of elastin affecting the recoil action.
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5
Q

What symptoms are are associated with COPD?

A

Breathlessness on exertion
Coughing (and sputum)
Wheezing

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6
Q

How many people in the UK are diagnosed with COPD, and what %?

A

1.2 million

50%

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7
Q

How many people suffer with COPD globally?

A

more than 300 million

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8
Q

In what countries have the highest prevalence of COPD and why?

A

Developing countries due to biomass smoke

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9
Q

What 3 diseases are identified to make up COPD

A

Asthma
Emphysema
Chronic Bronchitis

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10
Q

Is COPD more prevalent in males or females?

A

males

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11
Q

How is COPD becoming an increasing burden on the NHS?

A
  • Increase in admissions
  • Make up the vast majority of primary care (86%)
  • Costs (£819pa/p)
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12
Q

What do may people affected with COPD experience?

A

Progressive inactivity
Social isolation
Despondency
More dependent

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13
Q

What are the causes of COPD?

A 
SMOKING
Maternal smoking 
Air pollution
Chronic Asthma
Occupation
Passive smoking
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14
Q

What percentage of COPD is considered due to smoking?

A

85%

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15
Q

Why is maternal smoking considered attributable to COPD?

A

Lungs don’t develop to full capacity

Reduces FEV1 and increases respiratory illness

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16
Q

Why is occupation considered attributable to COPD?

A

Due to jobs exposing to dusts, vapours and fumes

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17
Q

What is the function of A1-antitrypsin and where is it produced?

A
  • Neutralises enzymes released by neutrophils

- Produced in the liver

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18
Q

How many variants of a1-antitrypsin are there?

A

75 variants

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19
Q

What % of the UK have the normal PiMM genotype?

A

86%

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20
Q

What is the troublesome genotype referred to, and what does this cause?

A

PiZZ - 10-20% of MM protein

This means there’s nothing to neutralise enzymes which causes tissue destruction by neutrophils.

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21
Q

What activity can trigger such reaction of PiZZ?

A

inhalation of smoke

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22
Q

What proportion of the COPD population have the PiZZ genotype?

A

0.03%

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23
Q

50% of people with COPD have said to have how many years of PiZZ genotype?

A

<40 years

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24
Q

Non-smokers with COPD are said to suffer with Dyspnoea at what age?

A

51 years

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25
Q

Smokers with COPD are said to suffer with Dyspnoea at what age?

A

32 years

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26
Q

Non-smokers with COPD are said to die at what age?

A

67 years

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27
Q

Smokers with COPD are said to die at what age?

A

48 years

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28
Q

What is the single most important aetiological factor in COPD

A

Cigarette smoking

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29
Q

What does smoking do?

A

Cause tissue destruction

lung ages more rapidly

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30
Q

What is important to consider when looking at smoking as the cause of COPD?

A

Total tobacco consumption

31
Q

What is tobacco consumption measured in?

A

In pack years

32
Q

What is 1 pack year?

A

1 pack a day/year

33
Q

If someone smoked 5 packs of cigarettes a day for 20 years, how many pack years would that be?

A

100 pack year

34
Q

What is the rate of decline for FEV1 in a non smoker and smoker respectively?

A

30ml/yr

50ml/yr (some 80ml/yr)

35
Q

What % of smokers develop clinically significant COPD?

A

20%

36
Q

What % of significant COPD patients have subclinical airflow obstruction?

A

30%

37
Q

What % of COPD patients never develop develop significant airflow obstruction?

A

50%

38
Q

Can COPD develop in never smokers? If so, how (give examples)?

A

Yes, via chronic asthma and alpha 1 antitrypsin deficiency

39
Q

Upon making the diagosis, what would you expect the of the symptoms over time?

A

gradually worsening over the years

40
Q

At what age does breathlessness typically occur?

A

typically 40-50

gradual onset

41
Q

Is there much variation on breathlessness?

A

No

42
Q

What could exacerbate breathlessness (slight and extreme cases)?

A
  • Hills, stairs, gardening, housework
  • Dressing, washing
  • Eventually at rest
43
Q

What % resolution of coughing and mucus can occur if you stop smoking?

A

94%

44
Q

how many pack years is typical in a patient with COPD?

A

20 pack years

45
Q

What are the signs of severe COPD?

A

Cyanosis
CO2 flap
bruising, cushoigoid(effects of steroid)

46
Q

What type of essential investigation is required when diagnosing COPD?

A

Spirometry

47
Q

How would you interpret airflow obstruction?

A

FEV1<80% predicted with FEV1/FVC ratio<70%

48
Q

What value is considered a normal FEV1?

A

> 80% predicted

49
Q

If the FEV1 is normal, what disease can you eliminate?

A

COPD

50
Q

What FEV1 value ranges correlates to moderate airflow obstruction?

A

50-79%

51
Q

What symptoms are associated with moderate AFO?

A

Cough
SOB on exertion
Moderate exertion

52
Q

What FEV1 value ranges correlates to severe AFO?

A

30-49%

53
Q

What FEV1 value ranges correlates to very severe AFO?

A

<30%

54
Q

What symptoms are associated with severe AFO?

A

SOB on mild exertion

Cough/sputum

55
Q

What symptoms are associated with very severe AFO?

A

SOB on exertion
Wheeze
Cough
Cor pulmonale

56
Q

What % of lung function can still survive?

A

5%

57
Q

If you were doing a full pulmonary function test, what disease would you be looking for?

A

Emphysema

58
Q

What does Gas trapping result in?

A
  • INCREASE Residual volume
  • INCREASE Total lung capacity
  • RV/TLC > 30%
59
Q

How can fixed AFO demonstrated?

A

Spirometry

60
Q

What does a decrease in CO gas transfer result in?

A
  • DECREASE TLCO,

- DECREASE KCO (tissue destruction)

61
Q

To what extent do COPD patients respond to bronchodilator reversibility, and what 2 methods are used?

A

MINIMAL/insignificant

o Baseline, 15 minutes post neb 2.5-5mg salbutamol
o Baseline, 30 minutes post neb 2.5-5mg salbutamol + 500mg ipratropium

62
Q

To what extent do COPD patients respond to ORAL CORTICOSTEROIDS, and what method is the method used?

A

MINIMAL/INSIGNIFICANT

  • 30-40mg Prednisolone daily for 2 weeks (0.6mg/kg)
  • Measure baseline and final FEV1
63
Q

If there is a signif. bronchodilator and steroid response, what does this suggest?

A

Asthmatic (component)

64
Q

What would you look for when performing a chest radiograph?

A

Hyperinflated lung fields
Flattened diaphragms
Lucent lung fields
Bullae

65
Q

How would you know if a lung was hyperinflated?

A

> 10 posterior ribs on chest radiograph

66
Q

When checking blood gases, if there was a reduction in PaO2, what could this indicate?

A

Type 1 respiratory failure

67
Q

When checking blood gases, if there was a reduction in PaO2 and an increase in PaCO2, what could this indicate?

A

Type ll respiratory failure

68
Q

During a FBC, if the HCT level came back > 0.52, what could this indicate?

A

Secondary polycythaemia

69
Q

What is can cause an acute exacerbation of COPD?

A

Usually precipitated by viral/bacterial infection
but also;
- pneumothorax, sedative drugs and trauma

70
Q

How do: pneumothorax, sedative drugs and trauma trigger acute COPD?

A

Build up of mucus causing infection

71
Q

What are the symptoms of acute exacerbation of COPD? list some

A 
o	Increase cough, 
o	increase sputum/increase sputum purulence 
o	increase short of breath, 
o	increase wheeze
o	unable to sleep
o	increase oedema, confusion, drowsiness
72
Q

What does it mean by the term increase sputum purulence?

A

colour changes

73
Q

What are the management options of COPD?

A

nebulised bronchodilator b2 & anti-muscarinic, (to open up the airways) O2
oral/iv corticosteroid, antibiotic, diuretic
iv aminophylline, respiratory stimulant, NIV

Respiratory System (4 decks)

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