Clinical Features of COPD Flashcards
What does COPD stand for?
Chronic obstructive pulmonary disease
What is COPD?
Chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible
COPD definition
Common, preventable and treatable disease characterised by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities
What three conditions can contribute to the causation of COPD
Chronic bronchitis, emphysema and asthma
What occupations are more likely to cause COPD?
Agriculture, Brick making, Mining, construction, dock, flour and grain, petroleum, pottery, quarries, rubber, plastics, stomemasonry, textiles, welding
What is the Aetiology of COPD
Smocking and pollutants
Host Factors
Patho-biology of COPD
Impaired lung growth
Accelerated decline
Lung injury
Lung & systemic inflammation
Pathology of COPD?
Small airway disorders
Emphysema
Systemic effects
Persistent airflow obstruction
What else can lead to COPD
Lower socioeconomic status
Airway hyperactivity
Chronic bronchitis
Childhood infection
Explain Alpha-1 Antitrypsin Deficiency
Rare, inherited disease with early onset COPD (45)
What is the role of Alpha-1 antitrypsin (AAT)?
Protease inhibitor made in the liver that limits damage caused by activated neutrophils releasing elastase in response to infection/cigarette smoke
What happens when Alpha-1 antitrypsin is low?
Alveolar damage and emphysema
basal predominance to emphysema
Liver fibrosis or cirrhosis
Smokers have…
More respiratory symptoms and lung abnormalities
Greater annual rate decline of FV1
Greater COPD mortality rate
What percentage of smokers develop COPD during their lifetime?
<50%.
What happens when you smoke during pregnancy?
Affect local foetus lung growth and priming of the immune system
What are the clinical features of COPD in general practice?
Initial presentation of symptoms through to a diagnosis of COPD Acute exacerbation (flare-up) pf COPD (diagnosed)
What are the initial presentations of COPD?
Shortness of breath Recurrent chest infections Ongoing cough Wheeze Productive cough/sputum
Less common initial symptoms?
Weight loss
Fatigue
Decreased exercise tolerance
Ankle swelling
Clinical features, on examination?
Cyanosis, Raised JVP, Cachexia, hyper-inflated chest, pursed lip breathing, use of accessory muscles, wheeze, peripheral oedema
Acute exacerbations
What investigations can be done to Diagnose COPD
No single test - History and Spirometry
What criteria must a person meet to diagnose COPD
>35 years old presence of risk factor presence of typical symptoms absence of clinical features of asthma airflow obstruction confirmed by post-bronchodilator spirometry
What is Spirometry used to diagnose?
Airflow obstruction
FEV1/FVC <0.7
What is the 1st stage of COPD?
Mild - FEV1 80% of predicted value or higher
What is the 2nd stage?
moderate - FEV1 50-79%
What is the 3rd Stage?
severe - FEV1 30-49% of predicted value
What is stage Stage 4?
very severe - FEV1 less than 30%
What is the difference between an obstructive disorder and a restrictive disorder?
In an obstructive disorder the FVC is usually reduced but to a lesser extent. In restrictive FVC is reduced <80%
What is the prevalance of COPD in the UK?
1.2 million living with diagnosed COPD = 2% pop.
2nd most common lung disease after asthma
50% undiagnosed
115,000 every year
Does COPD or asthma show a chronic productive cough?
COPD
What tests can you do to detect COPD?
Pulmonary Function test
Still not sure = Radiology
What are Acute Exacerbations Of COPD?
SOB Wheeze Chest tightness Cough Sputum - purulence/vol
What are severe Exacerbations?
Breathlessness
Accessory muscle use at rest
Purse lip breathing
Cyanosis (blush discolouration of the skin due to failed oxygen supply)
How can you manage acute exacerbations?
Change in inhalers
Oral steroids
Antibiotics
Self-management for select patients
What causes Acute Exacerbation in secondary care?
Viral/bacterial infection, Sedative drugs, pneumothorax, trauma
What does acute exacerbation in secondary care cause?
Confusion, cyanosis, breathlessness, flapping tremor, drowsy, pyrexial, wheeze
How can you test for acute exacerbation in secondary care?
CXR, blood gases, FBC, U&E, sputum culture, viral
How can you treat acute exacerbation?
Oxygen
Nebulised bronchodilator
Oral/IV corticosteroid +/- antibiotic (treating other coexisting conditions)
How can you define severe disease?
Respiratory failure (ABG) - Type 1 reduced pO2 - Type 2 also increased pCO2 Cor Pulmonale Secondary polycythaemia
What is the MRC Dyspnoea scale?
The dyspnoea scale has been in use for many years for grading the effect of breathlessness on daily activities.
What is grade 1 of the dyspnoea scale?
Not troubled by breathlessness except during strenuous
Grade 2?
Short of breath when hurrying or walking up a slight hill
Grade 3?
Walks slower than contemporaries on the level because of
Grade 4?
Stops for breath after walking about 100m or after a few minutes at my own pace
Grade 5?
Too breathless to leave house
What are the end stages of COPD?
Terminal illness
Unpredictable decline
Breathlessness and anxiety
Social aspects
What are the greatest causes of death in the UK due to lung diseases?
Lung cancer - 31%
COPD - 26.1%
Pneumonia - 25.3%
What is the Cost/burden of COPD int he UK?
1/8 hospital emissions are because of COPD
NHS grampian spends £10 million on prescribed inhalers each year
Burden of COPD in the world?
384 million COPD cases in 2010 (11.7%) with 3 million deaths annually
What is Key to a COPD diagnosis?
Demonstrating obstructive spirometry with a FEV1/FVC ratio of <0.7
