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Respiration > Clinical Features of COPD > Flashcards

Clinical Features of COPD Flashcards

1
Q

What does COPD stand for?

A

Chronic obstructive pulmonary disease

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2
Q

What is COPD?

A

Chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible

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3
Q

COPD definition

A

Common, preventable and treatable disease characterised by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities

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4
Q

What three conditions can contribute to the causation of COPD

A

Chronic bronchitis, emphysema and asthma

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5
Q

What occupations are more likely to cause COPD?

A

Agriculture, Brick making, Mining, construction, dock, flour and grain, petroleum, pottery, quarries, rubber, plastics, stomemasonry, textiles, welding

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6
Q

What is the Aetiology of COPD

A

Smocking and pollutants

Host Factors

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7
Q

Patho-biology of COPD

A

Impaired lung growth
Accelerated decline
Lung injury
Lung & systemic inflammation

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8
Q

Pathology of COPD?

A

Small airway disorders
Emphysema
Systemic effects
Persistent airflow obstruction

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9
Q

What else can lead to COPD

A

Lower socioeconomic status
Airway hyperactivity
Chronic bronchitis
Childhood infection

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10
Q

Explain Alpha-1 Antitrypsin Deficiency

A

Rare, inherited disease with early onset COPD (45)

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11
Q

What is the role of Alpha-1 antitrypsin (AAT)?

A

Protease inhibitor made in the liver that limits damage caused by activated neutrophils releasing elastase in response to infection/cigarette smoke

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12
Q

What happens when Alpha-1 antitrypsin is low?

A

Alveolar damage and emphysema
basal predominance to emphysema
Liver fibrosis or cirrhosis

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13
Q

Smokers have…

A

More respiratory symptoms and lung abnormalities
Greater annual rate decline of FV1
Greater COPD mortality rate

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14
Q

What percentage of smokers develop COPD during their lifetime?

A

<50%.

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15
Q

What happens when you smoke during pregnancy?

A

Affect local foetus lung growth and priming of the immune system

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16
Q

What are the clinical features of COPD in general practice?

A 
Initial presentation of symptoms through to a diagnosis of COPD
Acute exacerbation (flare-up) pf COPD (diagnosed)
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17
Q

What are the initial presentations of COPD?

A 
Shortness of breath
Recurrent chest infections
Ongoing cough
Wheeze
Productive cough/sputum
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18
Q

Less common initial symptoms?

A

Weight loss
Fatigue
Decreased exercise tolerance
Ankle swelling

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19
Q

Clinical features, on examination?

A

Cyanosis, Raised JVP, Cachexia, hyper-inflated chest, pursed lip breathing, use of accessory muscles, wheeze, peripheral oedema
Acute exacerbations

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20
Q

What investigations can be done to Diagnose COPD

A

No single test - History and Spirometry

21
Q

What criteria must a person meet to diagnose COPD

A 
>35 years old
presence of risk factor
presence of typical symptoms 
absence of clinical features of asthma
airflow obstruction confirmed by post-bronchodilator spirometry
22
Q

What is Spirometry used to diagnose?

A

Airflow obstruction

FEV1/FVC <0.7

23
Q

What is the 1st stage of COPD?

A

Mild - FEV1 80% of predicted value or higher

24
Q

What is the 2nd stage?

A

moderate - FEV1 50-79%

25
Q

What is the 3rd Stage?

A

severe - FEV1 30-49% of predicted value

26
Q

What is stage Stage 4?

A

very severe - FEV1 less than 30%

27
Q

What is the difference between an obstructive disorder and a restrictive disorder?

A

In an obstructive disorder the FVC is usually reduced but to a lesser extent. In restrictive FVC is reduced <80%

28
Q

What is the prevalance of COPD in the UK?

A

1.2 million living with diagnosed COPD = 2% pop.
2nd most common lung disease after asthma
50% undiagnosed
115,000 every year

29
Q

Does COPD or asthma show a chronic productive cough?

A

COPD

30
Q

What tests can you do to detect COPD?

A

Pulmonary Function test

Still not sure = Radiology

31
Q

What are Acute Exacerbations Of COPD?

A 
SOB
Wheeze
Chest tightness
Cough 
Sputum - purulence/vol
32
Q

What are severe Exacerbations?

A

Breathlessness
Accessory muscle use at rest
Purse lip breathing
Cyanosis (blush discolouration of the skin due to failed oxygen supply)

33
Q

How can you manage acute exacerbations?

A

Change in inhalers
Oral steroids
Antibiotics
Self-management for select patients

34
Q

What causes Acute Exacerbation in secondary care?

A

Viral/bacterial infection, Sedative drugs, pneumothorax, trauma

35
Q

What does acute exacerbation in secondary care cause?

A

Confusion, cyanosis, breathlessness, flapping tremor, drowsy, pyrexial, wheeze

36
Q

How can you test for acute exacerbation in secondary care?

A

CXR, blood gases, FBC, U&E, sputum culture, viral

37
Q

How can you treat acute exacerbation?

A

Oxygen
Nebulised bronchodilator
Oral/IV corticosteroid +/- antibiotic (treating other coexisting conditions)

38
Q

How can you define severe disease?

A 
Respiratory failure (ABG)
- Type 1 reduced pO2
- Type 2 also increased pCO2
Cor Pulmonale
Secondary polycythaemia
39
Q

What is the MRC Dyspnoea scale?

A

The dyspnoea scale has been in use for many years for grading the effect of breathlessness on daily activities.

40
Q

What is grade 1 of the dyspnoea scale?

A

Not troubled by breathlessness except during strenuous

41
Q

Grade 2?

A

Short of breath when hurrying or walking up a slight hill

42
Q

Grade 3?

A

Walks slower than contemporaries on the level because of

43
Q

Grade 4?

A

Stops for breath after walking about 100m or after a few minutes at my own pace

44
Q

Grade 5?

A

Too breathless to leave house

45
Q

What are the end stages of COPD?

A

Terminal illness
Unpredictable decline
Breathlessness and anxiety
Social aspects

46
Q

What are the greatest causes of death in the UK due to lung diseases?

A

Lung cancer - 31%
COPD - 26.1%
Pneumonia - 25.3%

47
Q

What is the Cost/burden of COPD int he UK?

A

1/8 hospital emissions are because of COPD

NHS grampian spends £10 million on prescribed inhalers each year

48
Q

Burden of COPD in the world?

A

384 million COPD cases in 2010 (11.7%) with 3 million deaths annually

49
Q

What is Key to a COPD diagnosis?

A

Demonstrating obstructive spirometry with a FEV1/FVC ratio of <0.7

Respiration (6 decks)

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