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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
What is the 3rd Stage?
severe - FEV1 30-49% of predicted value
26
What is stage Stage 4?
very severe - FEV1 less than 30%
27
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%
28
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
29
Does COPD or asthma show a chronic productive cough?
COPD
30
What tests can you do to detect COPD?
Pulmonary Function test | Still not sure = Radiology
31
What are Acute Exacerbations Of COPD?
``` SOB Wheeze Chest tightness Cough Sputum - purulence/vol ```
32
What are severe Exacerbations?
Breathlessness Accessory muscle use at rest Purse lip breathing Cyanosis (blush discolouration of the skin due to failed oxygen supply)
33
How can you manage acute exacerbations?
Change in inhalers Oral steroids Antibiotics Self-management for select patients
34
What causes Acute Exacerbation in secondary care?
Viral/bacterial infection, Sedative drugs, pneumothorax, trauma
35
What does acute exacerbation in secondary care cause?
Confusion, cyanosis, breathlessness, flapping tremor, drowsy, pyrexial, wheeze
36
How can you test for acute exacerbation in secondary care?
CXR, blood gases, FBC, U&E, sputum culture, viral
37
How can you treat acute exacerbation?
Oxygen Nebulised bronchodilator Oral/IV corticosteroid +/- antibiotic (treating other coexisting conditions)
38
How can you define severe disease?
``` Respiratory failure (ABG) - Type 1 reduced pO2 - Type 2 also increased pCO2 Cor Pulmonale Secondary polycythaemia ```
39
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.
40
What is grade 1 of the dyspnoea scale?
Not troubled by breathlessness except during strenuous
41
Grade 2?
Short of breath when hurrying or walking up a slight hill
42
Grade 3?
Walks slower than contemporaries on the level because of
43
Grade 4?
Stops for breath after walking about 100m or after a few minutes at my own pace
44
Grade 5?
Too breathless to leave house
45
What are the end stages of COPD?
Terminal illness Unpredictable decline Breathlessness and anxiety Social aspects
46
What are the greatest causes of death in the UK due to lung diseases?
Lung cancer - 31% COPD - 26.1% Pneumonia - 25.3%
47
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
48
Burden of COPD in the world?
384 million COPD cases in 2010 (11.7%) with 3 million deaths annually
49
What is Key to a COPD diagnosis?
Demonstrating obstructive spirometry with a FEV1/FVC ratio of <0.7

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