Clinical features of COPD

Question 1

WHO definition of COPD

Answer 1

a lung disease characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible (hence chronic)

Question 2

what does COPD stand for?

Answer 2

Chronic obstructive pulmonary disease

Question 3

how do you distinguish between asthma and COPD?

Answer 3

asthma is reversible where as COPD isn’t

Question 4

what is the biggest COPD risk factor in high and middle income countries?

Answer 4

tobacco smoke

Question 5

what is the biggest COPD risk factor in low- income countries

Answer 5

exposure to indoor air pollution such as the use of biomass fuels for cooking and heating

Question 6

what are some occupational exposures that can cause COPD?

Answer 6

exposure to dusts, vapours or fumes

Question 7

in the UK what is the biggest cause of COPD

Answer 7

smoking

Question 8

TRUE or FALSE. Any factor that affects lung growth during gestation and childhood has the potential for increasing an individual’s risk of developing COPD

Answer 8

TRUE

Question 9

FEV1 progression over time difference between people with NO COPD and those with COPD?

Answer 9

those without COPD have higher FEV1 results even into old age than those with COPD

Question 10

which gender are more likely to get COPD?

Answer 10

females

Question 11

what is one of the main causes to look out for in people that present with COPD at a young age

Answer 11

Alpha-1 antitrypsin deficiency.

Question 12

which 3 health conditions is COPD related with?

Answer 12

asthma
chronic bronchitis
emphysema

Question 13

what are the aetiologies of COPD

Answer 13

smoking and pollutants and host factors

Question 14

whats the pathobiology of COPD

Answer 14

impaired lung growth accelerated decline lung injury lung systemic inflammation

Question 15

what is Alpha-1 antitrypsin (AAT) and why is a lack of them a cause of COPD

Answer 15

It clears up proteases.

When you get an infection or inhale tobacco smoke etc neutrophils release proteases.
Normally antitrypsin would come and clear up these proteases however some people have a genetic disorder that means they don’t produce anti-trypsin or enough of it

Question 16

what’s the pathology of COPD?

Answer 16

small airway
disorders or abnormalities emphysema
systemic effects

Question 17

what is FEV1

Answer 17

Forced expiratory volume in one second

- It shows the amount of air a person can forcefully exhale in one second of the FVC test.

Question 18

Initial presentation of COPD (5)

Answer 18

it’s varied but there are some ‘typical’ symptoms

shortness of breath
recurrent chest infections
ongoing cough (not clearing up)
wheeze 
productive cough / sputum

Question 19

what are other less common symptoms associated with COPD? (4)

Answer 19

weight loss (calorie consumption)
fatigue
decreased exercise tolerance
ankle swelling (if it is causing heart failure)

Question 20

how do you diagnose COPD?

Answer 20

there is no single diagnostic test

you have to take a history and carry out spirometry test

Question 21

you can make a diagnosis of COPD if a person meets what criteria? (5)

Answer 21

over 35
has risk factors
shows typical symptoms
shows absence of clinical features of asthma
AND
has airflow obstruction confirmed by post-bronchodilator spirometry

Question 22

what is spirometry?

Answer 22

test used to help diagnose and monitor certain lung conditions/ lung function

Do this by measuring how much air you can breathe out in one forced breath ie one second (FEV1) and then carry on breathing out for the FVC which is forced vital capacity (total amount of air you can exhale after full inhalation)

ratio norm value 80%

Question 23

What happens to FEV1 and FVC in an obstructive disorder (hard to exhale)?

Answer 23

FEV1 is reduced
FVC is usually reduced but to a lesser extent than FEV1
ratio is reduced

Question 24

what is FVC?

Answer 24

the total amount of air that can be forcibly exhaled from the lungs after taking a full inhalation

Question 25

what is the predicted normal FVC and FEV1 value and ratio?

Answer 25

<80%

ratio <0.7

Question 26

What happens to FEV1 and FVC in an restrictive disorder (harder to expand lungs)?

Answer 26

FEV1 is reduced
FVC is reduced
but ratio is normal

Question 27

what is an x-ray used for in clinical setting for COPD

Answer 27

to exclude other pathology

it is not part of diagnostic

Question 28

what are signs of hyperinflation of the lungs on an x-ray?

Answer 28

bulla - large areas of dead space
small heart
more than 6 anterior ribs or 10 posterior showing - diapraghm moves down so can see ribs due to air in lungs

Question 29

what questions would you ask someone in clinical setting to work out if it was COPD or not?

Answer 29

Worse at night?
How much sputum? Variation?
Response to steroids? Triggers? (exercise)

Question 30

people with COPD have increased ____volume?

Answer 30

residual ie more air left over in lungs because can’t exhale much air

Question 31

difference in onset of COPD and asthma

Answer 31

onset of COPD is usually midlife/ older

onset of asthma is usually early childhood

Question 32

how do you manage COPD

Answer 32

Change in inhalers (technique, device, add bronchodilator, increase or add inhaled steroid) 
Oral steroids (Prednisolone tablets) Antibiotics

Question 33

what is cyanosis

Answer 33

a severe exacerbation involved with COPD that causes your skin to appear blue due to lack of O2

Question 34

what is cor pulmonale?

Answer 34

lung failure due to heart failure

Question 35

differences between chronic bronchitis and emphysema patients

Answer 35

chronic bronchitis - overweight and cyanotic, elevated haemoglobin, peripheral oedema, ronchi and wheezing

Emphysema- older and thin person, severe dyspnea (SOB), quiet chest, x-ray, hyperinflation with flattened diaphragms

Question 36

co-morbidities often found along side COPD

Answer 36

heart disease, cerebrovascular and peripheral vascular disease

Question 37

what are ronchi?

Answer 37

continuous low pitched, rattling lung sounds that often resemble snoring.

Question 38

TRUE OR FALSE

COPD is the second largest cause of emergency admissions in the UK

Answer 38

TRUE