Clinical features of COPD Flashcards
WHO definition of COPD
a lung disease characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible (hence chronic)
what does COPD stand for?
Chronic obstructive pulmonary disease
how do you distinguish between asthma and COPD?
asthma is reversible where as COPD isn’t
what is the biggest COPD risk factor in high and middle income countries?
tobacco smoke
what is the biggest COPD risk factor in low- income countries
exposure to indoor air pollution such as the use of biomass fuels for cooking and heating
what are some occupational exposures that can cause COPD?
exposure to dusts, vapours or fumes
in the UK what is the biggest cause of COPD
smoking
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
TRUE
FEV1 progression over time difference between people with NO COPD and those with COPD?
those without COPD have higher FEV1 results even into old age than those with COPD
which gender are more likely to get COPD?
females
what is one of the main causes to look out for in people that present with COPD at a young age
Alpha-1 antitrypsin deficiency.
which 3 health conditions is COPD related with?
asthma
chronic bronchitis
emphysema
what are the aetiologies of COPD
smoking and pollutants and host factors
whats the pathobiology of COPD
impaired lung growth accelerated decline lung injury lung systemic inflammation
what is Alpha-1 antitrypsin (AAT) and why is a lack of them a cause of COPD
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
what’s the pathology of COPD?
small airway
disorders or abnormalities emphysema
systemic effects
what is FEV1
Forced expiratory volume in one second
- It shows the amount of air a person can forcefully exhale in one second of the FVC test.
Initial presentation of COPD (5)
it’s varied but there are some ‘typical’ symptoms
shortness of breath recurrent chest infections ongoing cough (not clearing up) wheeze productive cough / sputum
what are other less common symptoms associated with COPD? (4)
weight loss (calorie consumption)
fatigue
decreased exercise tolerance
ankle swelling (if it is causing heart failure)
how do you diagnose COPD?
there is no single diagnostic test
you have to take a history and carry out spirometry test
you can make a diagnosis of COPD if a person meets what criteria? (5)
over 35
has risk factors
shows typical symptoms
shows absence of clinical features of asthma
AND
has airflow obstruction confirmed by post-bronchodilator spirometry
what is spirometry?
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%
What happens to FEV1 and FVC in an obstructive disorder (hard to exhale)?
FEV1 is reduced
FVC is usually reduced but to a lesser extent than FEV1
ratio is reduced
what is FVC?
the total amount of air that can be forcibly exhaled from the lungs after taking a full inhalation
what is the predicted normal FVC and FEV1 value and ratio?
<80%
ratio <0.7
What happens to FEV1 and FVC in an restrictive disorder (harder to expand lungs)?
FEV1 is reduced
FVC is reduced
but ratio is normal
what is an x-ray used for in clinical setting for COPD
to exclude other pathology
it is not part of diagnostic
what are signs of hyperinflation of the lungs on an x-ray?
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
what questions would you ask someone in clinical setting to work out if it was COPD or not?
Worse at night?
How much sputum? Variation?
Response to steroids? Triggers? (exercise)
people with COPD have increased ____volume?
residual ie more air left over in lungs because can’t exhale much air
difference in onset of COPD and asthma
onset of COPD is usually midlife/ older
onset of asthma is usually early childhood
how do you manage COPD
Change in inhalers (technique, device, add bronchodilator, increase or add inhaled steroid) Oral steroids (Prednisolone tablets) Antibiotics
what is cyanosis
a severe exacerbation involved with COPD that causes your skin to appear blue due to lack of O2
what is cor pulmonale?
lung failure due to heart failure
differences between chronic bronchitis and emphysema patients
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
co-morbidities often found along side COPD
heart disease, cerebrovascular and peripheral vascular disease
what are ronchi?
continuous low pitched, rattling lung sounds that often resemble snoring.
TRUE OR FALSE
COPD is the second largest cause of emergency admissions in the UK
TRUE
