clinical features of COPD

Question 1

Describe the defining features of COPD

Answer 1

• Defining features- Breathlessness, cough +/- sputum

Question 2

aetiological factors of COPD

Answer 2

• smoking
• pollutants
• smoking in pregnancy in utero affects the foetal lung growth
• alpha 1 antitrypsin deficieny

Question 3

Alpha-1 Antitrypsin Deficiency

Answer 3

• Rare, inherited disease presents with early onset COPD <45 years
• Alpha-1 antitrypsin (AAT) is a protease inhibitor made in the liver
  o Limits damage caused by activated neutrophils releasing elastase in response to infection/cigarette smoke (by releasing anti-elastase)
• When absent/low -> alveolar damage and emphysema

Question 4

• _Describe the symptoms, of COPD.

Answer 4

Common:

• Multitude of presentations which are usually recurrent
• Shortness of breath
• Recurrent chest infections
• Ongoing cough – “not clearing up”
• Wheeze
• Productive cough/ sputum

Less common:

• Weight loss- the work of breathing is so much harder
• Fatigue
• Decreased exercise tolerance
• Ankle swelling (if causing heart failure)
• Cor pulmonale- causes right sided failure

Question 5

describe signs of COPD

Answer 5

• Crackled air, reduced air entry, wheeze
• Stats along with respiratory rate

In diagnosed COPD you will see:

• Hyperinflated chest
• Using all of their muscles to breathe
• Cyanosis
• Pursed lip breathing
• Peripheral oedema
• Wheeze
• Raised JVP
• Cachexia

Question 6

efine the investigations used to diagnose COPD.

Answer 6

• No single diagnostic test- Symptoms, History(smoking, occupational exposure) and Spirometry

Severe exacerbation:
o	Breathless
o	Accessory muscle use at rest
o	Pure lip breathing
o	Cyanosis
o	Significant decrease in exercise tolerances
o	Fluid retention
o	Confusion
o	Heart problems can flare up

Question 7

Define the specific features to be included in the clinical history of COPD.

Answer 7

• History(smoking, occupational exposure)
• Cough, breathlessness, sputum
• family histroy

past medical history

-allergies

Question 8

Explain how to assess the severity of acute and chronic COPD. SPIROMETRY

Answer 8

• FEV1/FVC <70% post bronchodilator
• Normal FEV1 is 80%
• Moderate is 50-79%
• Acute is 30-59%
• Severe <30%

Question 9

Describe similarities and differences between asthma and COPD

Answer 9

Similar symptoms: These Chronic coughing, wheezing, and shortness of breath.

• COPD:
• symptoms over 35 years old,smoker, chronic productive ought, persistent and progressive breathlessness,
• Asthma
• symptoms under 35 years, variable breathlessness, wheeze, night time waking with breathlessness and/or wheeze, variability of symptoms day to day

Question 10

still not sure if its COPD?

Answer 10

• pulmonary function test

- CT scan

Question 11

when to diagnose patient with COPD

Answer 11

-
o Typical symptoms- breathlessness, cough, sputum

o >35 years
o Risk factor- Smoking or occupational exposure
o Absence of clinical features of asthma
o AND, airflow obstruction confirmed by post-bronchodilator spirometry

Question 12

severe COPD

Answer 12

a) Is caused by V/Q mismatch leading to resp failure.

b) Cor pulmonale

Question 13

a) type 1 rest failure V/ mismatch

Answer 13

• failure of gas exchange -> hypoxia
• insensitivity of central chemoreceptors to Co2 in medula -> no longer responds to hypoxaemia so there is reduced respiratory drive

Question 14

b) cor pulmonale

Answer 14

• abnormal enlargement of the right side of the heart
• caused by chronic hypoxia and subsequent vasoconstriction in pulmonary vasculature which causes pulmonary hypertension and -right side heart failure