Clinical Features of COPD Flashcards
COPD definition
Lung disease characterised by chronic obstruction of lung airflow
Diseases included within COPD
Chronic bronchitis
Emphysema
COPD symptoms are due to
Airway and/or alveolar abnormalities caused by significant exposure to noxious particles or gases
Risk factors of COPD
Smoking (no.1) Occupation Age Lower socioeconomic status Asthma/airway hyper-reactivity Childhood infection
Is COPD more common in men or women
Women
Alpha-1 antitrypsin
Protease inhibitor made in the liver
Function of alpha-1 antitrypsin
Limits damage caused by activated neutrophils releasing elastase in response to infection/cigarette smoke
Effect of alpha-1 antitrypsin deficiency
Alveolar damage and emphysema
Percentage of smokers that develop COPD
<50%
Common symptoms of COPD
Shortness of breath Recurrent chest infections Ongoing cough Sputum Wheeze Chest tightness
Less common symptoms of COPD
Weight loss Fatigue Decreased exercise tolerance Ankle swelling (heart failure) Cor pulmonale
Examination findings in COPD
Cyanosis Raised JVP Cachexia Wheeze Pursed lip breathing Hyper-inflated chest Use of accessory muscles Peripheral oedema Flapping tremor
mMRC breathlessness scale
0-4, 0 being breathlessness with strenuous exercise, 4 being too breathless to leave the house
Diagnosis criteria
Typical symptoms Aged > 35 Presence of risk factor Absence of clinical features of asthma Airflow obstruction confirmed by spirometry
Spirometry of stage 1 COPD
80%
Spirometry of stage 2 COPD
50-79%
Spirometry of stage 3 COPD
30-49%
Spirometry of stage 4 COPD
<30%
Spirometry demonstrates
Lack of reversibility
Spirometry in restrictive disorder
Ratio is normal as both FEV1 and FVC reduced
Signs on chest x-ray of COPD
Vascular hila Hyperinflation Bulla Small heart Flat diaphragm
How many people are living with COPD in the UK
1.2 million (2% pop)
How common is COPD out of all lung diseases
2nd most common
Is the prevalence of COPD increasing or decreasing
Increasing
How many people are diagnosed with COPD each year in the UK
115,000
Are incidences of COPD increasing or decreasing
Decreasing
Onset of COPD compared to asthma
In mid-life whereas asthma in early life
Progressiveness of symptoms of COPD
Slowly progressive
People with COPD usually have a history of
Tobacco smoking or exposure to other types of smoke
If unsure if asthma or COPD, carry out
Pulmonary function tests - lung volumes and transfer factor
Residual volume in COPD
Increases
Total lung capacity in COPD
Increases
RV/TLC
> 30%
Gas transfer in COPD
Reduces
Diffusion of carbon monoxide in COPD
Decreases
Carbon monoxide transfer coefficient abundance in COPD
Decreases
Radiology to differentiate between COPD and asthma
High resolution computed tomography (HRCT)
Differential finding in HRCT in COPD
Upper zone emphysema
2 main things that differentiate COPD and asthma
Diurnal variability and reversibility with bronchodilators
Management of acute exacerbations in primary care
Change in inhalers
Oral steroids (prednisolone)
Antibiotics
Acute exacerbation in secondary care triggers
Viral/bacterial infection
Sedative drugs
Trauma
Treatment of acute exacerbations in secondary care
Oxygen
Nebulised bronchodilator
Oral/IV corticosteroids
Antibiotics
Factors used to measure severity
Spirometry
Nature and magnitude of symptoms
History of moderate and severe exacerbations and future risk
Presence of co-morbidity
How much does NHS spend on prescribed inhalers each year
£10 million
Number of deaths from COPD worldwide annually
3 million
Predicated COPD related deaths worldwide annually in 2030
4.5 million
Number on thing patients can do to slow progression of COPD
Stop smoking
