Clinical Features of COPD COPY

Question 1

What is the definition of COPD?

Answer 1

Chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible

Slowly progressive disorder

Airflow obstruction doesn’t change much over several months

Question 2

Why does obstruction of the airways occur?

Answer 2

Small-airway narrowing - worsened by inflammation and mucus

Leads to progressive breathlessness on exertion, coughing, wheezing

Question 3

What happens to the airway wall?

Answer 3

Thickens

Question 4

What is ACOS

Answer 4

Asthma, COPD, overlap syndrome

Symptoms of Asthma and COPD

Question 5

What happens to elasticity and alveolar attachments?

Answer 5

Loss of elasticity and disrupted alveolar attachments

Question 6

What causes COPD

Answer 6

Smoking - main cause

Passive smoking

Maternal smoking (Reduces FEV1 and increases respiratory illness)

Air pollution

Occupation (jobs exposing to dusts, vapours, fumes)

Question 7

What percentage of smokers develop clinically significant COPD?

Answer 7

20%

Question 8

What is a normal pack year?

Answer 8

Over 20

Question 9

What is a pack year?

Answer 9

1 pack year = 1 pack a day for a year

Question 10

What is the rate of decline of FEV1?

Answer 10

Non-smoker - 30 ml/yr

SMOKER - 50 ml/yr

Question 11

What is your typical COPD patient?

Answer 11

• Typical symptoms
• >35 years
• Smoking or occupational exposure
• Absence of clinical features of asthma

Question 12

What are the differential diagnosis for COPD?

Answer 12

Asthma

Lung cancer

Left ventricular failure

Fibrosing alveolitis

Bronchiectasis Rarities

TB

Recurrent pulmonary emboli

Question 13

What separates COPD from asthma?

Answer 13

Asthma has variable airflow obstruction and reversible

COPD gradually worsens over time

Question 14

What are the symptoms of COPD?

Answer 14

Breathlessness

Cough with Sputum

Wheeze

Weight loss

Peripheral oedema

Question 15

What is sputum like?

Answer 15

Clear or mucoid sputum

Question 16

What does haemoptysis suggest rather than COPD?

Answer 16

Lung cancer/TB/bronchiectasis

Question 17

What does weight loss indicate?

Answer 17

Severe disease, TNF alpha

Question 18

What does peripheral oedema cause

Answer 18

Cor pulmonale (right heart failure secondary to lung disease), severe disease, respiratory failure

Question 19

What is typical past medical history?

Answer 19

Asthma as child

Adolescence Respiratory diseases

Ischaemic heart disease

Question 20

What are the signs of COPD?

Answer 20

Breathless with pursed lips and accessory muscle involvement

Cyanosis

Hyperinflated chest

Raised JVP

Decrease cardiac dullness to percussion

Decreases in breath sounds (no crackles)

Prolonged expiration with wheeze

Question 21

What is the interpretation of FEV1 of

Answer 21

Question 22

What is the purpose of full pulmonary function testing?

Answer 22

Loking for emphysema

Question 23

What is the effect of Gas trapping on lung volumes?

Answer 23

Increase in residual volume

Increase in total lung capacity

RV/TLC is greater than 30%

Question 24

What is the response to oral corticosteroids and bronchodilators?

Answer 24

Minimal

Question 25

What does significant bronchodilator/steroid response suggest?

Answer 25

asthma

Question 26

# Investigations What will a chest radiograph indicate?

Answer 26

Hyperinflated lung fields Flattened diaphragms Lucent lung fields Bullae

Question 27

# Investigations- Severe COPD What are the different type of blood gas measurements likely to be found?

Answer 27

Type 1: ↓ pO₂ Type 2: ↓ pO₂ and ↑ pCO_{2 (ventilatory failure)}

Question 28

# Investigations- Severe COPD What can a full blood count be indicative of?

Answer 28

Secondary polycthaemia Body produces ↑ erythropoietin in response to low O₂ ↑ Haemoglobin ↑ Haematocrit ↑ bloody viscosity

Question 29

# Investigations- Severe COPD What does an ECG tell you?

Answer 29

Right axis deviation P pulmonale (right atrial enlargement) T wave inversion

Question 30

What does sputum analysis indicate?

Answer 30

MC and S (Mucous culture and sensitivites) - S pneumoniae, H influenzae, M catarrahlis

Question 31

What can be the cause of an acute exacerbation?

Answer 31

Usually by viral and bacterial infection Consider sedative drugs, pneumothorax, trauma

Question 32

What are the symptoms of an acute exacerbations?

Answer 32

Confusion cyanosis severe breathless flapping tremor drowsy pyrexial wheeze “tripod” position

Question 33

What is the management for Acute exacerbations?

Answer 33

Oxygen Nebulised bronchodilator B2 anti-muscurinic Oral/iv corticosteroid +/-antibiotic IV aminophylline

Question 34

What are some characteristics of Severe COPD

Answer 34

Respiratory failure- reduced V/P Type 1: Decreased p02 Type 2: Decreased P02 Increased pC02 Flapping tremor- hypercapnia Cor pulmonale