Clinical Features of COPD COPY Flashcards
What is the definition of COPD?
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
Why does obstruction of the airways occur?
Small-airway narrowing - worsened by inflammation and mucus
Leads to progressive breathlessness on exertion, coughing, wheezing
What happens to the airway wall?
Thickens
What is ACOS
Asthma, COPD, overlap syndrome
Symptoms of Asthma and COPD
What happens to elasticity and alveolar attachments?
Loss of elasticity and disrupted alveolar attachments
What causes COPD
Smoking - main cause
Passive smoking
Maternal smoking (Reduces FEV1 and increases respiratory illness)
Air pollution
Occupation (jobs exposing to dusts, vapours, fumes)
What percentage of smokers develop clinically significant COPD?
20%
What is a normal pack year?
Over 20
What is a pack year?
1 pack year = 1 pack a day for a year
What is the rate of decline of FEV1?
Non-smoker - 30 ml/yr
SMOKER - 50 ml/yr
What is your typical COPD patient?
- Typical symptoms
- >35 years
- Smoking or occupational exposure
- Absence of clinical features of asthma
What are the differential diagnosis for COPD?
Asthma
Lung cancer
Left ventricular failure
Fibrosing alveolitis
Bronchiectasis Rarities
TB
Recurrent pulmonary emboli
What separates COPD from asthma?
Asthma has variable airflow obstruction and reversible
COPD gradually worsens over time
What are the symptoms of COPD?
Breathlessness
Cough with Sputum
Wheeze
Weight loss
Peripheral oedema
What is sputum like?
Clear or mucoid sputum
What does haemoptysis suggest rather than COPD?
Lung cancer/TB/bronchiectasis
What does weight loss indicate?
Severe disease, TNF alpha
What does peripheral oedema cause
Cor pulmonale (right heart failure secondary to lung disease), severe disease, respiratory failure
What is typical past medical history?
Asthma as child
Adolescence Respiratory diseases
Ischaemic heart disease
What are the signs of COPD?
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
What is the interpretation of FEV1 of
What is the purpose of full pulmonary function testing?
Loking for emphysema
What is the effect of Gas trapping on lung volumes?
Increase in residual volume
Increase in total lung capacity
RV/TLC is greater than 30%
What is the response to oral corticosteroids and bronchodilators?
Minimal
What does significant bronchodilator/steroid response suggest?
asthma
Investigations
What will a chest radiograph indicate?
Hyperinflated lung fields
Flattened diaphragms
Lucent lung fields
Bullae
Investigations- Severe COPD
What are the different type of blood gas measurements likely to be found?
Type 1: ↓ pO2
Type 2: ↓ pO2 and ↑ pCO2 (ventilatory failure)
Investigations- Severe COPD
What can a full blood count be indicative of?
Secondary polycthaemia
Body produces ↑ erythropoietin in response to low O2
↑ Haemoglobin
↑ Haematocrit
↑ bloody viscosity
Investigations- Severe COPD
What does an ECG tell you?
Right axis deviation
P pulmonale (right atrial enlargement)
T wave inversion
What does sputum analysis indicate?
MC and S (Mucous culture and sensitivites) - S pneumoniae, H influenzae, M catarrahlis
What can be the cause of an acute exacerbation?
Usually by viral and bacterial infection
Consider sedative drugs, pneumothorax, trauma
What are the symptoms of an acute exacerbations?
Confusion
cyanosis
severe breathless
flapping tremor
drowsy
pyrexial
wheeze
“tripod” position
What is the management for Acute exacerbations?
Oxygen
Nebulised bronchodilator
B2 anti-muscurinic
Oral/iv corticosteroid +/-antibiotic
IV aminophylline
What are some characteristics of Severe COPD
Respiratory failure- reduced V/P
Type 1: Decreased p02
Type 2: Decreased P02 Increased pC02
Flapping tremor- hypercapnia
Cor pulmonale
