Clinical Features of COPD COPY Flashcards
What is COPD purely defined by?
Airflow obstruction
What is their not mention of when defining COPD?
- Symptoms
- Bronchitis or emphysema
- Smoking
What causes airway obstruction?
Occurs due to small-airway narrowing
What can make airway obstruction worse?
Inflammation and mucus
What can worsened airway obstruction lead to?
Progressive breathlessness on exertion, along with coughing and wheezing
Who is treated for COPD?
Those who are symptomatic
What are the trends in prevalence of COPD?
- Male predominance
- Increasing prevalence
- More prevalent in the less educated
- More prevalent amongst lower income households
Where does COPD rank in the UKs mortality tables?
6th most common cause of death
How does COPD impact the NHS?
- Increasing burden on NHS
- Hospital admissions
- Beds
- GP visits
What must be paid for with each COPD patient?
- Inpatient hospitalisation
- Treatment
- Scheduled GP and specialist care
- Unscheduled GP and emergency department care
- Laboratory tests
What aspects of patients lives does COPD impact?
- Climbing stairs
- Gardening
- Housework
- Dressing
- Sleep disturbances
What is 85% of smoking attributable to?
Smoking
Apart from smoking, what other causes of COPD are there?
- Chronic asthma
- Passive smoking
- Maternal smoking
- Air pollution
- Occupation
- a1 antitrypsin deficiency
How does maternal smoking contribute to COPD?
Reduces FEV1 and increases respiratory illness
What occupations are thought to be associated with COPD?
- Coal mining
- Hard rock mining
- Tunnel working
- Concrete manufacturing
- Construction
- Farming
- Foundry working
- Plastics
- Textiles
- Rubber
- Leather
What does a1 antitrypsin do?
Neutralises enzymes released by neutrophils
What is the normal genotype and troublesome genotypes regarding a1 antitrypsin?
- Normal: PiMM
- Troublesome: PiZZ
What is important in tobacco related COPD?
Total tobacco consumption
What is 1 pack year equivalent to?
1 pack a day for a year
What does the BTS guidelines suggest is normal in smoking related COPD?
> 20 pack year smoking history
How does FEV1 differ with age?
It falls continuously and smoothly
What is the differential diagnosis for COPD?
- Asthma
- Lung cancer
- Left ventricular failure
- Fibrosing alveolitis
- Bronchiectasis
- TB
- Recurrent pulmonary emboli
What is the typical COPD patient?
Patient 40+ years, smoker/ex smoker, breathless on exertion, cough
How should someone with COPDs symptoms present?
Insidious, gradually worsening over the years
What should be done before making the diagnosis of COPD.
Exclude other possible diagnosis
What symptoms will COPD patients not have?
The features of variable airflow obstruction of asthma
What symptoms might a COPD patient present with?
- Breathlessness
- Cough and sputum
- Wheeze
- Weight loss
- Peripheral oedema
When might a COPD patient be breathless?
- It will have little variation and a gradual onset
- Climbing hills, stairs with loads or while hurrying
- Walking on the flat with contemporaries
- Gardening
- Housework
- Dressing and washing
- At rest
How might the cough and sputum of a COPD patient present?
- Long history of smokers cough
- Clear or mucoid sputum
- Early morning winter months
- All day winter months
- All day and all year
If there is haemoptysis, what should be considered?
- Lung cancer
- TB
- Bronchiectasis
When do COPD patients typically present with wheeze?
Typically on exertion
What does weight loss indicate?
Severe disease
What does peripheral oedema suggest?
- Cor pulmonale
- Severe disease
- Respiratory failure
What might be found in the past medical history of someone with COPD?
- Asthma as a child
- Respiratory diseases
- Ischaemic heart disease
What must you ask about in relation to drugs when taking a history?
- List of current inhalers and the doses
- Previous medications and effects on breathing
What is important to ask about in personal and social history?
- Occupation
- Smoking history
What signs might be present in a COPD patient?
- Breathlessness when entering clinic or undressing
- Pursed lip breathing
- Use of accessory muscles
- Cyanosis
- CO2 flap
- Effects of steroids (tissue skin, bruising, Cushingoid)
What might you find on examination of a COPD patient?
- Barrel chest, decreased expansion
- Laryngeal descent
- Paradoxial movement of ribs and abdomen
- Decreased cardiac dullness to percussion
- Decreased breath sounds
- Prolonged expiration with wheeze
- Palpable liver
- Cor pulmonale
What investigations should be conducted before diagnosing COPD?
- Spirometry
- Full pulmonary function testing
- Lung volumes
- Carbon monoxide gas transfer
- Reversibility to bronchodilators and oral corticosteroids
What investigations are useful in diagnosing COPD?
- Chest radiograph
- Blood gases
- Full blood count
- ECG
- Sputum
In spirometry results what does a normal FEV1 indicate?
Effectively rules out COPD
What spirometry results would indicate COPD?
FEV1 <80% predicted with FEV1/FVC ratio <70%
What are you looking for when carrying out full pulmonary function testing?
Emphysema
What does lung volumes involve in pulmonary function testing?
- Gas trapping
- Increased residual volume
- Increased total lung capacity
- RV/TLC >30%
What does carbon monoxide gas transfer involve in pulmonary function testing?
- Decreased gas transfer
- Decreased TLCO
- Decreased KCO (tissue destruction)
What can de demonstrated by spirometry?
Fixed airflow obstruction
How should a COPD patient respond to bronchodilators?
Minimal reversibility
How should a COPD patient respond to oral corticosteroids?
Minimal response
What is the method used when testing response to oral corticosteroids?
- 30-40mg Prednisolone daily for 2 weeks (0.6mg/kg)
- Measure baseline and final FEV1
- Increasing trend not to do trials of steroids though
What does significant bronchodilator/steroid response suggest?
Asthma or asthmatic component
What does response to bronchodilator/steroids not suggest?
Does not predict symptomatic benefit from long term use
What may be observed on a chest radiograph?
- Hyperinflated lung fields
- Flattened diaphragms
- Lucent lung fields
- Bullae
What are chest radiographs useful in?
- Bronchogenic carcinoma
- Interstitial disease
- Left ventricular failure
What might abnormal blood gas results suggest?
- Decreased PaO2 Type I respiratory failure
- Decreased PaO2 and increased PaCO2 Type II respiratory failure
What might a full blood count show?
Secondary polycythaemia
What might be identified on an ECG?
- Right axis deviation
- P pulmonale
- T wave inversion V1-V4
What might be found on a MC&S sputum test?
- S pneumoniae
- H influenzae
- M catarrahalis
What can precipitate an acute exacerbation of COPD?
- Viral/bacterial infection
- Sedative drugs
- Pneumothorax
- Trauma
How might a patient present with an acute exacerbation of COPD?
- Increased cough
- Increased sputum
- Increased sputum purulence
- Increased shortness of breath
- Increased wheeze
- Unable to sleep
- Increased oedema
- Confusion
- Drowsiness
- Cyanosis
- Flapping tremor
- Pyrexial
- Signs of COPD
What investigations are useful in diagnosing an acute exacerbation of COPD?
- Chest radiograph
- Blood gases
- FBC
- U&E
- Sputum culture
How should acute exacerbations of COPD be managed?
- Nebulised bronchodilator B2 and anti muscarinic
- O2
- Oral/iv corticosteroid
- Antibiotics
- Diuretic
- IV aminophylline
- Respiratory stimulant
- NIV
