clinical feaures of COPD

Question 1

what is COPD

Answer 1

characterised by persistent respiratory symptoms and airflow limitation that is due to airways and or alveolar abnormalities usually caused by significant exposure to noxious particles or gases

Question 2

what’s it’s étiology

Answer 2

smoking and pollutants

host factors

Question 3

what’s it’s pathobiology

Answer 3

impaired king growth
accelerated decline
lung injury
king and systemic inflammation

Question 4

what is it’s pathology

Answer 4

small airway disorders or abnormalities
emphysema
systemic effects

Question 5

what are its clinical manifestations

Answer 5

symptoms
exacerbations
comorbidities

Question 6

what is alpha - 1 anti trypsin deficiency

Answer 6

rare, inherited disease, presents with early onset COPD <45yrs
alpha -1 antitrypsin (AAT) is a protease inhibitor made in the liver - limits d’anges caused by activated by neutrophils releasing elastase in response to infection/cigarette smoke

Question 7

how does smoking affect you

Answer 7

you have more respiratory symptoms and lung function abnormalities
greater annual rate of decline in FEV1 (fletcher-leto curve)
greater COPD mortality rate than non smokers
less than 50% of smokers develop COPD in their lifetime but after 25 yrs smoking at least 25% of smokers will have significant COPD

Question 8

what does smoking during pregnancy effect

Answer 8

foetal lung growth and priming of immune system

Question 9

what are symptoms of COPD

Answer 9

• cough
• breathlessness
• sputum
• frequent chest infections
• wheezing
• weight loss
• fatigue
• swollen ankles

Question 10

what examination findings can lead to a diagnosis

Answer 10

cyanosis - pursed lip breathing
raised JVP - hyperinflation chest
cachexia - use of accessory muscles
wheeze - peripheral oedema

Question 11

what is the mMRC dyspnoea scale

Answer 11

breathlessness scale

Question 12

what criteria must a patient meet for a COPD diagnosis

Answer 12

• have typical symptoms
• > 35yrs
• presence of risk factor (smoking or occupational exposure)
• absence of clinical features of asthma
  AND
• airflow obstruction confirmed by post-bronchodilator spirometry

Question 13

what does spirometry do

Answer 13

diagnose airflow obstruction
FEV1/FVC < 0.7 post bronchodilator
demonstrates lack of reversibility

Question 14

what do the diff stages of spirometry mean

Answer 14

stage 1 - mild - FEV1 80% of predicted value or higher
2 - moderate - 50-79%
3 - severe - 30-48%
4 - very severe - less than 30%

Question 15

how do we differentiate between asthma, COPD and other diseases

Answer 15

HISTORY !!!!!
unifying diagnosis vs dual pathology
red flag symptoms

Question 16

what diseases should be ruled out before COPD

Answer 16

asthma 
congestive heart failure 
bronchiectasis 
tuberculosis 
obstructive bronchiolitis 
diffuse panbronchiolitis

Question 17

what are the differences between COPD and asthma

Answer 17

copd patients more likely to be smokers or ex smokers abs have chronic productive cough
symptoms under 35 more common for asthma
breathlessness consistent and progressive in copd but variable in asthma
more likely to wake at night in asthma

Question 18

what are some pulmonary function tests

Answer 18

long vol test

transfer factor test

Question 19

what can u use if ur still not sure on the disgnosis

Answer 19

radiology - high resolution computed tomography (ct)

Question 20

what are acute exacerbations of COPD

Answer 20

SOB
wheeze 
chest tightness
cough
sputum 
systemic upset
temperature 
fatigue

Question 21

what are some severe exacerbations

Answer 21

breathless 
accessory muscle use at rest
purse lip breathing
cyanosis 
decrease in exercise tolerance 
signs of sepsis 
fluid retention
confusion

Question 22

how would u manage acute exacerbations

Answer 22

• change inhalers (technique, device, add bronchodilator, increase or add inhaled steroid
• oral steroids
• antibiotics
• self management for select patients

Question 23

what’s the secondarybcare of acute exacerbation

Answer 23

trugger ? bacterial/viral infection - sedatives, pneumothorax, trauma
confusion, cyanosis, severe breathlessness, flapping tremor, drowsy, pure isk, wheeze, tripod position
CXR, blood gases, FBC, U&E, sputum culture, VTS

Question 24

what would secondary care treatment be

Answer 24

oxygen
nebulised bronchodilator
beta 2 and antimuscarinic
oral/iv corticosteroid +/- antibiotic

Question 25

how do you measure the severity of COPD

Answer 25

spirometry
nature and magnitude of symptoms (mrc scale and copd assessment tool)
history of exacerbations and future risk
presence of ci-morbidity

Question 26

what is a severe disease resulting from COPD

Answer 26

respiratory failure
type 1 - decrease in pO2
type 2 - decrease in pO2 and increase in pCO2

Question 27

what is cor pulmonale

Answer 27

tachycardia, oedematous, raised JVP, congested liver
ECG features:rught adios deviated
pul hypertension, tricuspid regurgitation

Question 28

what is secondary polycythaemia

Answer 28

body produces increases erythropoietin in response to low O2
increase hb, increase haematocrit
increase blood viscosity

Question 29

features of chronic bronchitis

Answer 29

daily productive cough for three months or more in at least 2 consecutive years 
overweight and cyanotic 
elevated hb 
peripheral edema 
rho chu and wheezing

Question 30

features of emphysema

Answer 30

permanent enlargement and destruction of airspace’s distal to the terminal bronchiole
older and thin
sévère dyspnea
quiet chest
x-ray shows hyperinflation w flattened diaphragms