clinical feaures of COPD Flashcards
what is COPD
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
what’s it’s étiology
smoking and pollutants
host factors
what’s it’s pathobiology
impaired king growth
accelerated decline
lung injury
king and systemic inflammation
what is it’s pathology
small airway disorders or abnormalities
emphysema
systemic effects
what are its clinical manifestations
symptoms
exacerbations
comorbidities
what is alpha - 1 anti trypsin deficiency
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
how does smoking affect you
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
what does smoking during pregnancy effect
foetal lung growth and priming of immune system
what are symptoms of COPD
- cough
- breathlessness
- sputum
- frequent chest infections
- wheezing
- weight loss
- fatigue
- swollen ankles
what examination findings can lead to a diagnosis
cyanosis - pursed lip breathing
raised JVP - hyperinflation chest
cachexia - use of accessory muscles
wheeze - peripheral oedema
what is the mMRC dyspnoea scale
breathlessness scale
what criteria must a patient meet for a COPD diagnosis
- 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
what does spirometry do
diagnose airflow obstruction
FEV1/FVC < 0.7 post bronchodilator
demonstrates lack of reversibility
what do the diff stages of spirometry mean
stage 1 - mild - FEV1 80% of predicted value or higher
2 - moderate - 50-79%
3 - severe - 30-48%
4 - very severe - less than 30%
how do we differentiate between asthma, COPD and other diseases
HISTORY !!!!!
unifying diagnosis vs dual pathology
red flag symptoms
what diseases should be ruled out before COPD
asthma congestive heart failure bronchiectasis tuberculosis obstructive bronchiolitis diffuse panbronchiolitis
what are the differences between COPD and asthma
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
what are some pulmonary function tests
long vol test
transfer factor test
what can u use if ur still not sure on the disgnosis
radiology - high resolution computed tomography (ct)
what are acute exacerbations of COPD
SOB wheeze chest tightness cough sputum systemic upset temperature fatigue
what are some severe exacerbations
breathless accessory muscle use at rest purse lip breathing cyanosis decrease in exercise tolerance signs of sepsis fluid retention confusion
how would u manage acute exacerbations
- change inhalers (technique, device, add bronchodilator, increase or add inhaled steroid
- oral steroids
- antibiotics
- self management for select patients
what’s the secondarybcare of acute exacerbation
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
what would secondary care treatment be
oxygen
nebulised bronchodilator
beta 2 and antimuscarinic
oral/iv corticosteroid +/- antibiotic
how do you measure the severity of COPD
spirometry
nature and magnitude of symptoms (mrc scale and copd assessment tool)
history of exacerbations and future risk
presence of ci-morbidity
what is a severe disease resulting from COPD
respiratory failure
type 1 - decrease in pO2
type 2 - decrease in pO2 and increase in pCO2
what is cor pulmonale
tachycardia, oedematous, raised JVP, congested liver
ECG features:rught adios deviated
pul hypertension, tricuspid regurgitation
what is secondary polycythaemia
body produces increases erythropoietin in response to low O2
increase hb, increase haematocrit
increase blood viscosity
features of chronic bronchitis
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
features of emphysema
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
