COPD Flashcards
What is COPD?
COPD is a clinical and pathophysiologic syndrome that includes emphysema and chronic bronchitis. These disorders have overlapping features, and because patients often have characteristics of more than one disorder, both are classified together as COPD
What are the different types of COPD?
COPD is a clinical and pathophysiologic syndrome that includes emphysema and chronic bronchitis. These disorders have overlapping features, and because patients often have characteristics of more than one disorder, both are classified together as COPD:
Emphysema
Chronic bronchitis
Bronchiectasis
What is emphysema?
Emphysema is a condition in which the air spaces are enlarged as a consequence of destruction of alveolar septa.
What is Chronic bronchitis?
disease characterised by a chronic cough that is productive of phlegm occurring on most days for 3 months of the year for 2 or more consecutive years without an otherwise-defined acute cause.
What is the most contributory factor of COPD?
Smoking is the most contributory factor of COPD. Other causes include:
environmental pollutants
Dust
Coal mining
recurrent upper respiratory infections
eosinophilia
bronchial hyper-responsiveness
α1- anti-trypsin deficiency (Genetics)
What are the characteristics of lungs with COPD?
Thick mucus causing chronic cough
air gets trapped in the lungs
baronial tubes become inflamed and narrowed
alveoli lose elasticity and shape making it hard to exhale
What is the pathophysiology of COPD?
What are the clinical signs and symptoms of COPD?
Wheezing
Barrel chest
Purse-Lip Breathing
Dyspnea
Chronic cough
Bronchitis- increased Sputum
Clubbing
Orthopneic
Uses of Accessory muscles to breathe
What is the difference in classic patient types of emphysema predominant vs bronchitis predominant COPD patients?
Emphysema predominant: Pink puffers
Bronchitis predominant:
Blue bloaters
What is the difference in clinical findings of emphysema predominant vs bronchitis predominant COPD patients?
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What is the difference in Chest radiography of emphysema predominant vs bronchitis predominant COPD patients?
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What is the pathophysiology of Emphysema?
What is the pathophysiology of
Chronic bronchitis?
What is the difference of respiratory efforts in pink puffers compared to blue bloaters?
Respiratory Effort:
Pink puffers have a high respiratory effort and tend to be breathless but well-oxygenated
Blue bloaters have less respiratory effort but are poorly oxygenated.
What is the difference in Body weight between pink puffers vs blue bloaters?
Pink puffers are typically thin, whereas blue bloaters are usually overweight.
What is the difference of skin colour between pink puffers vs blue bloaters?
Pink puffers have a pinkish complexion due to better oxygenation
Blue bloaters are cyanotic (bluish) due to chronic hypoxemia.
What is the difference of lung sounds in pink puffers compared to blue bloaters?
What are the different thing used to diagnose COPD?
Arterial blood gases
6 minute walk
Physical examination
Lung function test s
X-ray or CT scans
What will a physical examination of a pt suspected with COPD show?
In mild COPD clinical examinatio may be normal
as condition gets worse, signs will become apparent - especially during exarcebation.
Signs:
✅ Barrel Chest (↑AP Diameter) – Due to lung hyperinflation.
✅ Pursed-lip breathing – Helps reduce air trapping.
✅ Use of accessory muscles – Sternocleidomastoid, intercostals (sign of respiratory distress).
✅ Tripod position – Leaning forward to improve breathing.
✅ Cyanosis – Late-stage, due to chronic hypoxia.
✅ Cachexia & muscle wasting – Due to increased work of breathing & systemic inflammation.
✅ Wheezing, prolonged expiration, reduced breath sounds
Hyperresonance on percussion
Coarse crackles (early inspiration) – Suggestive of mucus in the airways.
Cor pulmonale
What are the cardiovascular signs of COPD in severe COPD?
Signs of Cor Pulmonale (Right Heart Failure due to Pulmonary Hypertension)
Raised JVP (Jugular Venous Pressure).
Peripheral edema (ankle swelling).
Hepatomegaly (due to right heart strain).
What is the difference between type 1 and type 2 respiratory failure?
Type 1 is primarily a problem of oxygen deficiency, while Type 2 involves carbon dioxide retention due to impaired ventilation.
Type 1 Respiratory Failure (Hypoxemic):
Cause: Primarily due to issues with oxygenation, such as ventilation-perfusion (V/Q) mismatch, shunting, or diffusion defects.
Key Feature: Low oxygen levels (PaO₂ < 8 kPa or 60 mmHg).
PaCO₂: Normal or low (often less than 6 kPa).
Examples: Conditions like pneumonia, (PE), (ARDS), and pulmonary edema.
Type 2: Type 2 Respiratory Failure (Hypercapnic):
Cause: Primarily due to alveolar hypoventilation where the lungs cannot remove enough carbon dioxide. This leads to elevated CO₂ levels in the blood.
Key Feature: High carbon dioxide levels (PaCO₂ > 6 kPa or 45 mmHg).
PaO₂: Low (PaO₂ < 8 kPa), but the main issue is CO₂ retention.
Examples: Conditions like COPD, neuromuscular diseases, and opioid overdose.
What will ABGs show if a pt has COPD?
ABG may reveal TYPE 2 RESPIRATORY FAILURE
How do you determine the extent of breathlessness?
- MEDICAL RESEARCH COUNCIL (MRC) DYSPNOEA SCALE
- shuttle test
- 6 minute walking test
What are the names of the questionnaires that assess overall function and quality of life?
St GEORGE’S RESPIRATORY QUESTIONNAIRE
COPD assessment test (CAT)
