COPD Flashcards
what does spirometry look like in COPD?
BIG decrease in FEV1, some decrease in FVC, therefore FEV1:FVC is decreased (normal is >70%)
Post bronchodilator there is some improvement (as opposed to obstruction from fibrosis that does not improve
What ages are normally involved and what is the average age of presentation
normally in middle aged and older
onset usually in 5th and 6th decades (40+)
what is the prevalence?
12.5% of those 45-70yrs
What factors are involved in causing COPD
Smoking (20/day for >20yrs) air pollution airway infection occupation - dusts, silica, cadmium Familial predisposition A1-ATD (emphysema) Broncial Hyper responsiveness age gender TB exposure
What factors are involved in causing COPD
Smoking (20/day for >20yrs) air pollution airway infection occupation - dusts, silica, cadmium Familial predisposition A1-ATD (emphysema) Broncial Hyper responsiveness CF IV drug use
Unless there is a hx of smoking or fam hx of A1ATD then it is not COPD
What is COPD
A respiratory dx characterised by airflow obstruction that is not fully reversible.
Airflow limitation is generally progressive and associated with abnormal inflammatory response of the lungs to noxious airborne agents (smoke)
2 types - emphysema and chronic bronchitis
What signs are there in COPD
tachypnoea reduced chest expansion hyper inflated lungs hyper-resonant percussion decreased breath sounds +/- Wheeze pursed lip breathing "pink puffer" - always breathless (more often emphysema) "blue bloater" - oedantous and central cyanosis (more often chronic bronchitis) signs of resp failure signs of Cor pulmonale
what are the signs of respiratory failure
???????
what are the signs of Cor pulmonale
cyanosis, peripheral oedema, Incr JVP 4th Heart sound diastolic mumur from pulm regurg hepatomegaly +/- ascites crepitations at lung bases +/- pleural effusionn
How do you investigate COPD (and expected results needed to indicate COPD)
Pulmonary Fn Tests
- Spirometry - post-SABA FEV1/FVC of <80%
CXR
How do you investigate COPD (and expected results needed to indicate COPD)
Pulmonary Fn Tests
- Spirometry - post-SABA FEV1/FVC of <80%
Pulmonary function testing (PFT) reveals airflow obstruction, as evidenced by an increased forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) ratio. Administration of bronchodilators has no effect, unlike the reversible obstruction seen in asthma.
CXR - hyperinflation, barrel chest, narrow mediastinum, bronchovascular markings, small heart
CT - bronchial wall thickening, alveolar septal destruction and airspace enlargement,, bullae
Blood Gas - normal or Increased PaCO2, decreased PaO2
ECG - Cor Pulmonale
FBC - anaemia, polycythaemia, but Hb and PCV may be raised.
What are the dx processes occurring in COPD types.
In chronic bronchitis, there is diffuse hyperplasia of mucous glands with associated hypersecretion and bronchial wall inflammation.
Emphysema involves the destruction of alveolar septa and pulmonary capillaries, leading to decreased elastic recoil and resultant air trapping.
What are the disease processes occurring in COPD types.
In chronic bronchitis, there is diffuse hyperplasia of mucous glands with associated hypersecretion and bronchial wall inflammation.
Emphysema involves the destruction of alveolar septa and pulmonary capillaries, leading to decreased elastic recoil and resultant air trapping.
Understanding Lung FN tests
- what is normal for FEV1 to FVC ratio
- what happens to FEV1 and FVC in restrictive lung dx
- What happens in obstructive dx
- Fev1 is normally 80% of FVC = 0.8
- FEV1 AND FVC are both reduced almost equally = normal to increased FEV1:FVC ratio in restrictive dx i.e. 1.0
- FEV1 is MORE reduced than FVC in obstructive dx = FEV1:FVC is reduced in obstructive dx e.g. 0.5 (50%)
What signs are there on X-ray for COPD
- chronic bronchitis on chest radiography :
- -nonspecific
- increased bronchovascular markings
- -cardiomegaly.
-Emphysema
–lung hyperinflation
– flattened hemidiaphragms,
–a small heart,
– possible bullous changes.
On the lateral radiograph,
–a “barrel chest” with widened anterior-posterior diameter may be visualized.
What are the features on CT of COPD
In chronic bronchitis, bronchial wall thickening may be seen in addition to enlarged vessels. Repeated inflammation can lead to scarring with bronchovascular irregularity and fibrosis.
Emphysema is diagnosed by alveolar septal destruction and airspace enlargement, which may occur in a variety of distributions. Centrilobular emphysema is predominantly seen in the upper lobes with panlobular emphysema predominating in the lower lobes. Paraseptal emphysema tends to occur near lung fissures and pleura. Formation of giant bullae may lead to compression of mediastinal structures, while rupture of pleural blebs may produce spontaneous pneumothorax / pneumomediastinum.
What is a good consultation checklist for Mx COPD
SMOKES
S- smoking cessation
M - medication - bronchodilators, Anticholinergics vaccination, corticosteroids
O - Oxygen - is it needed
K - Komorbidity - cardiac DysFn, sleep apnoea, osteoporosis, depression, asthma
E - Exercise and rehabilitation - physio for chest physio, breath exercises, aerobic exercise
S - Surgery - bullectomy, Lung Volume Reduction, Single Lung transplantation.
