COPD Flashcards
What are the causes of COPD not causes by direct smoking?
- Chronic Asthma
- Passive smoking
- Maternal smoking
- Air Pollution
- Occupation
- Alpha 1- anti trypsin deficiency
What does Alpha-1 antitrypsin do?
Neutralises enzymes released by neutophils
How many variants of of the gene for alpha 1- antitrypsin are there?
75
What is the normal genotype fo A1-antitrypsin?
PiMM-(86%)
What is the troublesome genotype fo A1-antitrypsin?
PiZZ -(0.03%)
What would be there differential diagnosis for a 40y/o smoker with cough and breathless on exertion?
COPD Asthma Lung Cancer Left Ventricular Failure Fibrosing alveolitis Bronchiectasis Rare: TB,Recurrent pulmonary emboli
How does COPD obstruct the airways?
- Inflammation
- Over production mucus
- Loss of elasticity and disrupted alveolar attachments
How many deaths arise from COPD a year?
30,000
6th most common cause of death
How many men die from COPD?
15,700
How many women die from COPD?
14,300
How do symptoms progress IN COPD?
Insidious, gradually worsening over the years!
What are the main symptoms of COPD?
- Breathlessness
- Cough & Sputum
- Wheeze
- Weight loss
- Peripheral oedema
Describe the Breathlessness onset by COPD
- Gradual
- Little variation
Describe the cough onset by COPD
- Long history of “Smokers cough”
- Clear Mucoid sputum
- Early morning and winter months
- 94% resolution if smoking stops
What would you suspect if haemoptysis:
- Lung Cancer
- TB
- Bronchiectasis
Describe the wheeze onset by COPD
Typically on exertion
Describe the weight loss onset by COPD
Indicates severe disease
Describe what causes peripheral oedema onset by COPD
-Cor pulmonale
-Severe disease
Respiratory failure
What is cor pulmonale?
Right heart failure due to secondary respiratory failure
What are the signs of COPD?
Breathlesss walking into clinic
Pursed lip breathing
Cyanosis
CO2 Flap
What signs of COPD could be seen during chest exam?
- Hyperexpasnsion chest
- Decrease in expansion
- Laryngeal descent
- Paradoxical mvmt of ribs and abdomen
- Cardiac dullness to percussion
- Decrease in breathe sounds
- Prolonged expriation and wheeze
- palpable liver
What is paradoxical breathing?
Paradoxical breathing is a condition when your chest moves inward during inhalation instead of moving outward
How is COPD graded?
FEV1 less than 80% of FVC
What are some essntial investigations for diagnosising COPD?
-Full pulmonary function testing
-Lung volume
-Carbon monoxide
gas transfer
Does asthma have reduced gas transfer?
NO
What is the minimum response bronchodilator reversibility ?
-Baseline , 15 minutes post neb 2.5-5mg subutamol
When is there a significant chance of reversibility?
Delta FEV1 greater than 200ml and delta FEV1 greater than 15% baseline
When response to bronchodilator/steroid is insignificant what does this suggest?
COPD
What are some clincal features found in a chest radiograph
- Hyperinflated lung fields (Greater than 10 posterior ribs seen)
- Flattened diaphragm
- Luncent lung fields
- Bullae
Define type 1 respiratory failure
Low PO2
Define type 2 respiratory failure
Low PO2
High PCO2
What would be shown on an ECG with a person with
- Right axis deviation
- P pulmonale
- T wave inversion v1-v4
What microorgansims cause increased sputum
s Pnemoniae
H influenza
M catarrahlis
What helps treatment of COPD?
- Neb Bronchodilator (beta 2 & anti muscarinic)
- 02
- Oral/IV corticosteroids
- Antibiotic
- Diuretic iv amniophylline
- respiratory stimulant
- NIV( non invasive ventilation)
