COPD Flashcards
What does COPD stand for?
Chronic obstructive pulmonary disease
What is COPD?
Chronic, slowly progressive disorder characterised by airflow obstruction that does not change markedly over several months
Which gender gets COPD?
Male
Causes of COPD
Smoking (85%) Chronic asthma Passive smoking Maternal smoking Air pollution Occupation (15-20%)
Examples of occupations causing COPD
Coal mining Hard rock mining Tunnel working Concrete manufacturing Construction Farming Foundry working Plastics Textiles Rubber Leather
What does a1-antitrypsin do?
Neutralises enzymes released by neutrophils
Genotypes of a1-antitrypsin deficiency
Normal genotype - PiMM (86%)
Troublesome genotype PiZZ (10-20%)
What can happen in a1-antitrypsin deficiency?
Bad emphysema can develop very quickly as nothing to neutralise the neutrophils
People tend to develop COPD at younger age
What is the most important cause of COPD?
Smoking
What % of smokers develop significant COPD?
20%
When would COPD tend to develop in non smokers?
Asthma
a1-antitrypsin
What is 1 pack year?
1 pack a day for a year
How many pack years does it usually take to develop COPD?
20 pack years
What is COPD defined by?
Airflow obstruction
Pathology of COPD
Luminal obstruction due to small airway narrowing and can be worsened by inflammation and mucus, leading to progressive breathlessness on exertion, along with coughing and wheezing
Breakage of alveolar cell membranes
What is a prime feature of COPD?
Mucus secretion
What is chronic bronchitis?
Sputum produced every day for at least 2 years
What is ACOS?
Asthma/COPD overlap syndrome
What conditions overlap to make up COPD?
Chronic bronchitis
Emphysema
Type of airflow obstruction in asthma
Reversible
Type of airflow obstruction in COPD
Fixed airflow obstruction
Presentation of COPD
SOB - gradual onset - little variation - progressively getting worse Cough - long history of 'smokers cough' - clear of mucoid sputum Wheeze - typically on exertion Progressive difficulty in performing ADLs Weight loss (severe disease,
Typical COPD patient
Patient >40+ years
Smoker / ex smoker
SOB on exertion
Cough
Differential diagnosis of COPD
Asthma Lung cancer LVF Fibrosing alveolitis Bronchiectasis TB Recurrent PE
If the patient has symptoms of COPD with haemoptysis, what conditions must be looked into?
Lung cancer
TB
Bronchiectasis
Examples of causes of peripheral oedema
Cor pulmonale
Severe disease
Respiratory failure
Signs of COPD
SOB walking into clinic, undressing Pursed lips Accessory muscles Cyanosis CO2 flap, tremor (B-agonists) Effects of steroids Hyperexpanded (barrel) chest Decreased expansion Less than 3 finger spaces between manubrium and larynx Laryngeal descent Paradoxical movement of ribs and abdomen Decrease in cardiac dullness to percussion Decreased breath sounds Prolonged expiration with wheeze Palpable liver Cor pulmonale
Why does pursed lips help in COPD?
Generates a bit more of a positive pressure which causes the airways to open up a bit more
Signs of steroid use
Thin skin
Bruising
Cushingoid
Do crackles occur in COPD?
NO
Signs of cor pulmonale
Increased JVP
Hepatomegaly
Ascites
Oedema
What are acute exacerbations of COPD caused by?
Viral/bacterial infection
Causes of acute exacerbation of COPD
Viral/bacterial infection
Sedative drugs
Pneumothorax
Trauma