COPD Flashcards
What are the main chronic conditions associated with breathlessness?
COPD
Asthma
Interstitial lung disease (Pulmonary fibrosis)
Bronchiectasis
Industrial or occupational lung diseases (asbetosis)
Lung cancer
What is asbestosis?
Chronic exposure to asbestos
What are the main causes of breathlessness?
Airways become inflamed and narrowed
Mucous plug, reduces cilia beating efficacy
Reduction in elasticity
What are the main acute conditions that cause breathlessness?
Flare up of asthma or COPD
Pulmonary embolism/clot in lungs
Pneumothorax/Collapsed lung
Accumulation of fluid of pleural cavity (heart failure), pleural effusion
What is dyspnoea?
breathlessness
What is orthopnea?
Breathlessness when lying flat
Why does heart failure contribute to dyspnoea?
Reduction in stroke volume due to inefficient contractile and diastolic time causes increased volume of blood in pulmonary capillaries –> accumulation of fluid within the pleural space
Why does orthopnea occur?
Systemic blood is redistributed, increasing volume present in the pulmonary capillaries
Reduction in respiratory rate when in sedentary position
Reduction in cardiac output due to decline in adrenaline.
Added pressure onto lungs due to increased fluid accumulation
Which cardiovascular/systemic conditions cause breathlessness?
Congestive heart failure Pulmonary oedema Valvular defects Acute coronary syndrome Anaemia
What happens during hyperventilation?
Smooth airway muscles and intercostal muscles become tense
Why does a panic attack result in breathlessness?
Exaggerated and accelerated build up of physical responses.
Respiratory rate increases
Adrenaline and cortisol is released
What are the symptoms of anxiety?
Syncope, sweating, vomiting, pounding heart, shaky limbs.
Why does obesity increase breathlessness?
Intercostal muscles weaken, weak muscles have a greater respiratory demand, requiring more oxygen to perform.
Increased effort to expire and be mobile.
Additional weight around abdomen and chest, restricts lung movement
Which BMI score is associated with obesity?
25+
What condition occurs due to obesity derived breathlessness?
Obesity hypoventilation
What is obesity hypoventilation?
Poor breathing contributes to reduced oxygen levels, and elevated carbon dioxide concentrations in blood.
What is grade 1 on the degree of breathlessness?
Not troubled by breathlessness except on strenuous exercise
Short of breath when hurrying on the level of walking up a slight hill
Grade 2
Walks slower than most people on the level, stops after a mile or so, or stops after 15 minutes walking at own pace
grade 3
What is grade four on the degree of breathlessness?
Stops for breath after walking about 100 yards or after a few minutes on level ground
What is grade five on the degree of breathlessness?
Too breathless to leave the house, breathless when undressing
What clinical investigations are performed to investigate FEV1 and FVC?
Breathing and lung function tests using a spirometer
How can the breathing rate be measured?
Number of breaths per minute
Auscultate and palpate the chest during breathing
Why should heart rate and rhythm be examined for patients presenting breathlessness?
To identify heart failures and the accumulation of fluid within the pleural cavities
What clinical examinations are performed for patients presenting breathlessness?
Monitor temperature Measure, weight, waist, height, BMI Examine the head, neck, armpits, and identify swollen lymph glands for signs of pathology Percussion Auscultation Palpate
What does crackling indicate during auscultation?
Pulmonary fibrosis
How is blood saturation monitored?
Pulse oximeter
Why is smoking a considerable factor?
Susceptibility to lung cancer, emphysema, COPD and CVD
Why should a chest radiography be performed?
Identify signs for heart failure, and pulmonary pathology (pleural effusion)
Why should an ECG be performed?
Signs of heart failure, arrhythmia, and pulmonary embolism
Why should spirometry be performed?
Signs of obstructive or restrictive patterns associated with interstitial lung disease
Why should a full blood count be performed?
Check for anaemia
Why should urea and electrolytes + random blood glucose be measured?
Test for renal failure and diabetes (Metabolic acidosis and breathlessness)
Why is a thyroid function test conducted?
Detect thyroid disease
What factors are measured to assess heart failure for patients without history of myocardial infarction?
BNP
NTproBNP
When should a chest radiography and referral to respiratory specialist occur?
Patients with suspected bronchiectasis
Define FEV1:
Forced expiratory volume in the first second
The volume of air that is expelled from the lungs within one second
Which parameters are compared during measurement of FEV1/FVC`?
Height, gender and age
What is the average deviation for FEV1?
80-120%
How are the FEV1 values impacted by an obstructive disorder?
Reduction
Obstruction to airflow, reduces the rate of air being transmitted across the bronchioles and expired
What is FVC?
Forced vital capacity
The volume of air that can be forcibly expelled from the lungs after complete inspiration (L)
What is the average FEV1/FVC ratio?
70-80% (Declines with age)
How is the FEV1/FVC ratio influenced in obstructive conditions?
Diminished due to increased airway resistance (FEV1), FVC is minimally reduced, therefore fev1 is significantly effected, resulting in a reduced ratio
What is the average range for COPD for FEV1/FVC ratio?
less than 80%-45%
How is the FEV1/FVC ratio impacted in restrictive conditions?
FEV1 and FVC both reduced proportionally, therefore the value may be normal or increased due to decreased lung compliance
What factors reduces FVC?
Cancer, emphysema, pneumonia, fibrosis, muscular dystrophy, cystic fibrosis and scoliosis
What two conditions are classified under COPD?
Emphysema and chronic bronchitis