COPD, asthma and lung cancer Flashcards
Is COPD reversible?
No
What is COPD?
- Damage due to chronic inflammation that differs from that seen in asthma and which is usually the result of tobacco smoke
- Significant airflow obstruction may be present before the individual is aware of it
What is affected by COPD?
- Small and large airway
* Inflammation
What are the symptoms of COPD?
• Breathlessness (dyspnoea)
• Increased sputum production / purulence during exacerbations
• Cough
• Wheeze
o Monophonic wheeze- single tone suggests narrowing of larger airway
o Polyphonic wheeze-associated with COPD and more severe asthma
Causes of COPD
• Smoking (most important) • Pollution • Alpha1-antitrypsin (emphysema)- family history • Alpha 1 antitrypsin deficiency o Chromosome 14 o Autosomal recessive disorder o Over 70 different phenotypes o Basal emphysema o Co-dominant alleles o Proteinase inhibitor - protects tissues from neutrophil elastase
What is FEV1?
• Forced expiratory volume in 1 second (FEV1)
o Volume of air that can be expelled from maximum inspiration in the first second
o Time dependent and reflects airway caliber
What is forced vital capacity?
o The volume of air that can be forcibly expelled from the lung from the maximum inspiration to the maximum expiration
o Volume dependent and reflects lung volume and not caliber
o COPD normal to slightly lower FVC
o Fibrosis don’t have as much airway space
Will COPD patients have a higher or lower FEV1?
Patients with COPD will have far lower FEV1 but similar FVC.
Obstructive disease- FEV1:FVC ratio has to be less than 0.7 (70%)
What are the symptoms of asthma?
- Cold
- Nocturnal cough and wheeze
- Eczema deteriorated
- Chest symptoms particularly bad in morning
- Symptoms worsened despite increased treatment
- Hoarse voice and tremor- due to thrush and tachycardia
- Breathlessness
What is asthma?
- A chronic inflammatory disorder of the airways
- Airway hyper-responsiveness
- Recurrent episodes of wheezing & breathlessness
- Chest tightness, coughing, particularly at night or in the early morning
- Variable, airflow obstruction that is often reversible either spontaneously or with treatment
- Worse at night and in morning
- Triggered by cold/exercise etc
What are the signs of asthma?
- Tachypnoea (abnormally rapid breathing)
- Wheeze
- Accessory muscles of respiration
- Paradoxical pulse
- Over-inflation of chest
What is the pathology of asthma?
- Chronic inflammatory disorder of airways
- Hyper-reactive smooth muscle
- Increased basal tone
- Mucus hypersecretion
- Mucosal oedema
What are the risk factors of asthma?
- Genes
- 10x higher: first degree relative / maternal atopy
- Obesity
- Maternal smoking
How can people be protected from getting asthma?
- Breast feeding
* Early exposure to animals (hygiene theory)
What are the clinical features differentiating COPD with asthma?
Feature COPD Asthma
Smoker or ex-smoker
COPD- Nearly all Asthma- Possibly
Chronic productive cough
COPD-Common Asthma-Uncommon
Symptoms under age 35
COPD-Rare
Asthma-Often
Breathlessness
COPD-Persistent and progressive
Asthma- Variable
Night-time waking with breathlessness and/or wheeze
COPD- Uncommon Asthma- Common
Significant diurnal or day-to-day variability of symptoms
COPD-Uncommon Asthma-Common
