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Respiratory System & CVS Physiology Year 1 > COPD Clinical Features > Flashcards

COPD Clinical Features Flashcards

1
Q

What is the definition of COPD?

A

Chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible, common, preventable and treatable disease with persistent respiratory symptoms and airflow limitation.

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2
Q

What is incidence?

A

A new number of cases is being diagnosed within a certain time period.

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3
Q

What is the prevalence?

A

The number of cases in a population at any specific point in time.

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4
Q

What is the aetiology of COPD?

A 
#1 is smoking
#2 Biomass fuel cooking and heating
#3 Occupations such as agriculture, mining, brick making, welders, construction.
#4 Female and old age
#5 Low socioeconomic status
#6 Asthma and chronic bronchitis 
#7 Childhood infection
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5
Q

What is Alpha 1 Antitrypsin deficiency?

A

it is a rare inherited disease with early onset of COPD (under 45 years)

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6
Q

What is alpha 1 antitrypsin?

A

It is a protease inhibitor made in the liver which limits the damage caused by activated neutrophils releasing elastase in response to infection/smoking.

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7
Q

What are triggers that may make you think of alpha 1 antityrpsin?

A
  • Someone who is very young
  • Basal predominance to emphysema
  • Liver fibrosis or cirrhosis
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8
Q

What do smokers normally have?

A

They have more respiratory symptoms and lung function abnormalities, greater annual rate of decline in FEV1, greater COPD mortality

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9
Q

How does smoking affect a foetus?

A

It affects fetal lung growth and the priming of the immune system.

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10
Q

What are the main symptoms of COPD?

A

Cough, Breathlessness, Sputum, chest infections, wheezing, weight loss, fatigue, swollen ankles.

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11
Q

What are some identifying factors of COPD?

A

Age
Smoking history
Onset/Progression

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12
Q

What are examination finding of diagnosed COPD?

A 
Cyanosis 
Raised JVP
Cachexia
Wheeze
Pursed lip breathing 
Hyperinflated chest
Use of accessory muscles 
Pulmonary oedema
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13
Q

What is JVP?

A

It is the vertical distance between the highest point at which pulsation of the jugular vein can be seen and the sternal angle.

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14
Q

What is cachexia?

A

The body overzealously breaks down skeletal muscle and adipose tissue.

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15
Q

Is there any diagnostic test for COPD?

A

No

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16
Q

What are the criteria for diagnosing COPD?

A
  • Typical symptoms
  • Over 35 years of age
  • Presence of risk factor
  • Absence of clinical features of asthma
  • Airflow obstruction done by post-bronchodilator spirometry
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17
Q

What is end term COPD?

A

It is not part of the staging process, it is more a global assessment of the patient.

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18
Q

What type of radiological imaging is useful when trying to diagnose COPD?

A

X-Ray

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19
Q

What is hyperinflation shown as in an X-Ray?

A

More than six anterior ribs and ten posterior ribs counted from the mid clavicular line.

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20
Q

What can you do if youre not sure if the patient has asthma?

A

Pulmonary function tests:

  • Lung volumes: Increased residual volume and increased lung capacity (emphysema)
  • transfer factor: reduced transfer factor (COPD rather than asthma)
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21
Q

What ratio for residual capacity/total lung volume is diagnostic of emphysema?

A

> 30%

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22
Q

What are the signs of the acute exacerbations?

A
  • Shortness of breath
  • Wheeze
  • Chest tightness
  • Cough
  • Sputum
  • Unable to smoke
  • Systemic upset
  • Temperature
  • Fatigue
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23
Q

What are the sign of severe exacerbations?

A 
Breathless (RR >25/min)
Accessory muscle use at rest 
Purse lip breathing 
Cyanosis 
Decrease in exercise tolerance
Signs of sepsis 
Fluid retention
Confusion
24
Q

What can trigger exacerbations?

A

Changes in air quality
Pneumothorax
Blood clots
Changes in medication, Viral and bacterial infections.

25
Q

How do you measure sevrity of COPD?

A
  • Spirometry
  • Nature and magnitude of symptoms
  • History of moderate and severe exacerbation and future risk (number per year, hospitalization)
  • Presence of co-morbidity (Heart disease, Atrial Fibrillation: irregular heart beat, Obesity.
26
Q

What happens to ventilation and perfusion in COPD?

A

There is a matched reduction in the ventilation and perfusion.

27
Q

What happens during type one respiratory failure?

A

People are hypoxic only and have a reduced partial pressure of oxygen in the blood.

28
Q

What happens during type 2 respiratory failure?

A

There is a reduced partial pressure of oxygen in the blood and an increased partial pressure of carbon dioxide (which is mainly due to ventilatory failure)

29
Q

What happens in ventilatory failure?

A

It only occurs in people with severe COPD, its difficult to get oxygen in and so as a result they are hypoxic, but it’s also difficult to get carbon dioxide out, there is very severe destruction of the lung.

30
Q

What is hypercapnea?

A

Build up of carbon dioxide, at greater risk of dying

31
Q

What is a hypoxic drive?

A

They rely on chemo-receptors in the carotid body and the aortic arch to detect a drop in oxygen levels.

32
Q

How is oxygen administered for a COPD patient?

A

Use controlled oxygen devices with a lower oxygen saturation of about 88% to 92% saturation.

33
Q

What is cor pulmonale?

A

It is essentially right sided heart failure as a result of lung disease, if shunting occurs for too long it can lead a back pressure in the pulmonary arteries. increased thickness of the muscle on the right side of the lung and more pressure on the left side of the lung.

34
Q

What is secondary polycythaemia?

A

The body produces increased erythropoietin in response to low oxygen levels, Increases hemoglobin, increases hematocrit, increases blood viscosity.

35
Q

Is COPD a cause of finger clubbing?

A

No

36
Q

True/False: 1 in 8 hospital admission is related to COPD

A

True

37
Q

Why does obstruction of the airways occur?

A

Small-airway narrowing - and can be worsened by inflammation and mucus, leading to progressive breathlessness on exertion, along with coughing and wheezing.

38
Q

What causes luminal occlusion?

A

Secretion of mucus and inflammatory exudate. Thickening of airway wall

39
Q

What happens to elasticity and alveolar attachments?

A

Loss of elasticity and disrupted alveolar attachments

40
Q

What causes COPD apart from smoking?

A

Passive smoking Maternal smoking (Reduces FEV1 and increases respiratory illness) Air pollution Occupation (jobs exposing to dusts, vapours, fumes)

41
Q

What is the rate of decline of FEV1?

A

Non-smoker - 30 ml/yr SMOKER - 50 ml/yr

42
Q

What are the differential diagnosis for COPD?

A

COPD Asthma Lung cancer Left ventricular failure Fibrosing alveolitis Bronchiectasis Rarities: TB, recurrent pulmonary emboli

43
Q

What does haemoptysis suggest rather than COPD?

A

Lung cancer, TB, Bronchiectasis

44
Q

What does weight loss indicate?

A

Severe disease, TNF alpha

45
Q

What is a typical past medical history?

A

Asthma as a child, adolescence Respiratory diseases Ischaemic heart disease

46
Q

What are the signs of COPD?

A

Breathless walking in to clinic, undressing, Pursed lip breathing, accessory muscles, Cyanosis CO2 flap, Tremor (beta-agonists), Effects of steroids: tissue skin, bruising, Cushingoid, Hyperexpanded chest, Laryngeal descent, Paradoxical movement of ribs and abdomen, Decrease cardiac dullness to percussion
Decreases in breath sounds (no crackles) Prolonged expiration with wheeze, Palpable liver, Cor pulmonale: increased jugular venous pressure, hepatomegaly, ascites, oedema

47
Q

What is the effect of gas trapping on lung volumes?

A

Increase in residual volume, Increase in total lung capacity, RV/TLC is greater than 30%

48
Q

What are the findings in carbon monoxide gas transfer?

A

Decreased gas transfer
(decreased TLCO which is the diffusing capacity for carbon monoxide)
Decreased KCO (KCOmeasures the integrity of the blood–gasbarrier)

49
Q

What is the response to oral corticosteroids and bronchodilators?

A

Minimal

50
Q

What does significant bronchodilator/steroid response suggest?

A

Asthma

51
Q

What will a chest radiograph show?

A

Hyperinflated lung fields, Flattened diaphragms, Lucent lung fields, Bullae
(Can rule out bronchogenic carcinoma, interstitial disease, left ventricular failure)

52
Q

What can a full blood count be indicative of?

A

Secondary polycthaemia.

53
Q

What does an ECG tell you?

A

Right axis deviation, P Pulmonale, T wave inversion.

54
Q

What does sputum analysis indicate?

A

MC and S (Mucous culture and sensitivites) -S pneumoniae, H influenzae, M catarrahlis

55
Q

What is the management for acute exacerbations?

A

Nebulised bronchodilator beta 2 and anti-muscarinic, O2, Oral/iv corticosteroid, antibiotic, diuretic, iv aminophyline, respiratory stimulant, NIV

Respiratory System & CVS Physiology Year 1 (58 decks)

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