COPD - Clinical Features Flashcards
What is COPD?
- Chronic Obstructive Pulmonary Disease
- characterised by its irreversibility.
- It is made up of chronic bronchitis and emphysema.
How is chronic bronchitis defined?
Cough with sputum production for at least 3 months in 2 consecutive years.
What is the pathophysiology of chronic bronchitis?
- chronic infection results in chronic infiltration of the respiratory submucosa by inflammatory cells.
- resulting in mucous gland hyperplasia and;
- smooth muscle hypertrophy
- thickening of airway wall
- luminal occlusion by secretions of mucous and inflammatory exudate
How is emphysema defined?
- permanently dilated airways distal to the terminal bronchioles with alveolar destruction and bullae formation.
- associated with alpha-1 antitrypsin and increased elastase activity.
What is the pathophysiology of emphysema?
- alveolar walls are destroyed resulting in bullae formation and the fusion of adjacent alveoli.
- results in decreased surface area for gas exchange.
- reduced elastic recoil with subsequent air trapping.
What are the causes of COPD?
6 points
GASHES
- Genetics: alpha-1 antitrypsin deficiency results in loss of protection against proteases (i.e. increased elastase activity).
- Air pollution
- Smoking
- Host factors
- Exposure (e.g. occupational risk)
- Second-hand smoke exposure
What is the main cause of COPD?
Smoking
What other host factors predispose a person to COPD development?
Socio-economic status
Asthma/co-morbidities
Childhood infection
What is the term given to COPD sufferers where chronic bronchitis dominates?
Blue bloaters
What is the term given to COPD sufferers where emphysema dominates?
Pink puffers
What sort of inflammation occurs in COPD?
neutrophilic airway inflammation
After 25 years of smoking, at least _____ of smokers without initial disease will have clinically significant COPD (stage ___ or worse) and ____ will have any COPD.
25%
2
30-40%
Smoking in pregnancy may affect ______________ and priming of the _________.
Foetal lung development
immune system
How do you calculate pack years?
No. smoked per day/no. per pack * No. of years smoked
How many pack years is typical of a COPD patient?
> 20
What are the initial typical symptoms presented before COPD diagnosis?
- Shortness of breath
- Productive cough/sputum
- Ongoing cough
- Recurring infections
- Wheeze
Symptoms will have persisted over a long time and will gradually be getting worse.
What is important to gather from the patient history?
- Age
- Smoking history
- Recurrence of symptoms
What are the less common symptoms presented before a COPD diagnosis?
- Weight loss (calorie consumption)
- Fatigue
- Decreased exercise tolerance
- Ankle swelling (if causing heart failure)
- Cor Pulmonale
What is a typical patient with COPD?
40+ years, smoker/ex-smoker, breathless on exertion, cough
What would be the differential diagnosis when diagnosing a 40+ years patient who smokes or has done in the past, is breathless on exertion and has a cough?
COPD Asthma Lung cancer Left ventricular failure Fibrosing alveolitis Bronchiectasis Rarities: TB, recurrent pulmonary emboli
Describe the breathlessness that comes with COPD?
Occurs on exertion at first with little variation and has a gradual onset. It worsens until the patient is breathless at rest.
Describe the cough and sputum that comes with COPD?
- long history of smokers cough
- clear or mucoid sputum
- moves from early morning in winter months to all day in winter to all day all year
If there is haemoptysis, is it COPD?
No, it could be lung cancer, TB or bronchiectasis.
Describe the wheeze associated with COPD.
- minor symptom (not as important as in asthma)
- it is typical on exertion
