COPD Signs, Symptoms, Treatments, diagnosis

Question 1

State COPD clinical apearance

Answer 1

• cough with white/clear sputum
• Wheezing and breathlessness
• Symptoms worsened by weather, atmospheric conditions
• Reduced muscle mass, general weakness, hypertension, osteoporosis

Question 2

What are typical signs for COPD?

Answer 2

Mild COPD: No signs, quiet wheezes

Severe COPD: Tachypnoea, poor chest expansio, accessory muscles

Question 3

What features would make you suspect COPD? (note that no individual factor is diagnositc)

Answer 3

• History of breathlessness and sputum production in someone who smokes
• Alpha-1-antitrypsin deficiency

Question 4

What result would you expect to see in spriometry test for a COPD patient?

Answer 4

• FEV/FVC = <70%

Question 5

What are possible findings of COPD on an X-ray

Answer 5

• flattened diaphragm
• lung hyperinflation (due to air trapping)

Question 6

What other imaging can be useful if an X-ray was not clear?

Answer 6

CT

Question 7

What discrepancies would you aspect to see in arterial blood gas tests for COPD patient?

Answer 7

• often normal at rest, but get worst during exercise
• In advanced COPD, there may be hypoxemia and hypercapnia

Question 8

Management and treatment of COPD

Smoking cessation: Most useful measure is to suggest to the patient to stop smoking. This can slow down the rate of disease.

Bronchodilators: Beta adrenergic agonists, Antimuscarinic drugs, Xanthines

Corticosteroids: Prenisolone - looking for FEV increase of 15%

Question 9

Give examples of antimuscarinic drugs

Answer 9

• Tiotropium
• Ipratropium

Question 10

GIve examples of a corticosteroid used to treat COPD

Answer 10

Prednisolone

Question 11

Label the following components of the spirometry output

Answer 11

Question 12

Define Tidal volume

Answer 12

the change in volum of lungs between inspiration and expiration in relaxed breathing

Question 13

Define inspiratory reserve volume

Answer 13

The amount of air that can be inspired beyond the tidal volume

Question 14

Define expiratory reserve volume

Answer 14

The amount of air that can be expelled after tidal expiration

Question 15

Define residual volume

Answer 15

The amount of volume of air that remains lungs after a full breath - essentially cannot be breathed out - prevents lungs from collapsing

Question 16

Define inspiratory capacity

Answer 16

The total amount ofair that can be inspired after a tidal expiration

Question 17

Define functional residual capacity

Answer 17

The amount of air in the lungs after a tidaly expiration

Question 18

Define vital capacity

Answer 18

The maximum amount of air that can be expelled from the lungs after maximum inhalation

Question 19

Define forced expiratory volume

Answer 19

The maximal volume of gas which can be expired from the lungs in the first second of expiration from full inspiration

Question 20

What are the 3 main facotrs which affect FEV1?

Answer 20

Height, age, gender

Question 21

Define the Forced Vital capacity (FVC)

Answer 21

Amount of air that can be exhaled from the lungs after taking the deepest breath possible .

Question 22

What is the FEV1/FVC ratio

Answer 22

The proportion of FVC which can be expelled during the first second of expiration, expressed as a percentage.

Question 23

Define peak expiratory flow

Answer 23

Tests how quickly a person call exhale.

Question 24

Explain the differences you would expect to see in spirometry tests between obstructive lung disease and restrictive lung disease. Explain the difference between obstructive and restrictive lung disease (give examples of each)

Answer 24

Obstructive: When airways are physically obstructed in some way, making it difficult to breath. FEV is lowered with normal FVC. FEV1 and FVC ratio is LOW. Examples include asthma, COPD, cystic fibrosis

Restrictive: Lung expansion is restricted in some way; FEV/FVC ratio is normal although absolute values are lowered - Examples include pulmonary fibrosis (reduced compliance), Sarcoidosis, Scoliosis, Neuromuscular disease

Question 25

State tests for COPD

Answer 25

• X-ray
• Spirometry
• Bloods (for Alpha-1-Antitrypsin deficiency) - also to rule out iron deficiency which can cause similar symptoms