Lectures Flashcards
Describe the defining features and epidemiology of COPD
Disease of the poor- tend to smoke more and have worse diets.
Becoming more common.
More common in males.
Deaths reflect smoking trends
6th most common cause of death in UK
85% of COPD is due to smoking
15% of COPD is due to maternal smoking, occupation, chronic asthma (very rare), air pollution
State the symptoms of COPD
- Breathlessness- gradual onset
- Cough and sputum- clear (not haemoptysis), all the time
- Wheeze- typically on exertion
- Weight loss- indicates severe disease
- Peripheral oedema Cor pulmonale, respiratory failure
- lung volume increases as air cannot get out
- gas exchange decreases
State some questions that should asked while taking a history from a patient suspected for having COPD
PMH- childhood breathing problems, heart disease, asthma as a child
FMH- familial diseases
DXH- inhalers, beta blockers, aspirin
PSH- pets, occupation, exercise, psychosocial history, pack years
Describe what might be seen on an X ray of someone with COPD
Chest X ray:
Hyperinflated lung fields (> 10 posterior ribs) – it is harder to exhale than it is to inhale so the volume in the lungs slowly increases.
Flattened diaphragms
Lucent lung fields – less dense areas of lung tissue suggesting emphysema.
Bullae – cavities in the lung tissue from emphysema.
With COPD should the spirometry should obstructive or restrictive patterns?
obstructive
What are the two common conditions associated with COPD?
Chronic bronchitis
Emphysema
state some causes of COPD
- Smoking
- Pollution
- Occupation: dust
- Alpha-1-antitrypsin deficiency (allows elastin to be broken down by elastase therefore tissue destruction)
- Age
- Increasing in developing countries
State the morphological changes to vessels with chronic bronchitis
Large Airways
• Mucous gland hyperplasia (increase in size)
• Goblet cell hyperplasia (cilia is lost and transparent goblet cells cover the epithelium)
• Inflammation and fibrosis is a minor component
Small Airways
• Goblet cells appear
• Inflammation and fibrosis in long standing disease (vessels lose shape and look jaggy/disorganized)
What are the three types go emphysema ?
• CENTRIACINAR (Hole in the middle of the lung tissue surrounded by healthy lung tissue. Starts with bronchiole dilation. Tends to be in apical part of lung.)
Dilation based around respiratory bronchioles with preservation of distal alveoli
- PANACINAR (diffuse enlargement across the respiratory acini -> non-functional)
- PERIACINAR/SCAR (when bulla {emphysematous space greater than 1cm} form at the peripheral of lung. If bulla burst they can leak air and cause a spontaneous pneumothorax)
State the definition of COPD
Chronic obstructive pulmonary disease (COPD) is a chronic, slowly progressive disorder characterised by airflow obstruction that does not change markedly over several months. Most of the the lung function impairment is fixed, although some reversibility can be produced by bronchodilator (or other) therapy
¥ NO mention of symptoms
¥ NO mention of bronchitis or emphysema
¥ NO mention of smoking
What is the mortality of COPD
o 6th most common cause of death in UK (5th in world)
o 30,000 deaths per year (more men than women)
What are the main causes of COPD
85% - smoking
15% -
o Chronic Asthma- (rare) very small risk
o Passive smoking
o Maternal smoking
Reduces FEV1 and increases respiratory illness
o Air pollution
Prevalence of COPD increased with air pollution
Geographic & temporal associations between pollution, COPD symptoms, deaths & airflow obstruction
Globally burning of biomass (organic fuel: with poor ventilation) fuel (3 billion people), women & children
o Occupation
jobs exposing to dusts, vapours, fumes
Coal mining, hard rock mining, tunnel working, concrete manufacturing, construction, farming, foundry working, plastics, textiles, rubber, leather.
o 1-antitrypsin deficiency
1-antitrypsin neutralises enzymes released by neutrophils
Clinical signs of COPD during an examination
- Breathless walking in to clinic, undressing (Pursed lip breathing, accessory muscles)
- Cyanosis
- CO2 flap, Tremor (-agonists),
- Effects of steroids: tissue skin, bruising, Cushingoid
- Hyperexpanded (barrel) chest, expansion,
Can COPD symptoms be reversed?
- COPD has fixed airflow obstruction so will not be reversed by drugs (eg. Salbutamol) or oral corticosteroids.
- If reversible then would suggest asthma.
What is hypocapnia
a state of reduced carbon dioxide in the blood. Hypocapnia usually results from deep or rapid breathing, known as hyperventilation, eventually leads to alkalosis.
