Clinical features od COPD Flashcards
(34 cards)
What is the main key symptoms of COPD?
Wheezing, SOB, Ongoing cough, Recurring chest infection and sputum
What is the main characterization of COPD and what diseases can overlap/can branch from this?
COPD is fixed airflow obstruction
Chronic bronchitis and emphysema
What is the main aetiology of COPD?
Smoking and occupations such as construction and mining. Gender: Female Age: getting older Asthma Chronic bronchitis Childhood infection
What is alpha-1 antitrypsin deficiency?
Rare, inherited disease that casues imbalanced production of elastase which destroys elastin
Early onset COPD <45yrs
What is alpha-1 antitrypsin?
protease inhibitor made in the liver.
Limits damage caused by activated neutrophils releasing elastase in response to infection/cigarette smoke
This elastase can destroy the alveolar tissue too
anti1 takes away the elastase enzyme.
When its not there, the elastase attacks the tissue and damages the body
Why does smoking contribute to the increased risk of developing COPD?
Greater annual rate of decline in FEV1 (fletcher-peto curve)
Environmental Tobacco Smoke (ETS) may be a factor
What is the effect of smoking on pregnancy?
Affects foetal growth and priming of the immune system
What are the two groups of COPD patients usually?
Initial presentation of symptoms through to a diagnosis of COPD (UNDIAGNOSED)
Acute exacerbation (flare-up) of COPD (DIAGNOSED)
What is the initial presentation of COPD?
Varied:
Shortness of reath Chest infection recurrent Ongoing cough Wheeze Productive cough/sputum
Age, smoking,
What are examples of end stage presentations?
Weight loss (calorie consumption)
Fatigue
Decreased exercise tolerance
Ankle swelling (if causing heart failure)
Describe some of the examination findings
Cyanosis = pursed lips
Raised JVP = hyperinflated chest
Cachexia = muscle weakness
Wheeze = Peripheral oedema
What is the diagnostic test?
No single diagnostic test: relies of symptoms, history and spirometry
Diagnose COPD if meets all criteria: Typical symptoms over 35years Presence of risk factors (smoking/occupation) Absence of clinical features of asthma
and airflow obstruction confirmed by post bronchodilator spirometry
What does a spirometry and a bronchiodilator demonstrate?
Lack of reversibility
What are the 4 stages identified using spirometry?
Stage 1, mild — FEV1 80% of predicted value or higher. With these values, a
diagnosis of COPD can only be made on the basis of respiratory symptoms.
Stage 2, moderate — FEV1 50–79% of predicted value.
Stage 3, severe — FEV1 30–49% of predicted value.
Stage 4, very severe — FEV1 less than 30% of predicted value.
What is the predicted FEV1 value for stage 2?
50–79%
What is the predicted FEV1 value for stage 3?
30-49%
What is the predicted FEV1 value for stage 4?
Les that 30%
Why do a chest X-ray for the COPD patient?
Excludes alternate pathology and screen for malignancy
What changes do you see in the chest xray of a patient with COPD?
Bulla, flat diaphragm, hyperinflation and vascular hila
What is the prevalence of COPD and is it increases or decreasing?
And how many are undiagnosed?
50% undiagnosed
Prevalence increases
2% population with COPD
Is incidence decreasing?
Yes
What are the things to look out for in a pulmonary function test for lung volumes?
↑ residual volume
↑ total lung capacity RV/TLC > 30%
Abdnomal transfer factors for pulmonary function tests?
Reduced gas transfer
↓ DLco
↓ Kco
Which zone does emphysema occur in smokers?
Upper zone
