Clinical features of COPD

Question 1

What does prevelance mean?

Answer 1

No. people living with the disease (water in bath tub)

Question 2

What is incidence?

Answer 2

Incidence = Number of new cases in a defined time period i.e. per year (information on risk of contracting the disease) (amount of new water being added to the bath tub)

Question 3

Is COPD more common in men or women?

Answer 3

Men, but this is now plateauing.

Question 4

Does the prevalence of COPD increase or decrease with social deprivation?

Answer 4

The prevalence of COPD increases with social deprivation; unclear whether this reflects exposure to cigarette smoke or to air pollutants, poor nutrition, crowding or other factors related to low socioeconomic status

Question 5

Within which care system is COPD usually managed?

Answer 5

Primary Care

Question 6

What is the no.1 cause of COPD

Answer 6

Smoking

In high- and middle-income countries tobacco smoke is the biggest risk factor, meanwhile in low-income countries exposure to indoor air pollution, such as the use of biomass fuels for cooking and heating, causes the COPD burden.

Also occupation can have an effect

Question 7

An analysis of the large U.S. population-based National Health and Nutrition Examination Survey III survey of almost 10,000 adults aged 30-75 years estimated the fraction of COPD attributable to workplace exposures was 19.2% overall, and 31.1% among never-smokers. True or False?

Answer 7

True

Question 8

What can predispose COPD?

Answer 8

Increasing age and female sex,low socio-economic status, pre-existing asthma, chronic bronchitis, recurrent childhood infection

Question 9

What is Alpha-1 Antitrypsin Deficiency? What disease does it lead to and when?

Answer 9

Rare, inherited disease, presents with early onset COPD <45yrs

Question 10

Where is Alpha-1 antitrypsin (AAT) made and what is it’s function?

Answer 10

Alpha-1 antitrypsin (AAT) is a protease inhibitor made in the liver.
Limits damage caused by activated neutrophils releasing elastase in response to infection/cigarette smoke.

Question 11

What happens when there is low or absent amounts of Alpha-1 Antitrypsin?

Answer 11

alveolar damage and emphysema

Question 12

What else can be affected by Alpha-1 Antitrypsin Deficiency?

Answer 12

Liver fibrosis or cirrhosis

basal predominance to emphysema

Question 13

How can smoking in pregnancy affect the foetus?

Answer 13

may affect foetal lung growth and priming of the immune system

Question 14

What % of smokers will develop COPD during their lifetime?

Answer 14

Less than 50%. After 25 years of smoking, at least 25% of smokers will have clinically significant COPD (stage 2 or worse)

Question 15

True/false:
Smokers have…
a)Less respiratory symptoms and lung function abnormalities
b)Smaller annual rate of decline in FEV1 (Fletcher-Peto Curve)
c)Greater COPD mortality rate than non-smokers

Answer 15

a) false b)false c)true

Smokers have…
MORE respiratory symptoms and lung function abnormalities
GREATER annual rate of decline in FEV1 (Fletcher-Peto Curve)
Greater COPD mortality rate than non-smokers

Question 16

Why could screening smokers’ lung function in early middle age, help to prevent severe or fatal COPD

Answer 16

The effect of quitting at age 45 can make the difference between a normal lifespan and premature death, because the subsequent rate of loss may revert to normal, extending the period of time before FEV1 is reduced to disabilitating or death. The screening may help to persuade those to stop smoking.

Question 17

What is JVP and will it be raised in COPD?

Answer 17

Jugular Venous Pressure. Yes, it will be raised

Question 18

What are the clinical signs of COPD?

Answer 18

Cyanosis Pursed lip breathing
Raised JVP Hyperinflated chest
Cachexia (severe weight loss) Use of accessory muscles
Wheeze Peripheral oedema

Question 19

What are the criteria to diagnose COPD?

Answer 19

Typical symptoms
>35 years
Presence of risk factor (smoking or occupational exposure)
Absence of clinical features of asthma (lack of reversibility - demonstrated on post-bronchodilator challange)

AND
Airflow obstruction confirmed by post-bronchodilator spirometry

Question 20

What are the FEV1% of values (of predicted value) for GOLD classification - spirometry:
Stage 1 - mild
Stage 2 -moderate
Stage 3, severe
Stage 4 very severe

Answer 20

Doesn’t always corroloate to how unwell they are.

FEV1/FVC <0.7 post bronchodilator
Demonstrates lack of reversibility
Only done as if working up ?COPD –
not routinely

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.

Question 21

Where is COPD mainly managed

Answer 21

Primary care

Question 22

What clinical features could make you think of Alpha-1 Antitrypsin deficiency?

Answer 22

A young person presenting with COPD features, very basal predominance to their emphysema - usually emphysema goes to the tops of the lungs as it’s caused by inhalation toxicity from cigarettes. Liver fibrosis or cirrhosis.

Question 23

What are the symptoms of COPD

Answer 23

Common:
Cough
Breathlessness
Sputum
Frequent chest infections
Wheezing
Other symptoms
Weight loss
Fatigue
Swollen ankles

Question 24

What is the mMRC Dyspnoea scale and what numbers does it go from?

Answer 24

Modified Medical Research Council - Dyspnoea (breathing difficulty) scale

0-4
0= no issues, ony strenuous exercise
1= short of breath hurryng on ground level/up a slight hill
2= Walk slower/ otherwise have to stop of breath every so often
3= stop for breath after about 100yrds on level ground
4 = too breathless to leave house. Breathless on dressing

Question 25

Why does a chest X-ray help in the diagnosis of COPD?

Answer 25

Excludes other pathologies eg. lung cancer.
Can also see typical signs of COPD on x-ray:
Hyperinflation at the bottom of the lungs(more than 6 anterior or 10 posterior ribs showing
Flat diaphragm
Reduced lung markings at the top
Small heart (being squashed)
vascular hila (due to pulmonary hypertension)

Question 26

Be wary of multiple conditions. Obese patients often have restrictive lung disease which can lead to a falsly good FEV1/FVC ratio, but still have bronchitis? true or false?

Answer 26

true

Question 27

COPD: An increase/decrease in residual volume?
Increase/Decrease in total lung capacitty?
Residual vol/Total lung capacity greater than what?

Answer 27

Increase
Increase(emphysema??)
30% -pretty diagnostic of emphysema

Question 28

What further diagnostic test can be done to help diagnose COPD?

Answer 28

High resolution Computed Tomography (HRCT) - High-res CT

Looking for centrilobular emphysema
Honeycombing, lung cysts and bronchiectasis and signet ring signs = other conditions

Question 29

What are the signs of a sever exacerbation of COPD?

Answer 29

Resp rate more than 25/min
Accessory muscles at rest
Purse lip breathing
Cyanosis (less than 92% O2 sats)
Sig. Decrease in exercise tolerance
Signs of sepsis (if caused by infection)
Fluid retention
Confusuon

Question 30

Other tha infections (viral/bacterial, most common) what can cause exacerbatio ?

Answer 30

Change in air quality
Other complications of resp. Diseases eg pneumothorax
Blood clots

Question 31

What is type 1 and type 2 respiratory failure?

Answer 31

Type 1 = hypoxic (low pO2)

Type 2 = ventilatory failure (low pO2 and high pCO2)

Question 32

Will everyone with COPD develop type 2 resp failure?

Answer 32

No, not everyone but is possible. Usually only at end stage of the disease.

Question 33

What are the signs of retained CO2 (hypercapnia)?

Answer 33

Drowsy

Flapping tremor

Question 34

What is Secondary polycythaemia

Answer 34

The bodys responce to low O2, increase in erythropoitin, increase in rbc, increase in viscocity.

Question 35

Is COPD a cause of finger clubbing?

Answer 35

no

Question 36

What treatment givesyou the best value for money in QALY (quality-adjusted life-years)?

Answer 36

flu vaccination, smoking cessation and pulmonary rehabilitation. Non-pharmacological interventions in COPD are very effective and very important.

Question 37

Is Terbutaline a short-acting beta agonist used as a reliever medication in asthma.

Answer 37

Yes