Clinical Features of COPD

Question 1

Define COPD

Answer 1

A chronic slowly progressive airflow obstruction that shows little change over months. Most impairment is fixed but some can be reversed with bronchodilators

Question 2

How does COPD relate to Chronic Bronchitis & emphysema?

Answer 2

Most people with COPD have it as a result of chronic bronchitis & emphsema. Some also have Asthma.

Question 3

What obstructs the airways in COPD?

Answer 3

• Fibrosis thickens the airway walls
• Mucuous & inflammatory exudate blocks the airway
• Lymphoid follicles in severe disease
• Loss of eleasticity due to broken alveolar attachments.

Question 4

Why defines chronic bronchitis?

Answer 4

Coughing up sputum almost every day for 4 or more months of the year for 2 or more years

Question 5

What are the common causes for COPD?

Answer 5

• Smoking ~85%
• Chronic Asthma
• Maternal Smoking
• Air pollution
• Occupation
• Genetics

Question 6

What occupations can lead to COPD?

Answer 6

Mining/tunneling
Construciton
Work with plastics, leather, textiels

Question 7

What genetic conditions can lead to COPD?

Answer 7

Enzyme deficiencies,

Specifically Alpha1-antitrypsin deficiency results in emphysema.

Question 8

What does alpha1-antitrypsin normally do?

Answer 8

Neutralises the enzymes released by neutrophils so they dont damage the tissue or cause inflammation

Question 9

What level of smokin is indicative of COPD?

Answer 9

> 20 pack years

Question 10

How does FEV1 decline in a normal person and a smoker?

Answer 10

~30ml/yr

In a smoker more like 50-80ml/yr

Question 11

How do we rule out asthma when diagnosisng a patient?

Answer 11

If the symptoms are constant then its not asthma

Question 12

When would we consider lung cancer or bronchiecstasis over COPD?

Answer 12

If there is harmoptysis

Question 13

What is smoker’s cough?

Answer 13

Coughing up clear or mucoi sputum, gradually becomes more regular over time.
(almost all resolve if they stop smoking)

Question 14

What are the common symptoms of COPD?

Answer 14

Wheeze
Weight loss in severe disease
Peripheral Oedema (due to cor pulmonale via respiratory failure)
SOBOE
Cough

Question 15

What illnesses do you look for in a history when diagnosing COPD?

Answer 15

Childhood Asthma
Respiratory Disease
Ischaemic heart failure

Question 16

Why would you ask about the effect of previous breathing meds?

Answer 16

To see if theyre effects correlate with what youd expect form COPD. As opposed to asthma etc

Question 17

What signs might you see in the clinic?

Answer 17

Breathless with pursed lips and accessory muscle involvement.
Cyanosis
CO2 tremor
Hyperinflated chest
Larygeal descent
Slow expiration
Palapable Liver

Question 18

How do we treat a CO2 trmor?

Answer 18

With a B-agonist

Question 19

How far can the larynx descend?

Answer 19

As far as the manubrium

Question 20

What FEV1 & FEV1/FVC valuse are expected in COPD?

Answer 20

• FEV1 < 80% of predicted

- FEV1/FVC < 70% of predicted

Question 21

What are the grades of airflow obstruction as measured by FEV1?

Answer 21

80% or above - Fine
50-79% - Moderate AFO
30-49% - Severe AFO
<30% - Very Severe AFO

Question 22

What is the point of pulmonary function tests?

Answer 22

To detect evidence of emphysema