Clinical Features of COPD

Question 1

What is the definition of COPD?

Answer 1

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.

Question 2

What does the definition of COPD not mention?

Answer 2

NO mention of symptoms NO mention of bronchitis or emphysema NO mention of smoking

Question 3

Why does obstruction of the airways occur?

Answer 3

Small-airway narrowing - and can be worsened by inflammation and mucus, leading to progressive breathlessness on exertion, along with coughing and wheezing.

Question 4

What causes luminal occlusion?

Answer 4

Secretion of mucus and inflammatory exudate. Thickening of airway wall

Question 5

What happens to the airway wall?

Answer 5

Thickens

Question 6

ACOS?

Answer 6

Asthma, COPD, overlap syndrome

Question 7

What happens to elasticity and alveolar attachments?

Answer 7

Loss of elasticity and disrupted alveolar attachments

Question 8

What causes COPD (apart from smoking?)

Answer 8

Passive smoking Maternal smoking (Reduces FEV1 and increases respiratory illness) Air pollution Occupation (jobs exposing to dusts, vapours, fumes)

Question 9

What are the two genotypes for alpha 1 antitrypsin deficiency? (75 variants)

Answer 9

Normal (86% UK) - PiMM Troublesome genotype (PiZZ)

Question 10

What is the effect of alpha 1 antitrypsin ?

Answer 10

Neutralises enzymes released by neutrophils.

Question 11

What percentage of smokers develop clinically significant COPD?

Answer 11

20%

Question 12

What is a normal pack year?

Answer 12

Over 20

Question 13

What is a pack year?

Answer 13

1 pack year = 1 pack a day for a year

Question 14

What is the rate of decline of FEV1?

Answer 14

Non-smoker - 30 ml/yr SMOKER - 50 ml/yr

Question 15

What is your typical COPD patient?

Answer 15

Patient 40+ years, smoker/ex-smoker, breathless on exertion, cough

Question 16

What are the differential diagnosis for COPD?

Answer 16

COPD Asthma Lung cancer Left ventricular failure Fibrosing alveolitis Bronchiectasis Rarities: TB, recurrent pulmonary emboli

Question 17

What separates COPD from asthma?

Answer 17

Asthma has variable airflow obstruction COPD, gradually worsens over the years

Question 18

What are the symptoms of COPD?

Answer 18

Breathlessness Cough and Sputum Wheeze Weight loss Peripheral oedema

Question 19

What is sputum like?

Answer 19

Clear or mucoid sputum

Question 20

What does haemoptysis suggest rather than COPD?

Answer 20

Lung cancer/TB/bronchiectasis

Question 21

What does weight loss indicate?

Answer 21

Severe disease, TNF alpha

Question 22

What does peipheral oedema

Answer 22

Cor pulmonale (right heart failure secondary to lung disease), severe disease, respiratory failure

Question 23

What is typical past medical history?

Answer 23

Asthma as a child, adolescence Respiratory diseases Ischaemic heart disease

Question 24

What are the signs of COPD?

Answer 24

Breathless walking in to clinic, undressing

Pursed lip breathing, accessory muscles

Cyanosis CO2 flap, Tremor (beta-agonists), Effects of steroids: tissue skin, bruising, Cushingoid

Hyperexpanded chest

Laryngeal descent

Paradoxical movement of ribs and abdomen

Decrease cardiac dullness to percussion

Decreases in breath sounds (no crackles) Prolonged expiration with wheeze

Palpable liver

Cor pulmonale: increased jugular venous pressure, hepatomegaly, ascites, oedema

Question 25

What is the interpretation of FEV1 of

Answer 25

Question 26

What is the purpose of full pulmonary function testing?

Answer 26

Loking for emphysema

Question 27

What is the effect of Gas trapping on lung volumes?

Answer 27

Increase in residual volume

Increase in total lung capacity

RV/TLC is greater than 30%

Question 28

What are the findings in carbon monoxide gas transfer?

Answer 28

Decreased gas transfer

(decreased TLCO which is the diffusing capacity for carbon monoxide)

Decreased KCO (KCO measures the integrity of the blood–gas barrier)

Question 29

What are the tests involved in the full pulmonary funciton testing?

Answer 29

Lung volumes

Carbon monoxide gas transfer

Question 30

What is the response to oral corticosteroids and bronchodilators?

Answer 30

Minimal

Question 31

What does significant bronchodilator/steroid response suggest?

Answer 31

asthma

Question 32

What will a chest radiograph indicate?

Answer 32

Hyperinflated lung fields

Flattened diaphragms

Lucent lung fields

Bullae

(Can rule out bronchogenic carcinoma, interstitial disease, left ventricular failure)

Question 33

What are the different type of blood gas measurements likely to be found?

Answer 33

Question 34

What can a full blood count be indicative of?

Answer 34

Secondary polycthaemia

Question 35

What does an ECG tell you?

Answer 35

Right axis deviation

P pulmonale (right atrial enlargement)

T wave inversion

Question 36

What does sputum analysis indicate?

Answer 36

MC and S (Mucous culture and sensitivites) - S pneumoniae, H influenzae, M catarrahlis

Question 37

What can be the cause of an acute exacerbation?

Answer 37

Usually precipitated by viral and bacterial infection

But consider sedative drugs, pneumothorax, trauma

Question 38

What are the symptoms of an acute exacerbations?

Answer 38

Increase cough, sputum, sputum purulence, shortness of breath, wheeze, unable to sleep, increase oedema, confusion, drowsiness, cyanosis, breathless, flapping tremor, pyrexial

Question 39

What is the management for Acute exacerbations?

Answer 39

Nebulised bronchodilator beta 2 and anti-muscarinic, O2, Oral/iv corticosteroid, antibiotic, diuretic, iv aminophyline, respiratory stimulant, NIV