Clinical Features of COPD

Question 1

What is COPD?

Answer 1

Chronic slowly progressive disorder charcaterised by; fixed airflow obstruction that gets worse over time

Question 2

Is COPD reversible?

Answer 2

for the most part, however to some degree by a bronchodilator or other therapy form

Question 3

How does airway obstruction occur?

Answer 3

small-airway narrowing and can be worsened by inflammation and mucus

Question 4

How does inflammation worsen airflow obstruction

Answer 4

Neutrophilic airway inflammation;

• release of proteolytic enzymes
• loss of alveolar lung,
• therefore loss of elastin affecting the recoil action.

Question 5

What symptoms are are associated with COPD?

Answer 5

Breathlessness on exertion
Coughing (and sputum)
Wheezing

Question 6

How many people in the UK are diagnosed with COPD, and what %?

Answer 6

1.2 million

50%

Question 7

How many people suffer with COPD globally?

Answer 7

more than 300 million

Question 8

In what countries have the highest prevalence of COPD and why?

Answer 8

Developing countries due to biomass smoke

Question 9

What 3 diseases are identified to make up COPD

Answer 9

Asthma
Emphysema
Chronic Bronchitis

Question 10

Is COPD more prevalent in males or females?

Answer 10

males

Question 11

How is COPD becoming an increasing burden on the NHS?

Answer 11

• Increase in admissions
• Make up the vast majority of primary care (86%)
• Costs (£819pa/p)

Question 12

What do may people affected with COPD experience?

Answer 12

Progressive inactivity
Social isolation
Despondency
More dependent

Question 13

What are the causes of COPD?

Answer 13

SMOKING
Maternal smoking 
Air pollution
Chronic Asthma
Occupation
Passive smoking

Question 14

What percentage of COPD is considered due to smoking?

Answer 14

85%

Question 15

Why is maternal smoking considered attributable to COPD?

Answer 15

Lungs don’t develop to full capacity

Reduces FEV1 and increases respiratory illness

Question 16

Why is occupation considered attributable to COPD?

Answer 16

Due to jobs exposing to dusts, vapours and fumes

Question 17

What is the function of A1-antitrypsin and where is it produced?

Answer 17

• Neutralises enzymes released by neutrophils

- Produced in the liver

Question 18

How many variants of a1-antitrypsin are there?

Answer 18

75 variants

Question 19

What % of the UK have the normal PiMM genotype?

Answer 19

86%

Question 20

What is the troublesome genotype referred to, and what does this cause?

Answer 20

PiZZ - 10-20% of MM protein

This means there’s nothing to neutralise enzymes which causes tissue destruction by neutrophils.

Question 21

What activity can trigger such reaction of PiZZ?

Answer 21

inhalation of smoke

Question 22

What proportion of the COPD population have the PiZZ genotype?

Answer 22

0.03%

Question 23

50% of people with COPD have said to have how many years of PiZZ genotype?

Answer 23

<40 years

Question 24

Non-smokers with COPD are said to suffer with Dyspnoea at what age?

Answer 24

51 years

Question 25

Smokers with COPD are said to suffer with Dyspnoea at what age?

Answer 25

32 years

Question 26

Non-smokers with COPD are said to die at what age?

Answer 26

67 years

Question 27

Smokers with COPD are said to die at what age?

Answer 27

48 years

Question 28

What is the single most important aetiological factor in COPD

Answer 28

Cigarette smoking

Question 29

What does smoking do?

Answer 29

Cause tissue destruction | lung ages more rapidly

Question 30

What is important to consider when looking at smoking as the cause of COPD?

Answer 30

Total tobacco consumption

Question 31

What is tobacco consumption measured in?

Answer 31

In pack years

Question 32

What is 1 pack year?

Answer 32

1 pack a day/year

Question 33

If someone smoked 5 packs of cigarettes a day for 20 years, how many pack years would that be?

Answer 33

100 pack year

Question 34

What is the rate of decline for FEV1 in a non smoker and smoker respectively?

Answer 34

30ml/yr | 50ml/yr (some 80ml/yr)

Question 35

What % of smokers develop clinically significant COPD?

Answer 35

20%

Question 36

What % of significant COPD patients have subclinical airflow obstruction?

Answer 36

30%

Question 37

What % of COPD patients never develop develop significant airflow obstruction?

Answer 37

50%

Question 38

Can COPD develop in never smokers? If so, how (give examples)?

Answer 38

Yes, via chronic asthma and alpha 1 antitrypsin deficiency

Question 39

Upon making the diagosis, what would you expect the of the symptoms over time?

Answer 39

gradually worsening over the years

Question 40

At what age does breathlessness typically occur?

Answer 40

typically 40-50 | gradual onset

Question 41

Is there much variation on breathlessness?

Answer 41

No

Question 42

What could exacerbate breathlessness (slight and extreme cases)?

Answer 42

- Hills, stairs, gardening, housework - Dressing, washing - Eventually at rest

Question 43

What % resolution of coughing and mucus can occur if you stop smoking?

Answer 43

94%

Question 44

how many pack years is typical in a patient with COPD?

Answer 44

20 pack years

Question 45

What are the signs of severe COPD?

Answer 45

Cyanosis CO2 flap bruising, cushoigoid(effects of steroid)

Question 46

What type of essential investigation is required when diagnosing COPD?

Answer 46

Spirometry

Question 47

How would you interpret airflow obstruction?

Answer 47

FEV1<80% predicted with FEV1/FVC ratio<70%

Question 48

What value is considered a normal FEV1?

Answer 48

>80% predicted

Question 49

If the FEV1 is normal, what disease can you eliminate?

Answer 49

COPD

Question 50

What FEV1 value ranges correlates to moderate airflow obstruction?

Answer 50

50-79%

Question 51

What symptoms are associated with moderate AFO?

Answer 51

Cough SOB on exertion Moderate exertion

Question 52

What FEV1 value ranges correlates to severe AFO?

Answer 52

30-49%

Question 53

What FEV1 value ranges correlates to very severe AFO?

Answer 53

<30%

Question 54

What symptoms are associated with severe AFO?

Answer 54

SOB on mild exertion | Cough/sputum

Question 55

What symptoms are associated with very severe AFO?

Answer 55

SOB on exertion Wheeze Cough Cor pulmonale

Question 56

What % of lung function can still survive?

Answer 56

5%

Question 57

If you were doing a full pulmonary function test, what disease would you be looking for?

Answer 57

Emphysema

Question 58

What does Gas trapping result in?

Answer 58

- INCREASE Residual volume - INCREASE Total lung capacity - RV/TLC > 30%

Question 59

How can fixed AFO demonstrated?

Answer 59

Spirometry

Question 60

What does a decrease in CO gas transfer result in?

Answer 60

- DECREASE TLCO, | - DECREASE KCO (tissue destruction)

Question 61

To what extent do COPD patients respond to bronchodilator reversibility, and what 2 methods are used?

Answer 61

MINIMAL/insignificant o Baseline, 15 minutes post neb 2.5-5mg salbutamol o Baseline, 30 minutes post neb 2.5-5mg salbutamol + 500mg ipratropium

Question 62

To what extent do COPD patients respond to ORAL CORTICOSTEROIDS, and what method is the method used?

Answer 62

MINIMAL/INSIGNIFICANT - 30-40mg Prednisolone daily for 2 weeks (0.6mg/kg) - Measure baseline and final FEV1

Question 63

If there is a signif. bronchodilator and steroid response, what does this suggest?

Answer 63

Asthmatic (component)

Question 64

What would you look for when performing a chest radiograph?

Answer 64

Hyperinflated lung fields Flattened diaphragms Lucent lung fields Bullae

Question 65

How would you know if a lung was hyperinflated?

Answer 65

> 10 posterior ribs on chest radiograph

Question 66

When checking blood gases, if there was a reduction in PaO2, what could this indicate?

Answer 66

Type 1 respiratory failure

Question 67

When checking blood gases, if there was a reduction in PaO2 and an increase in PaCO2, what could this indicate?

Answer 67

Type ll respiratory failure

Question 68

During a FBC, if the HCT level came back > 0.52, what could this indicate?

Answer 68

Secondary polycythaemia

Question 69

What is can cause an acute exacerbation of COPD?

Answer 69

Usually precipitated by viral/bacterial infection but also; - pneumothorax, sedative drugs and trauma

Question 70

How do: pneumothorax, sedative drugs and trauma trigger acute COPD?

Answer 70

Build up of mucus causing infection

Question 71

What are the symptoms of acute exacerbation of COPD? list some

Answer 71

``` o Increase cough, o increase sputum/increase sputum purulence o increase short of breath, o increase wheeze o unable to sleep o increase oedema, confusion, drowsiness ```

Question 72

What does it mean by the term increase sputum purulence?

Answer 72

colour changes

Question 73

What are the management options of COPD?

Answer 73

nebulised bronchodilator b2 & anti-muscarinic, (to open up the airways) O2 oral/iv corticosteroid, antibiotic, diuretic iv aminophylline, respiratory stimulant, NIV