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respiratory system year 1 > clinical features of COPD > Flashcards

clinical features of COPD Flashcards

1
Q

define COPD

A

a lung disease characterised by chronic obstruction of lung airflow that interferes with normal breathing and is not full reversible breathlessness, cough +/- sputum

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2
Q

COPD is characterised by…

A

persistent respiratory symptoms and airflow limitation due to airway +/- alveolar abnormalities usually caused by significant exposure to noxious particles or gases

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3
Q

what is the most common cause of copd

A

smoking

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4
Q

who is at higher risk of copd, males or females

A

females genetic predisposition

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5
Q

name 3 occupational causes of COPD

A

agriculture brick making cadmium mining dock workers construction flour and grain foundry workers petroleum pottery/ceramic quarries rubber plastics stonemasonry textiles welders

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6
Q

name 2 other causes of COPD

A

occupational biomass burning air pollution contributing factors: lower socioeconomic status asthma/hyper-reactive airway chronic bronchitis childhood infection

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7
Q

progression of COPD to clinical disease

A
  1. smoking and pollutants, host factors 2. impaired lung growth, accelerated decline, lung injury, lung and systemic inflammation 3. small airway disorders, emphysema, systemic effects 4. airflow limitation and clinical manifestation (symptoms, exacerbations, co-morbidities)
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8
Q

alpha-1 antitrypsin deficiency and COPD

A

rare inherited disease presents with early onset COPD <45y/o when absent/low –> alveolar damage and emphysema can also result in liver fibrosis or cirrhosis

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9
Q

what is alpha-1 antitrypsin

A

protease inhibitor made in the liver limits damage caused by activated neutrophils releasing elastase in response to infection/cigarette smoke

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10
Q

what % of smokers will develop COPD

A

<50% after 25yrs of smoking, at least 25% w/o any initial disease will have clinically significant COPD (stage 2 or worse) and 30-40% will have any COPD passive smoking also has an effect

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11
Q

impact of smoking on lung function

A

more resp symptoms and lung function abnormalities greater annual rate of decline in FEV1 (Fletcher-Peto curve) greater COPD mortality rate than non-smokers

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12
Q

smoking in pregnancy

A

may affect foetal lung growth and priming of the immune system

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13
Q

initial presentation of COPD

A

varies

some typical symptoms:

SOB

cough

sputum production

wheeze

recurrent chest infections

less common symptoms:

weight loss

fatigue

decreased exercise tolerance

ankle swelling (if causing heart failure)

cor pulmonale

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14
Q

clinical features of COPD on examination

A

if undiagnosed: little findings unless acute flare/chest infection

diagnosed: cyanosis, raised JVP, cacheaxia, hyperinflated chest, pursed lip breathing, use of accessory muscles, audible wheeze, peripheral oedema

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15
Q

investigations for COPD

A

no single diagnostic test

hx and spirometry

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16
Q

making a diagnosis of COPD

A

have to meet all of the following criteria:

35y/o

presence of risk factor (smoking, occupational exposure)

presence of typical sx

abscence of clinical features of asthma

AND

airflow obstruction confirmed by post-bronchodilator spirometry

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17
Q

spirometry in COPD

A

demonstrates lack of reversibility

FEV1/FVC <0.7 post bronchodilator

18
Q

stages of COPD

A
  1. mild: FEV1 80% of predicted or higher, diagnosis made on respiratory symptoms
  2. moderate: FEV1 50-79% of predicted
  3. severe: FEV1 30-49% of predicted
  4. very severe: FEV1 <30% predicted
19
Q

obstructive pattern in spirometry

A

large reduction in FEV1: <80% predicted normal

FVC reduced by not by as much: <80% predicted normal

FEV1/FVC <0.7

20
Q

Features of COPD on CXR

A

vascular hila (bulky)

hyperinflation (can see >6 anterior ribs/10 posterior ribs, measured in mid-clavicular line)

bulla (large areas with no lung markings)

small heart

flat diaphragm

21
Q

why would a CXR be carried out with COPD

A

excludes alternate pathology rather than diagnostic

screen for malignancy

22
Q

prevalence of COPD

A

2% population

at least 50% underdiagnosed

increasing prevalance

decreasing incidence

M>F

23
Q

differentiating between COPD and asthma

A

COPD: nearly all smoker/ex smoker, >35y/o , chronic productive cough, persistent and progressive SOB, night time waking (due to SOB +/- wheeze) uncommon, little diurnal variation in sx

asthma: can be smoker/ex smoker, often <35y/o, chronic productive cough uncommon, variable SOB, night time wakening common, diurnal variability of sx

24
Q

pulmonary function tests for COPD

A

lung volumes: increased residual volume, increased total lung capacity, RV/TLC >30%

transfer factor: reduced gas transfer, reduced DLco, reduced Kco

25
Q

signs of acute exacerbation of COPD

A

SOB

wheeze

chest tightness

cough

sputum - purulence, volume (different to normal)

unable to smoke

systemic upset, temperature, fatigue

26
Q

features of COPD on HRCT - high resolution CT

A

signet ring sign

honeycombing

traction bronchiectasis

lung cysts

centrilobular emphysema

27
Q

signs of severe exacerbation of COPD

A

SOB (RR >25/min)

accessory muscle use at rest purse lip breathing

cyanosis (<92% o/a)

significant decrease in exercise tolerance

signs of sepsis

fluid retention

confusion

28
Q

differential diagnosis for COPD acute exacerbation

A

pnuemonia

PE

MI

LVF

lung cancer

pleural effusion

pneumothorax

29
Q

management of acute exacerbation of COPD

A

change inhalers (technique, device, add bronchodilator, increase or add inhaled steroid)

nebulisers

oral steroids (prednisolone)

abx

self-management for selected patients

30
Q

when to admit a patient to hospital for acute COPD exacerbation

A

unable to cope at home, living alone

severe SOB

poor/deteriorating general condition

poor level of activity/confined to bed

cyanosis, worsening peripheral oedema

impaired level of consciousness

already recieving LTOT

rapid rate of onset, acute confusion

significant co-morbidity

SaO2 <90%

changes on CXR

31
Q

acute exacerbation of COPD 2y care management

A

determine trigger - viral/bacterial infection (most common), sedative drugs, pneumothorax, trauma

confusion, cyanosis, severe SOB, flapping tremor, drowsy, pyrexial, wheeze, tripod position

investigations

treatment

32
Q

2y care investigations for acute exacerbation of COPD

A

CXR

blood gases

FBC

U+E

sputum culture

viral

33
Q

2y care treatment of acute exacerbation of COPD

A

oxygen

nebulised bronchodilator (beta 2 and antimuscarinic)

oral/IV corticosteroid +/- abx

treat other co-existing conditions

34
Q

severe COPD

A

respiratory failure (ABG)

flapping tremor (high co2 - hypercapnia)

Cor pulmonale: tachycardic, oedematous, congested liver

2y polycythaemia - increased Hb, increased haematocrit (body produces increased erythropoetin, increased blood viscosity)

35
Q

ECG and ECHO features of cor pulmonale

A

ECG: right axis deviation, P pulmonale, T wave inversion V1-V4

echo: pulmonary hypertension, tricuspid regurgitation

36
Q

measuring severity of COPD

A

spirometry

nature and magnitude of sx

hx of moderate and severe exacerbations and furture risk - number per year, hospitalisation

presence of co-morbidity

37
Q

features of severe COPD

A

chronic bronchitis (blue bloater): overweight and cyanotic, elevated Hb, peripheral oedema, rhonci and wheezing

emphysema (pink puffer): older and thin, severe dyspnoea, quiet chest, CXR - hyperinflation, flattened diaphragm

38
Q

MRC DYSPNOEA SCALE

A
  1. not troubled by SOB except during strenuous exercise
  2. SOB when hurrying/walking up a slight hill
  3. walks slower than others on level ground due to SOB or has to stop for breath when walking at own pace
  4. stops for breath after walking about 100m or after a few minutes on the level
  5. too breathless to leave the house or breathless when dressing/undressing
39
Q

end stage COPD

A

terminal illness

unpredictable decline, acute decline

palliation of symptoms - SOB and anxiety

social aspects - care, housebound, oxygen at home

40
Q

what is the most important thing that patients can do to slow progression of the disease

A

stop smoking

respiratory system year 1 (25 decks)

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