COPD Flashcards
(49 cards)
What are the two conditions that are involved in COPD?
Chronic bronchitis- Inflammation of the airways
Emphysema- Alveolar destruction
what is the main cause of COPD?
Smoking
Also other pulmonary irritants
What is chronic bronchitis?
Inflammation of the airways which leads to airway obstruction and increase in mucous production
How is bronchitis clinically defined?
Having a productive cough for at least 3 months each year for 2 or more consecutive years
What happens with emphysema?
There is destruction of the alveolar walls, this reduces the elastic recoil and leads to air trapping and reduced ventilation
The loss of alveolar tissue also causes loss of gas exchange barrier
What might cause COPD in a young patient (<45 years old)?
Alpha 1 antitrypsin deficiency-
Elastase accumulates in the lungs causing breakdown of elastin. Alpha 1 antitrypsin accumulates in the liver and causes cirrhosis
What symptoms might someone with COPD describe?
Worsening breathlessness Productive cough (at least three months of a year for 2 consecutive years) Fatigue Reduced exercise tolerance Wheeze Chest tightness (due to obstruction)
What signs may you see in a patient with COPD during examination?
Barrel chest Central/Peripheral cyanosis Expiratory wheeze- due to obstruction Hyperresonance on percussion Signs of RHF
How is COPD diagnosed?
Spirometry- FEV1:FVC < 0.7
What are the spirometry findings for COPD?
FEV1: FVC <0.7
FEV1 less than 80% of predicted
Little improvement on reversibility testing
How should dyspnoea be graded?
MRC dyspnoea scare
What is grade 1 on the MRC dyspnoea scale?
Not troubled by breathlessness except on strenuous exercise
What is grade 2 on the MRC dyspnoea scale?
Short of breath when hurrying or walking up a whill
What is grade 3 on the MRC dyspnoea scale?
Walks slower than contemporaries on level ground because of breathlessness or has to stop for breath on level ground when walking at own pace
What is grade 4 on the MRC dyspnoea scale?
Stops for breath after walking about 100m or after a few minutes on level ground
What is grade 5 on the MRC dyspnoea scale?
Too breathless to leave the house or breathless when dressing or undressing
What FVC:FEV1 ratio suggestive obstructive lung disease?
FEV1:FVC >0.7
What can be done during spirometry to differentiate COPD from asthma?
Bronchodilator reversibility is seen in asthma
There is little bronchodilator reversibility in COPD
What is important to ask smokers at every appointment?
If they’ve considered quitting and recommend NHS stop smoking services
What other investigations should all patients have when suspecting COPD?
Spirometry is diagnostic
CXR- Exclude other pathologies
FBC- Anaemia or polycythaemia (secondary to hypoxia)
BMI
Other investigations depend upon the suspected cause
When might you ask patients to do serial at home peak flow measurements?
Exclude asthma if still diagnostic uncertainty
What cardiac investigations might you want to check for patients with COPD?
Bloods- BNP, FBC
CXR- Pulmonary oedema
ECG- Signs of ventricular hypertrophy, AF, other arrhythmia
ECHO
What blood test might you want to check in patients who are less than 45 who present with symptoms of COPD?
Serum alpha 1 antitrypsin
Causes lung and liver injury
What features would help you differentiate between COPD and asthma?
COPD is more likely to occur in older patients
COPD is more likely to occur in patients with a smoking history
COPD is associated with a chronic productive cough
Asthma is associated with symptoms in childhood
Asthma is associated with atopy
Asthma shows diurnal variation
Asthma shows bronchodilator reversibility with FEV1
