State COPD clinical apearance
- cough with white/clear sputum
- Wheezing and breathlessness
- Symptoms worsened by weather, atmospheric conditions
- Reduced muscle mass, general weakness, hypertension, osteoporosis
What are typical signs for COPD?
Mild COPD: No signs, quiet wheezes
Severe COPD: Tachypnoea, poor chest expansio, accessory muscles
What features would make you suspect COPD? (note that no individual factor is diagnositc)
- History of breathlessness and sputum production in someone who smokes
- Alpha-1-antitrypsin deficiency
What result would you expect to see in spriometry test for a COPD patient?
- FEV/FVC = <70%
What are possible findings of COPD on an X-ray
- flattened diaphragm
- lung hyperinflation (due to air trapping)
What other imaging can be useful if an X-ray was not clear?
What discrepancies would you aspect to see in arterial blood gas tests for COPD patient?
- often normal at rest, but get worst during exercise
- In advanced COPD, there may be hypoxemia and hypercapnia
Management and treatment of COPD
Smoking cessation: Most useful measure is to suggest to the patient to stop smoking. This can slow down the rate of disease.
Bronchodilators: Beta adrenergic agonists, Antimuscarinic drugs, Xanthines
Corticosteroids: Prenisolone - looking for FEV increase of 15%
Give examples of antimuscarinic drugs
GIve examples of a corticosteroid used to treat COPD
Label the following components of the spirometry output
Define Tidal volume
the change in volum of lungs between inspiration and expiration in relaxed breathing
Define inspiratory reserve volume
The amount of air that can be inspired beyond the tidal volume
Define expiratory reserve volume
The amount of air that can be expelled after tidal expiration
Define residual volume
The amount of volume of air that remains lungs after a full breath - essentially cannot be breathed out - prevents lungs from collapsing
Define inspiratory capacity
The total amount ofair that can be inspired after a tidal expiration
Define functional residual capacity
The amount of air in the lungs after a tidaly expiration
Define vital capacity
The maximum amount of air that can be expelled from the lungs after maximum inhalation
Define forced expiratory volume
The maximal volume of gas which can be expired from the lungs in the first second of expiration from full inspiration
What are the 3 main facotrs which affect FEV1?
Height, age, gender
Define the Forced Vital capacity (FVC)
Amount of air that can be exhaled from the lungs after taking the deepest breath possible .
What is the FEV1/FVC ratio
The proportion of FVC which can be expelled during the first second of expiration, expressed as a percentage.
Define peak expiratory flow
Tests how quickly a person call exhale.
Explain the differences you would expect to see in spirometry tests between obstructive lung disease and restrictive lung disease. Explain the difference between obstructive and restrictive lung disease (give examples of each)
Obstructive: When airways are physically obstructed in some way, making it difficult to breath. FEV is lowered with normal FVC. FEV1 and FVC ratio is LOW. Examples include asthma, COPD, cystic fibrosis
Restrictive: Lung expansion is restricted in some way; FEV/FVC ratio is normal although absolute values are lowered - Examples include pulmonary fibrosis (reduced compliance), Sarcoidosis, Scoliosis, Neuromuscular disease
State tests for COPD