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Chronic obstructive pulmonary disease (COPD), Diagnosing COPD - Coggle…
Chronic obstructive pulmonary disease (COPD)
COPD
a common preventable and treatable disease, is characterised by persistent airflow limitation that is usually progressive and associated with enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases
progressive lung disease
airflow obstruction with little or no reversibility
stats:
kills 30,000 people a yer in the uk
est that 2 million people in uk have COPD but are currently undiagnosed
prevalence 5-15% in industrialised countries
major cause of mortality and morbidity
3rd most common cause of death globally 2020
spans 20-50 years and is slow and progressive
COPD - umbrella term for: Chronic bronchitis, Emphysema, chronic severe asthma
Patients typically have co-morbidities - IHD, CF, osteoporosis, diabetes metabolic syndrome, normocyclic anaemia, depression + more
causes: smoking, industrial pollutants, mining, bacterial infection, viral infection, wood fire, biomass fuels, vehicle exhaust pollution
Pathophysiology of COPD
inflammation of alveoli + airways , floppy elastic lining + damaged tissue
Symptoms: cough, dysponea or laboured breathing, excessive sputum production, chest tightness or wheeze, Oedema, heart failure, recurrent chest infections, hyper inflated lungs, fatigue, chest pain/discomfort
Emphysema
permanent enlargement of the alveoli
Destruction of alveolar walls
Lungs lose their elasticity
Walls of terminal bronchioles and alveoli are destroyed by inflammation
airway collapse
Air trapping
bronchioles open on inspiration but collapse on expiration. Air trapped within alveoli. Hyperinflation - barrel chest. Diaphragm flattens. Ventilation capacity decreased.
barrel chest - enlarged chest, rounded cross section, fixed horizontal position of ribs
Enlarged alveoli sacs-dead space
S+S: accessory muscles used to help with breathing, tire easily, energy use ++
The heart
: alveolar walls disintegrate, increases resistance in pulmonary circulation, right ventricle has to work harder, enlarged right ventricle, cor pulmonale
usually co-exists with chronic bronchitis, primarily a disease of the alveoli, caused by smoking or congenital (lack of a1 antitrypsin)
Chronic bronchitis
Bronchitis - an inflammation of the lining of the bronchial tubes
Chronic bronchitis is defined as cough that occurs every day with sputum production that lasts for at least 3 months, 2 years in a row
Major cause: smoking, bronchial irritants, usually inhaled repeatedly by the affected person
What?
the lining off the bronchial tubes repeatedly becomes irritated and inflamed
the continuous irritation and swelling can damage the airways and cause a buildup of sticky mucus, making it difficult for air to move through the lungs
this leads to breathing difficulties that gradually get worse
Inflammation can do damage to the cilia
when the cilia don't work properly, the airways often become a breeding ground for bacterial and viral infections
infections typically trigger the initial irritation and swelling that leas to acute bronchitis
Chronic production of excessive mucus
lower respiratory airways become inflamed and fibrosed causing airway obstruction
frequent chest infections
Smoking
in acute cases of exposure to smoke, coughing is induced and cilia beating increases to clear the smoke out of the lungs
In long term exposure, smoker's cilia beat slower than normal, and continue to slow down the longer the person smokes
takes 16 breaths to get rid of a lungful of inhaled gas
it is important to encourage all patients to give up smoking
CT + X-ray
Alpha 1 anti-trypsin deficiency
a rare inherited condition which can cause lung and liver problems
lack a protective enzyme inhibitor called Alpha 1 antii-trypsin deficiency
more vulnerable to the effects of inhaling smoke or other toxic materials like dust, fumes or chemicals
More likely to develop COPD
Diagnosing COPD
BODE index - prognosis
assessment of the prognosis of COPD
B
MI
Airflow
O
bstruction
D
ysponea
E
xercise capacity
Approx 4 year survival rate: 0-2 points 80%, 3-4 points 67%, 5-6 points 57%, 7-10 points 18%
Symptoms
Airflow obstruction
Airflow obstruction due to a combination of damage to the airways and also to lungparenchyma
The damage is the result of chronicinflammation that differs to that seen in asthma
Significant airflow obstruction may be present before the individual is aware of it
Cough
Morning productive cough- often present on waking- but not disturbing sleep
often worse in winter
nitially intermittent, later present everyday (often throughout the day)
May be unproductive despite airflow limitation
Cough syncope may occur after prolonged bouts
Sputum
Initially mucoid and not excessive (<1 egg-cupful/day)
Purulent with exacerbation of COPD
Daily production of sputum for 3 or more months in 2 consecutive years- chronic bronchitis
Can be difficult to evaluate due to swallowing rather than expectoration
Dyspnoea
shortness of breath
Major source of disability and anxiety
Wheeze
More characteristic of asthma or severe COPD
Audible wheeze may arise at laryngeal level
inspiratory and expiratory wheezes can be present
Chest tightness often follows exertion
NICE, 2018
A diagnosis of COPD should be considered in patients over the age of 35 who have a risk factor (smoking) and who present with one or more of the following symptoms
risk factors
smoking
occupational exposure
exposure to fumes
Symptoms
exertion breathlessness
Chronic cough
regular sputum production
frequent winter 'bronchitis'
wheeze
Spirometery on diagnosis
perform spirometry
at diagnosis
to reconsider the diagnosis, for people who show an exceptionally good response to treatment
to monitor disease progression
diagnosis confirmed if post-bronchodilator values:
FEV1/FVC < 0.7 (i.e. <70%)
FEV1 < 80% of predicted
•FEV1 = forced expiratory volume in 1 second. •FVC = forced vital capacity
Further. investigations on diagnosis
patients should also have:
Chest x-ray
a full blood count (FBC) to identify anaemia or polycythaemia
BMI calculated
Additional investigations may include:
Sputum culture
Home peak flow measurement (to exclude measurements)
ECG
Echocardiogram
CT thorax
Serum alpha-1 antitrypsin
Breathlessness on diagnosis
Medical research council (MRC) dyspnoea should be used to grade the breathlessness according to the level of exertion required to elicit it
