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8 Cards in this Set
- Front
- Back
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COPD Risk factors
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-tobacco smoke
-alpha-1-antitrypsin deficiency -environmental factors (ie second hand smoke) -chronic asthma -Hx of cardiopulmonary disease -FHx of COPD, heart disease, asthma -occupational (industrial dusts, fumes) -overall health -history of resp infections (freq, severity) -pulmonary meds |
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COPD symptoms
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-cough, sputum, dyspnoea
-wheezing (end expiratory) |
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COPD signs
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prolonged forced expiratory time (>=6 sec)
-end-expiratory wheezes on forced expiration, decreased breath sounds, and/or inspiratory crackles -tachypnoea -tachycardia -cyanosis -using accessory resp muscles -hyperresonance on percussion -signs of cor pulmonale -barrel chest - |
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COPD diagnosis
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-screen: PEFR <350 L/min
-FEV1 decreased to 70% (mild) or to 50% (severe) -decreased vital capacity but increased TLC, residual volume, FRC |
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risk factors for stable angina, MI, unstable angina
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-DM
-hyperlipidemia -HTN -CAD -smoking -FHx of CAD or MI in first degree relatives <45 males, <55 females -low HDL -high homocysteine - |
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Hx in COPD
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-cough, sputum, wheeze, dyspnoea, weight loss, Sx of RHF (leg oedema, abdo distention).
-sleep apnoea (snoring, stop breathing day time fatigue) -how long have had COPD Sx? -smoking Hx: when started (adolescence?), how long (>10yrs?), how many per day, exposure to second hand -occupational exposures (uranium or coal mining), toluene from plastics, solid fuel fire exposure, air pollution. asbestos esp with smoking -exercise tolerance (change?), how coping financially, home life ADLs, medication adherence and SEs, home oxygen use or steroids and bronchodilators -diet and nutritional status -emotional, social, occupational impact of disease -FHx of alpha1 antitrypsin and COPD (<11mmol/L ZZ allele), or asthma and atopy. |
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examination of COPD
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-look for pursed lip breathing use of accessory muscles, barrel chest, Hoover's sign cachexia
-cyanosis -sputum mug -BP, HR (AF?) -URTI signs? -Tracheal tug, JVP -bronchial breath sounds, long forced expiratory time -low diaphragms expanded lungs -wheeze and crackles (insp) -heart sounds muffled -signs of RHF (increased JVP, loud P2, abdominojugular reflux, ascites, hepatomegaly, pulsative liver, paedal oedema sacral oedema |
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Ix of COPD
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-CXR (expanded lung fields, elongated heart, flattened diaphragms, bullae, infection?)
-sputum culture -ECG (Atrial arhythmias) -FBC (polycythaemia) -pulmonary function tests (reversibilty? 15%/200ml, FEV1, FVC, CO diffusion test <50%=exercise hypoxia) -exercise tolerance test -ABGs -alpha1 antitrypsin measurement |
