Asthma & COPD extra

• Clinical Features - Asthma and COPD:

  • Shortness Of Breath
  • increase in Work Of Breath
  • Wheeze
  • Cough
  • Mucus production
  • decrease in Exercise tolerance
  • Hyperinflation
  • Hypoventilation -> respiratory acidosis, type 2 respiratory failure -> patients with asthma go to intensive care, patients with COPD do not (they get non invasive ventilation instead)
• Subjective History:

  • Age
  • Allergy - allergy test e.g. skin prick test, do they have an EpiPen, family history of allergies
  • Smoking history - pack years
  • Breathlessness - worse in the morning
  • Cough - wet or dry, does it bring up sputum, how often
  • Sputum
  • Exercise tolerance
• On Examination:

  • Respiratory pattern
  • Respiratory rate
  • I:E ratio
  • Accessory muscle use
  • Pursed lip breathing
  • Shape of thorax
  • Cor pulmonale - abnormal hypertrophy of the right side of the heart
  • Auscultation - expiratory wheeze for asthma, crackle sounds on inspiration for COPD
• Airflow obstruction due to asthma and COPD:

  1. Airflow obstruction due to inflammation (asthma) or loss of radial traction (COPD)
  2. increase in Airway resistance / Air trapping
  3. Airway obstruction causes shunt and Hyperinflation causes increased dead space, Impaired gas exchange
  4. decrease in Compliance (due to hyperinflation)
  5. Increase in Work Of Breath
  6. Breathlessness
• The characteristic that best clinically distinguishes the two disorders is the degree of reversibility of airflow obstruction:

  • The airflow obstruction of asthma is generally largely reversible
  • while that of COPD is largely irreversible
• Investigations and Results:

  • Chest x-ray
  • Arterial blood gases
  • Lung function tests:
  • PEFR
  • Spirometry

  
• Pulmonary Rehabilitation (PR):

  • Exercise
  • Education
  • Breathlessness management – at rest and on exertion
  • Sputum clearance techniques if appropriate
  • Smoking cessation