Investigations:

1. Lung function tests: obstructive spirometry and flow-volume loops, reduced FEV1 to<80% predicted, FEV1/FVC< 70%, reversibility less than 12%, raised total lung volume, FRC and residual volume because of emphysema, air trapping and loss of elastic recoil.

2. Chest X-ray shows data of emphysema.

3. Sputum examination is significant if patient has exacerbation (microscopy and culture)

4. Pulse oximetry and arterial blood gas analysis - P_a O₂ decreased, Sa O₂ <95%.

Classification of COPD by severity (GOLD):

Stage 0, at risk: Lung function still normal; chronic symptoms (chronic cough and sputum production).

Stage I, Mild COPD: Mild airways limitation (FEV1/FVC<70%, but FEV1≥80% predicted) and usually, but not always, chronic cough and sputum production.

Stage II, Moderate COPD: Worsening airways limitation (FEV1/FVC<70%, 50%≤FEV1<80% predicted) and usually progression of symptoms, with shortness of breath typically developing on exertion.

Stage III, Severe COPD: Further worsening of airflow limitation (FEV1/FVC<70%, 30%≤FEV1<50% predicted) progression of symptoms with shortness of breath and exacerbations which have impact on patient’s quality of life.

Stage IV, Very severe COPD: severe airflow limitation (FEV1/FVC<70%, FEV1<30% predicted) or FEV1<50% plus chronic respiratory failure. Quality of life is very appreciably impaired and exacerbations may be life-threatening.

7. Reference source

• Handbook of diseases.-.2^nd ed.- Springhouse Corporation, 2000 – P.79-82, 206-210.

Professor assistant Demchuk H.V.

Test for self-control

1. Bronchial asthma is a…

1. Acute inflammatory disease;

2. Acute infective disease;

3. Chonic infective disease;

4. Chonic iinflammatory disease;

5. northing from above.

2. Chronic obstructive pulmonary disease is a…

1. chronic inflammatory of trachea and large bronchus

2. chronic inflammatory of large and medium bronchus

3. chronic inflammatory of medium, small bronchus with involving lung parenchyma and vessels

4. All from above

5. Northing from above

3. Which symptoms characterize bronchial asthma?

1. Mixed dyspnea, cough with purulent sputum

2. Episodic dry cough, tightness of the chest, wheezing

3. Chest pain with radiation to jaw, inspiratory dyspnea

4. Permanent expiratory dyspnea, cough

5. Episodic hemoptysis and dyspnea due to physical effort

4. Which symptoms characterize COPD?

1. Mixed dyspnea, dry cough, chest pain

2. Episodic dry cough, tightness of the chest, wheezing

3. Chest pain with radiation to jaw, inspiratory dyspnea

4. Permanent expiratory dyspnea, cough, sputum production

5. Episodic hemoptysis and dyspnea due to physical effort

5. What symptom doesn’t characterize bronchial asthma?

1. Wheezing

2. cough

3. tightness in the chest

4. dyspnea

5. purulent sputum

6. What symptom doesn’t characterize COPD?

1. Wheezing

2. cough

3. chest pain

4. dyspnea

5. purulent sputum

7. What change of vocal fremitus can be at the patient with COPD?

1. Amplifying

2. Decreasing

3. Absence

4. Not changed

5. Change depends on clinical situation

8. What change of vocal fremitus can be at the patient with bronchial asthma?

1. Amplifying

2. Decreasing

3. Absence

4. Not changed

5. Change depends on clinical situation

9. If patient has asthma symptoms 1-2 times in a week, 1 night awaking in a mouth, he has…

1. Intermitend asthma;

2. Mild persistent asthma;

3. Moderate persistent asthma;

4. Severe persistent asthma;

5. depends on clinical situation

10. If patient has asthma symptoms 1-2 times in a day, 1 night awaking in a week, he has…

1. Intermitend asthma;

2. Mild persistent asthma;

3. Moderate persistent asthma;

4. Severe persistent asthma;

5. depends on clinical situation

11. If patient has asthma symptoms 1-2 times in a year, night awaking is absent, he has…

1. Intermitend asthma;

2. Mild persistent asthma;

3. Moderate persistent asthma;

4. Severe persistent asthma;

5. depends on clinical situation

12. If patient has asthma symptoms 8-10 times in a day, every night awaking, he has…

1. Intermitend asthma;

2. Mild persistent asthma;

3. Moderate persistent asthma;

4. Severe persistent asthma;

5. depends on clinical situation

13. How percussion sound is changed at the patient with COPD?

1. unchanged

2. dull

3. small box sound

4. tympanic

5. depend on clinical situation

14. How mobility of the lung border is changed at the patient with COPD?

1. unchanged

2. limited

3. increased

4. became immovable

5. depend on clinical situation

15. How percussion sound is changed at the patient with mild asthma?

1. unchanged

2. dull

3. small box sound

4. tympanic

5. depend on clinical situation

16. What are auscultation findings at the patient with asthma attack?

1. Vesicular rough breathing with prorogated expiration, wheezing

2. Diminished vesicular breathing,

3. Diminished vesicular breathing and moist rales

4. Diminished vesicular breathing and crepitation

5. Vesicular breathing and pleural friction rub

17. What are auscultation findings at the patient with COPD?

1. Vesicular rough breathing

2. Diminished vesicular breathing with prolongated expiration, wheezing

3. Diminished vesicular breathing and moist rales

4. Diminished vesicular breathing and crepitation

5. Vesicular breathing and pleural friction rub

18. How is FEV1 increased after bronchial spasmolytic if patient has reversible obstruction?

1. >12% from initial

2. >20% from initial

3. >25% from initial

4. > 30% from initial

5. > 10% from initial

19. If patient has permanent expiratory dyspnea during physical effort, FEV1 is 52% from predicted and FEV1/FVC 55% he has…

1. Mild COPD

2. Moderate COPD

3. Severe COPD

4. Very severe COPD

5. Depend on clinical situation

20. If patient has permanent expiratory dyspnea in a rest, FEV1 is 22% from predicted and FEV1/FVC 45% he has…

1. Mild COPD

2. Moderate COPD

3. Severe COPD

4. Very severe COPD

5. Depend on clinical situation

Control questions:

1. What is a bronchial asthma?

2. What are causes of bronchial asthma?

3. What stage of bronchial asthma do you know?

4. What are the main symptoms of bronchial asthma?

5. What are signs of bronchial asthma?

6. Which instrumental and laboratory investigations are used for establishing bronchial asthma?

7. What is COPD?

8. What are risk factors of COPD?

9. What are the main symptoms and signs of COPD?

10. What are findings of instrumental investigations of patients with COPD?

11. What stage of COPD do you know?