Respiratory Exam
 
Respiratory Exam

 

 

 

 

Chronic Obstructive Pulmonary Disease

 
 
 
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Overview

  • Several clinical signs allow for the clinical suspicion of chronic obstructive pulmonary disease, which can then be confirmed with pulmonary function testing.

    • Signs of Chronic Obstruction Pulmonary Disease

    • General Signs

    • Respiratory distress - tachypnoea, pursed lip breathing, accessory muscle use, intercostal / subcostal recession
    • Barrel chest (emphysema)
    • Tar-stained fingers (smoking)
    • Asterixis (CO2 retention)
    • Reduced chest expansion
    • Reduced breath sounds
    • Wheeze

    • Signs of Complications

    • Infective exacerbation - fevers, green sputum
    • Cor pulmonale - raised JVP, ascites, pleural effusions, peripheral oedema
    • Pulmonary hypertension - prominent a wave, parasternal heave, loud / palpable P2
    • Polycythaemia - polycythaemic facies
    • Steroid complications - Cushing’s syndrome, oral candidiasis

    • Signs of Management

    • Oxygen
    • Inhalers
    • Lung transplant scar

Pathogenesis

    • Risk Factors for COPD

    • Smoking
    • Occupational exposure - coal, toluene (plastics)
    • Environmental air pollution
    • Alpha-1 antitrypsin deficiency

Complications

    • Complications of COPD

    • Disease-Related

    • Pneumonia
    • Cor pulmonale
    • Pulmonary hypertension
    • Pneumothorax
    • Respiratory failure
    • Polycythaemia

    • Treatment-Related

    • Cushing’s syndrome (steroids)
    • Oral candidiasis (steroids)
    • Tremor (beta agonists)
 
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