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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