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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