Last reviewed: 5 Jul 2021
Last updated: 18 Dec 2020

Summary

Definition

History and exam

Key diagnostic factors

  • cough
  • shortness of breath
  • sputum production
  • exposure to risk factors

Other diagnostic factors

  • barrel chest
  • hyper-resonance on percussion
  • distant breath sounds on auscultation
  • poor air movement on auscultation
  • wheezing on auscultation
  • coarse crackles
  • tachypnoea
  • asterixis
  • distended neck veins
  • lower-extremity swelling
  • fatigue
  • weight loss
  • muscle loss
  • headache
  • pursed lip breathing
  • cyanosis
  • loud P2
  • hepatojugular reflux
  • hepatosplenomegaly
  • clubbing

Risk factors

  • cigarette smoking
  • advanced age
  • genetic factors
  • white ancestry
  • exposure to air pollution
  • exposure to burning solid or biomass fuel
  • occupational exposure to dusts, chemicals, vapors, fumes, or gases
  • developmentally abnormal lung
  • male sex
  • low socio-economic status
  • rheumatoid arthritis

Diagnostic investigations

1st investigations to order

  • spirometry
  • standardised symptoms score
  • pulse oximetry
  • ABG
  • CXR
  • FBC
  • ECG

Investigations to consider

  • pulmonary function tests
  • chest CT scan
  • serial peak flow measurement
  • sputum culture
  • alpha-1 antitrypsin level
  • exercise testing
  • sleep study
  • respiratory muscle function
  • echocardiogram

Treatment algorithm

Contributors

Authors

Manoochehr Abadian Sharifabad, MD
Manoochehr Abadian Sharifabad

Fountain Valley Regional Medical Center

Fountain Valley

CA

Disclosures

MAS declares that he has no competing interests.

Acknowledgements

Dr Manoochehr Abadian Sharifabad would like to gratefully acknowledge Dr Jonathan P. Parsons and Dr Michael Ezzie, the previous contributors to this topic. JPP has contributed at speakers' bureaus for GlaxoSmithKline, Inc., Schering-Plough, Inc., and AstraZeneca, Inc. ME declares that he has no competing interests.

Peer reviewers

Hormoz Ashtyani, MD, FCCP

Hackensack University Medical Center

Hackensack

NJ

Disclosures

HA declares that he has no competing interests.

William Janssen, MD

Assistant Professor of Medicine

National Jewish Medical and Research Center

University of Colorado Health Sciences Center

Denver

CO

Disclosures

WJ declares that he has no competing interests.

Francis Thien, MD, FRACP, FCCP

Associate Professor

Director of Respiratory Medicine

Eastern Health & Monash University

Victoria

Australia

Disclosures

FT declares that he has no competing interests.

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