Summary
Definition
History and exam
Key diagnostic factors
- dyspnea
- cough
- wheeze
- changes in sputum volume/color/thickness
- tachypnea
- cyanosis
Other diagnostic factors
- past medical history of COPD
- tobacco dependence
- past medical history of gastroesophageal reflux/swallowing dysfunction
- malaise and fatigue
- chest tightness
- features of cor pulmonale
- environmental/occupational exposure to pollutants or dust
- change in mental status
- fever
- accessory muscle use
- paradoxical movements of abdomen
Risk factors
- viral infection
- bacterial infection
- gastroesophageal reflux/swallowing dysfunction
- smoking
- atypical bacterial infection
- air pollutants
- change in weather
Diagnostic tests
1st tests to order
- oxygen saturation on pulse oximetry
- chest x-ray
- ECG
- ABG
- CBC with differential
- eosinophil count
- C-reactive protein
- basic metabolic panel for electrolytes, BUN, + creatinine
Tests to consider
- sputum culture + Gram stain
- respiratory virus diagnostics
- cardiac troponin
- B-type natriuretic peptide (BNP)
- CT scan of chest
Treatment algorithm
Contributors
Expert advisers
Carolyn L. Rochester, MD
Professor of Medicine
Yale School of Medicine
New Haven
VA Connecticut Healthcare System
West Haven
CT
Disclosures
CLR serves on the COPD scientific advisory board for GlaxoSmithKline Pharmaceuticals but has no competing interests pertaining to this publication.
Richard A. Martinello, MD
Associate Professor
Yale School of Medicine
New Haven
CT
Disclosures
RAM declares that he has no competing interests.
Peer reviewers
Antonio Anzueto, MD
Professor of Medicine
University of Texas Health
Section Chief
South Texas Veterans Health Care System
San Antonio
TX
Disclosures
AA has been a consultant for GlaxoSmithKline, AstraZeneca, Boehringer-Ingelheim, Theravance and Grifols. AA has been reimbursed for his services by these companies. AA is a member of the GOLD scientific committee.
Expert advisers: comorbidities
Pankaj Shah, MD
Endocrinologist
Assistant Professor of Medicine
Department of Internal Medicine
Chair, Hospital Diabetes and Endocrinology Core Group
Mayo Clinic
Rochester
MN
Disclosures
As part of his job at his institute, PS provides expert opinion in a physician education tool called "Ask Mayo Expert", where he is one of several "Subject Matter Experts." He also addresses academic educational activities in the US and abroad as part of his institutional duty. PS declares no other competing interests.
Preethi Pirlamarla, MD
Physician (Cardiologist)
Advanced Heart Failure and Cardiac Transplant
Director of Quality Improvement for Advanced Heart Failure Department
Heart Institute at University of Washington Medical Center - Montlake
Seattle
WA
Disclosures
PP declares that she has no competing interests.
Lorenzo Azzalini, MD, PhD, MSc, FACC, FSCAI
Associate Professor of Medicine
Division of Cardiology
Department of Medicine
University of Washington
Director of Interventional Cardiology Research, Heart Institute at University of Washington Medical Center - Montlake
Seattle
WA
Disclosures
LA has received consulting fees from Teleflex, Abiomed, GE Healthcare, Reflow Medical, Shockwave, and Cardiovascular Systems, Inc.; received a research grant by Abiomed; serves on the advisory board of Abiomed and GE Healthcare; and owns equity in Reflow Medical.
Philip R. Muskin, MD, MA, DLFAPA, LFACLP
Professor of Psychiatry
Columbia University Irving Medical Center
Senior Consultant in Consultation-Liaison Psychiatry
New York-Presbyterian/Columbia University Irving Medical Center
New York
NY
Disclosures
PRM is an Associate Editor of American Psychiatric Association Publishing and on the editorial board for the journal Focus, for which he receives no compensation. At the American Board of Psychiatry and Neurology he is a member of the Article Based Certification Committee for Consultation-Liaison Psychiatry (no compensation), and at the American Psychiatric Association he is a member of the Scientific Program Committee for the Annual Meeting 2025 (no compensation). PRM serves as an expert witness in psychiatric malpractice lawsuits, for which he is compensated. He was grant co-investigator for the proposal “Can hypnosis enhance the ability to regulate behavioral and brain markers of emotion regulation?” (Proposal No. 75037-NS, Department of the Army, US Army Combat Capabilities Development Command, Army Research Office), which ended in 2023. PRM receives royalties from American Psychiatric Association Publishing for The American Psychiatric Publishing Study Guide for the Psychiatry Board Examination (edited by Muskin PR and Dickerman AL, American Psychiatric Publishing, 2016), and makes presentations at the American Psychiatric Association and Academy of Consultation-Liaison Psychiatry Annual Meetings.
Neera Ahuja, MD, FACP
Associate Chief Medical Officer - Inpatient Care Services
Division Chief - Hospital Medicine
Professor of Medicine
Stanford Healthcare and Stanford University School of Medicine
Stanford
CA
Disclosures
NA is a member of the Clinical Advisory Board for Atropos Health, and a consultant for Gilead. She has given expert testimony, received academic grants, and created a research project (in ClinicalTrials.gov) on food insecurity. She has provided educational material to the Society of Hospital Medicine, Stanford, and participated in Speakers Bureaus.
Seki Balogun, MD, FACP, AGSF
Professor of Medicine
Geriatrician and Palliative Care Physician
University of Oklahoma Health Sciences Center
Oklahoma City
OK
Disclosures
SB serves as a medical editor and faculty speaker with the American Physician Institute. She also serves on the United States Medical Licensing Examination (USMLE) Step 3 Interdisciplinary Review Committee.
Khalilah Gates, MD
Associate Professor of Medicine (Pulmonary and Critical Care)
Assistant Dean of Learning and Academic Performance
Division of Pulmonary and Critical Care
Department of Medicine
Northwestern University Feinberg School of Medicine
Medical Director, Diversity and Inclusion Education
NM Academy
Chicago
IL
Disclosures
KG is a Board Member of the Respiratory Health Association, where she focuses on communication for COPD and asthma and has no financial agreements or obligations.
Karen Jubanyik, MD
Associate Professor of Emergency Medicine
Director
Emergency Medicine Clerkship
Yale School of Medicine
New Haven
CT
Disclosures
KJ declares that she has no competing interests.
Ziad Zoghby, MD, MBA, FACP
Associate Professor of Medicine
Division of Nephrology and Hypertension
Department of Medicine
Mayo Clinic
Rochester
MN
Disclosures
ZZ received fees for consultancy work in 2022 and 2023 for ChroniSense Ltd, a remote digital health company. He has served since 2018 on the Nephrology Specialty Board for EPIC, an electronic health record vendor, and is the elected Chair of the Board for 2024-2025 (a nonpaid position).
Madeleine Alexeeva, DO
Emergency Medicine Physician
Vituity
Visalia
CA
Associate Program Director of Emergency Medicine Residency
Kaweah Health Medical Center
Visalia
CA
Disclosures
MA declares that she has no competing interests.
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