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
Emerging tests
- procalcitonin
- vitamin D
- immunoglobulins
Treatment algorithm
at presentation
after stabilization
Contributors
Expert advisers
Forest W. Arnold, DO, MSc, FIDSA
Professor of Medicine
Chief, Division of Infectious Diseases
Director Infectious Diseases Fellowship Training Program
Department of Medicine
School of Medicine
University of Louisville
Louisville
KY
Disclosures
FWA declares that he has no competing interests.
Peer reviewers
Krishna Sundar, MD, FCCP
Associate Professor (Clinical)
Department of Medicine
University of Utah
Director
Pulmonary and Critical Care Research
IHC Urban South
Utah Valley Pulmonary Clinic
UT
Disclosures
KS declares that he has no competing interests.
Ozan Akca, MD
Director of Research
Associate Professor
Department of Anesthesiology and Perioperative Medicine
Neuroscience and Anesthesia Intensive Care Unit
University of Louisville
Louisville
KY
Disclosures
OA declares that he has no competing interests.
Differentials
- Congestive heart failure
- Pneumonia
- Pleural effusion
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- Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease
- Chronic obstructive pulmonary disease: screening
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