Chronic obstructive pulmonary disease (COPD) is characterized by chronic respiratory symptoms and airflow limitation that is often progressive and not fully reversible.
Suspected in patients with a history of smoking, occupational and environmental risk factors, or a personal or family history of chronic lung disease.
Presents with shortness of breath, wheeze, cough, and sputum production.
Diagnostic tests include pulmonary function tests, chest x-ray, chest computed tomography scan, oximetry, and arterial blood gas analysis.
Patients should be encouraged to stop smoking or occupational exposure and be vaccinated against viral influenza and Streptococcus pneumoniae.
Treatment options include bronchodilators, inhaled corticosteroids, phosphodiesterase-4 inhibitors, antibiotics, and mucolytics.
Long-term oxygen therapy improves survival in severe COPD.
Pulmonary rehabilitation improves exercise tolerance, dyspnea, and health status in stable patients.
Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung disease state characterized by chronic respiratory symptoms and airflow limitation that is not fully reversible. It encompasses emphysema, bronchiolitis, and chronic bronchitis. The airflow limitation is often progressive and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases. It is primarily caused by cigarette smoking. Although COPD affects the lungs, it also has significant systemic consequences. Exacerbations and comorbidities are important contributors to the overall condition and prognosis in individual patients.
History and exam
- barrel chest
- hyperresonance on percussion
- distant breath sounds on auscultation
- poor air movement on auscultation
- wheezing on auscultation
- coarse crackles
- distended neck veins
- lower-extremity swelling
- weight loss
- muscle loss
- pursed lip breathing
- loud P2
- hepatojugular reflux
- cigarette smoking
- advanced age
- genetic factors
- lung growth and development
- white ancestry
- exposure to air pollution
- exposure to burning solid or biomass fuel
- occupational exposure to dusts, chemicals, pesticides, vapors, fumes, or gases
- male sex
- low socioeconomic status
- rheumatoid arthritis
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