Chronic obstructive pulmonary disease (COPD) is a progressive disease state characterized by airflow limitation that is 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 progressive 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 preventable and treatable disease state characterized by airflow limitation that is not fully reversible. It encompasses both emphysema and chronic bronchitis. The airflow limitation is usually 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.
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History and exam
Key diagnostic factors
- shortness of breath
- sputum production
- exposure to risk factors
Other diagnostic factors
- 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
1st investigations to order
- standardised symptoms score
- pulse oximetry
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
Manoochehr Abadian Sharifabad, MD
Fountain Valley Regional Medical Center
MAS declares that he has no competing interests.
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.
Hormoz Ashtyani, MD, FCCP
Hackensack University Medical Center
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
WJ declares that he has no competing interests.
Francis Thien, MD, FRACP, FCCP
Director of Respiratory Medicine
Eastern Health & Monash University
FT declares that he has no competing interests.
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