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Last reviewed: 25 Jun 2024
Last updated: 17 Apr 2024



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 use
  • 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 platelets
  • C-reactive protein
  • eosinophil count
  • 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



Carolyn L. Rochester, MD

Professor of Medicine

Yale School of Medicine

New Haven

VA Connecticut Healthcare System

West Haven



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



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



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.

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