A 67-year-old woman with a history of COPD presents with 3 days of worsening dyspnea and increased frequency of coughing. Her cough is now productive of green, purulent sputum. The patient has a 100-pack-year history of smoking. She has had intermittent, low-grade fever of 100°F (37.7°C) for the past 3 days and her appetite is poor. She has required increased use of rescue bronchodilator therapy in addition to her maintenance medications to control symptoms.
COPD often goes unrecognized. By the time it is diagnosed, patients typically experience dyspnea with only mild to moderate exertion and may have a chronic productive cough, and FEV1 is often already <50% of predicted level. Many patients are diagnosed with COPD for the first time when they require hospitalization for an acute exacerbation of disease. Exacerbations may be triggered by an infection or exposure to an airborne pollutant or other change in environmental conditions. Patients commonly present with a complaint of increased dyspnea, a change in the intensity and frequency of chronic cough and/or wheezing, and a change in the color and/or volume of sputum produced. Patients experiencing an exacerbation may have a low-grade fever, but the presence of a fever, especially >101.3°F (>38.5°C) should increase suspicion for an alternate diagnosis such as pneumonia.
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