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Última revisão: 19 Oct 2025
Última atualização: 21 Jun 2023

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • dispneia
  • tosse
  • aumento da purulência e volume do escarro
  • sibilo
  • constrição/dor torácica
  • taquipneia
  • taquicardia
  • fatores de risco
  • cor pulmonale

Outros fatores diagnósticos

  • sinais de insuficiência respiratória
  • febre
  • refluxo gastroesofágico e/ou disfunção da deglutição

Fatores de risco

  • infecção bacteriana
  • refluxo gastroesofágico e/ou disfunção da deglutição
  • infecção viral
  • poluentes
  • infecção bacteriana atípica
  • mudança climática

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • gasometria arterial (no hospital)
  • oximetria de pulso (no hospital e na comunidade)
  • ECG (no hospital e na comunidade, se disponível)
  • Hemograma completo com plaquetas (no hospital)
  • ureia, eletrólitos e creatinina (no hospital)
  • Proteína C-reativa (no hospital)
  • Radiografia torácica (no hospital)
  • microscopia de escarro, cultura e coloração de Gram (no hospital)
  • vitamina D (no hospital ou na comunidade)

Investigações a serem consideradas

  • hemoculturas
  • diagnóstico de vírus respiratório
  • troponina cardíaca
  • nível sérico de teofilina
  • peptídeo natriurético do tipo B (BNP)
  • TC do tórax
  • espirometria

Novos exames

  • procalcitonina
  • proteína C-reativa no local de atendimento
  • contagem de eosinófilos

Algoritmo de tratamento

Colaboradores

Consultores especialistas

Jonathan Bennett, MD

Honorary Professor of Respiratory Sciences

University of Leicester

Respiratory Consultant

Glenfield Hospital

Leicester

UK

Biografia

JB is Chair of the British Thoracic Society (BTS). He is also deputy medical director RCP Invited service Reviews, and speaker at National Society (eg., BTS), Primary Care respiratory Society, Society Cardiothoracic Surgeons meetings.

Declarações

JB declares that he has no competing interests.

Richard Russell

Specialty Registrar in Respiratory Medicine

Glenfield Hospital

Leicester

UK

Declarações

RJR received sponsorship from AstraZeneca to attend a conference, May 2018 (covering travel, accommodation, and conference fee).

Acknowledgements

BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work has been retained in parts of the content:

Carolyn L. Rochester MD

Associate Professor

Yale University School of Medicine

New Haven

VA Connecticut Healthcare System

West Haven

CT

Richard A. Martinello MD

Associate Professor

Yale University School of Medicine

New Haven

Veterans Health Administration

Office of Public Health

West Haven

CT

Declarações

CLR serves on the COPD scientific advisory board for GlaxoSmithKline Pharmaceuticals but has no competing interests pertaining to this publication. RAM declares that he has no competing interests.

Revisores

Carlos Echevarria

Consultant Respiratory Physician

Royal Victoria Infirmary

Newcastle upon Tyne

UK

Declarações

CE declares that he has no competing interests.

Créditos aos pareceristas

Os tópicos do BMJ Best Practice são constantemente atualizados, seguindo os desenvolvimentos das evidências e das diretrizes. Os pareceristas aqui listados revisaram o conteúdo pelo menos uma vez durante a história do tópico.

Declarações

As afiliações e declarações dos pareceristas referem--se ao momento da revisão.

Consultores especialistas: comorbidades

Martyn Patel, BMBcH, FRCP, MA

Consultant, Older People's Medicine

Norfolk and Norwich University Hospitals

NHS Foundation Trust

Norwich

UK

Declarações

MP is the NHS representative on the board for Norwich Institute for Healthy Ageing (unpaid role). MP participated in a podcast on the evolving nature and importance of comorbidities for BMJ Best Practice in October 2024. MP is submitting an application to the NIHR Research for Patient Benefit (RfPB) Grant Call on physical frailty, an Integrated Care Board (ICB) priority.

Paul Cockwell, PhD, FRCP

Consultant Nephrologist

Queen Elizabeth Hospital Birmingham

Professor of Nephrology (honorary)

University of Birmingham

Birmingham

UK

Declarações

PC is immediate past-president and a trustee of UK Kidney Association (UKKA), which is the UK professional organisation that supports healthcare professionals involved in care for, and research, innovation and education in, kidney disease. UKKA has a broad remit with relationships with multiple partners and includes responsibility for UK Kidney Week, the major educational meeting for UK kidney professionals. PC is medical director for long-term conditions and prevention for NHS Birmingham and Solihull, with responsibilities that include commissioning and transformation of clinical care including areas relevant to the information on chronic kidney disease in the BMJ Best Practice Comorbidity Manager. PC has a non-remunerated research partnership with Boehringer Ingelheim into the epidemiology of chronic kidney disease. PC has received honoraria from Astra Zeneca for leading educational meetings for chronic kidney disease and long-term conditions. PC is author of the BMJ Learning module on chronic kidney disease.

Rajiv Sankaranarayanan, MBBS, FRCP (Lon), FESC, FHFA, PhD

Consultant Cardiologist and Heart Failure Lead

Liverpool University Hospitals NHS Foundation Trust

Liverpool Centre for Cardiovascular Science and NIHR Research Scholar and Honorary Senior Clinical Lecturer

University of Liverpool

Liverpool

UK

Declarações

RS has research grants from the British Heart Foundation, the NIHR, NHSX (Transformation Agency), AstraZeneca, Biotronik, and the University of Liverpool. RS has received speaker fees/honoraria and travel reimbursement for conferences from AstraZeneca, Novartis, Vifor, Medtronic, Biotronik, Pfizer, Daaichi Sankyo, Roche, and Boehringer. RS has been appointed to: NHS England GIRFT Clinical Lead; NHS England HF Clinical Lead for Cheshire and Merseyside ICB; NHS England PIFU Pathway Committee for Heart Failure (2021); British Cardiovascular Society Vice President-Elect Digital, Communications and Media Committee; British Society for Heart Failure Board Councillor; Clinical Advisory Board of UK’s patient-led charity Pumping Marvellous (2020); and NHS England HF Expert Group.

Rachael Evans, MBChB, FRCP (UK), PhD

Associate Professor (Clinical)

University of Leicester

Honorary Consultant Respiratory Physician

Glenfield Hospital

Leicester

UK

Declarações

RAE has given a lecture for a non-promotional industry-led session on long COVID by Moderna in 2023 and provided consultancy for a long COVID project for Astra Zeneca over the past 36 months totalling <£3000. RAE is the Chief Investigator for a long COVID study funded by Genentec Roche by a grant awarded to the University of Leicester.

Gerry Rayman, MD, FRCP

Consultant Physician and Head of Service

Diabetes and Endocrine Centre and the Diabetes Research Unit

Ipswich Hospitals NHS Trust

Ipswich

UK

Declarações

GR received funding from Menarini in 2024 to attend the European Association for the Study of Diabetes conference. GR declares he received speaker fees from Abbott and consultancy fees from Eli Lily. GR undertakes several research projects on behalf of East Suffolk and North Essex NHS Foundation Trust for pharmaceutical companies which are on the NIHR portfolio (he does not receive payment himself for these).

Sotiris Posporelis, MD, MRCPsych

Consultant Liaison Neuropsychiatrist

King’s College Hospital

South London and Maudsley NHS Foundation Trust

Honorary Senior Clinical Lecturer

Institute of Psychiatry, Psychology & Neuroscience

King’s College London

London

UK

Declarações

SP declares that he has no competing interests.

Asangaedem Akpan, MPH, FRCP

Consultant Geriatrician

Bunbury Regional Hospital

Western Australia Country Health Service

Bunbury

Western Australia

Visiting Professor

University of Cumbria

Carlisle

Honorary Clinical Associate Professor

University of Liverpool

Liverpool

UK

Declarações

AA has a limited company that is seeking consultancy work offering reviews of healthcare services, facilitation of workshops, advice/review of publications.

Sanjay Agrawal, MBChB, FRCP

Consultant in Respiratory and Intensive Care Medicine

University Hospitals of Leicester NHS Trust

Leicester

UK

Declarações

SA is a board member of Action for Smoking for Health (ASH), a healthcare charity related to tobacco control advocacy. SA is the National Specialty Advisor on Tobacco for NHS England and the Special Advisor for Tobacco for the Royal College of Physicians. SA undertakes research on the field of tobacco control but is not chief investigator for any studies at the time of making this declaration nor has he received any money or grants from pharmaceutical companies.

Acknowledgement: Martin Cowie

BMJ Best Practice would like to gratefully acknowledge Professor Martin Cowie for his previous role as expert adviser for the cardiovascular disease information in the Comorbidities Manager.

Martin Cowie MD, MSc, FRCP, FRCP (Ed), FESC, FHFA, FACC

Professor of Cardiology

Imperial College London (Royal Brompton Hospital)

London

UK

Declarações

MC is chair of the European Society of Cardiology Digital Health Committee and a trustee of the Atrial Fibrillation Society. He has previously been a non-executive director of the National Institute for Health and Care Excellence. MC provides consultancy advice to AstraZeneca, Servier, Abbott, Medtronic, Boston Scientific, and Genomics PLC. MC declares that none of these interests is directly related to topics advised on for this project.

Acknowledgement: Andrew Lewington

BMJ Best Practice would like to gratefully acknowledge Dr Andrew Lewington for his previous role as expert adviser for the chronic kidney disease information in the Comorbidities Manager.

Andrew Lewington, BSc (Hons), MBBS, MEd, MD, FRCP

Consultant Renal Physician

Honorary Associate Professor

Nephrology Department

Leeds Teaching Hospitals NHS Trust

Head of MBChB

School of Medicine

University of Leeds

Leeds

UK

Declarações

AL has been the principal applicant/co-applicant for a number of grants including: Engineering and Physical Sciences Research Council Research - multiplexed AKI biomarker detection with a single molecule biosensor; Leeds Cares - a novel, non-invasive diagnostic approach to assess kidney transplant health through the targeted measurement of biomarkers of kidney injury and immune response in kidney transplant recipients at the Leeds Teaching Hospitals NHS Trust; Kidney Research Yorkshire - use of enhanced technology to characterise haemodialysis treatment for acute kidney injury (AKI); Bringing It Home - validation of a micro-sampling technique for measuring tacrolimus and creatinine remotely, and to fund a research nurse; British Renal Society - renal function assessment with point of care creatinine in diverse populations (RAPID), and several NIHR grants including on a) Improving the quality of post-discharge care following AKI b) An investigation into the use of remote blood sample collection to reduce health inequalities in patients with mental health disorders c) A comparison of remote blood collection devices: a human factor use study d) Defining the characteristics for a novel automatic device to monitor urine output in catheterised patients e) Leeds Medtech and In-vitro Diagnostic Cooperative Grant Extension f) Surgical MedTech Co-operative for the 2019/20 proof-of-principle funding stream g) A pilot investigation into the use of beta-trace protein for residual renal function estimation in haemodialysis h) Application of functional MRI to improve assessment of chronic kidney disease (AFiRM study) i) SuperResPath-Renal: Quantitative super-resolution technology for a fast, decentralised clinical diagnosis of renal pathologies. AL is the co-author of several manuscripts including on extracorporeal treatments, AKI, kidney function testing prior to contrast-enhanced CT, plasma exchange and glucocorticoids in severe ANCA-associated vasculitis, COVID-19 rapid diagnostics, multimodal image-guided ablation on management of renal cancer in Von-Hippel-Lindau syndrome, and a summary of NICE guidance on CKD. AL is the author of several book chapters on nephrology and AKI. AL has received expenses for accommodation and travel for conferences at which he has given lectures, other than those delivered virtually. AL was a member of the AKI Scientific Program Committee for the ISN World Congress of Nephrology 2020-2021 and Chair of this same committee in 2021-2022.

Acknowledgement: Hamish McAuley

BMJ Best Practice would like to gratefully acknowledge Dr Hamish McAuley for his previous involvement in the creation of comorbidity content relevant to asthma and COPD.

Hamish McAuley, MBBS, BSc, MRCP

Clinical Research Fellow

Specialist Registrar (ST5)

University of Leicester

Respiratory Biomedical Research Unit

Glenfield Hospital

Leicester

UK

Declarações

HM declares that he has no competing interests.

Revisores: comorbidades

Martyn Patel, BMBcH, FRCP, MA

Consultant, Older People's Medicine

Norfolk and Norwich University Hospitals

NHS Foundation Trust

Norwich

UK

Declarações

MP is the NHS representative on the board for Norwich Institute for Healthy Ageing (unpaid role). MP participated in a podcast on the evolving nature and importance of comorbidities for BMJ Best Practice in October 2024. MP is submitting an application to the NIHR Research for Patient Benefit (RfPB) Grant Call on physical frailty, an Integrated Care Board (ICB) priority.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2023 report. 2023 [internet publication].Texto completo

National Institute for Health and Care Excellence. Chronic obstructive pulmonary disease in over 16s: diagnosis and management. July 2019 [internet publication].Texto completo

National Institute for Health and Care Excellence. Chronic obstructive pulmonary disease (acute exacerbation): antimicrobial prescribing. December 2018 [internet publication].Texto completo

British Thoracic Society. BTS guideline for oxygen use in healthcare and emergency settings. June 2017 [internet publication].Texto completo

Davidson AC, Banham S, Elliott M, et al. BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults. Thorax. 2016 Apr;71 Suppl 2:ii1-35.Texto completo  Resumo

Artigos de referência

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