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Last reviewed: 20 Aug 2025
Last updated: 13 May 2025

Summary

Definition

History and exam

Key diagnostic factors

  • tosse
  • dispneia
  • produção de escarro
  • exposição a fatores de risco

Other diagnostic factors

  • tórax em tonel
  • hiper-ressonância/timpanismo à percussão
  • murmúrio vesicular diminuído à ausculta pulmonar
  • expansibilidade reduzida à ausculta
  • sibilância à ausculta
  • crepitação grossa
  • taquipneia
  • asterixis (flapping)
  • veias jugulares distendidas
  • edema de membros inferiores
  • fadiga
  • perda de peso
  • perda muscular
  • cefaleia
  • Respiração com lábios franzidos
  • cianose
  • hiperfonese da segunda bulha no foco pulmonar (P2)
  • refluxo hepatojugular
  • hepatoesplenomegalia
  • baqueteamento digital

Risk factors

  • tabagismo
  • idade avançada
  • fatores genéticos
  • crescimento e desenvolvimento pulmonar
  • ascendência branca
  • exposição à poluição do ar
  • exposição à queima de combustíveis sólidos ou biomassa
  • exposição ocupacional a poeira, produtos químicos, pesticidas, vapores, fumaças ou gases
  • sexo masculino
  • condição socioeconômica baixa
  • artrite reumatoide

Diagnostic investigations

1st investigations to order

  • espirometria
  • Escore de sintomas padronizados
  • oximetria de pulso
  • gasometria arterial
  • Radiografia torácica
  • Hemograma completo

Investigations to consider

  • testes de função pulmonar
  • tomografia do tórax
  • medição seriada do pico do fluxo
  • cultura de escarro
  • nível de alfa 1-antitripsina
  • teste ergométrico
  • estudo do sono
  • função do músculo respiratório
  • eletrocardiograma (ECG)
  • ecocardiograma
  • contagem de eosinófilos no sangue

Treatment algorithm

Contributors

Authors

Manoochehr Abadian Sharifabad, MD
Manoochehr Abadian Sharifabad

Fountain Valley Regional Medical Center

Fountain Valley

CA

Disclosures

MAS declares that he has no competing interests.

Acknowledgements

Dr Manoochehr Abadian Sharifabad would like to gratefully acknowledge Dr Jonathan P. Parsons and Dr Michael Ezzie, the previous contributors to this topic.

Disclosures

JPP has contributed at speakers' bureaus for GlaxoSmithKline, Inc., Schering-Plough, Inc., and AstraZeneca, Inc. ME declares that he has no competing interests.

Peer reviewers

Hormoz Ashtyani, MD, FCCP

Hackensack University Medical Center

Hackensack

NJ

Disclosures

HA declares that he has no competing interests.

Alejandro Comellas, MD

Clinical Professor of Internal Medicine-Pulmonary, Critical Care and Occupational Medicine

University of Iowa

Iowa City

IA

Disclosures

AC has received payments as a consultant for GSK and AstraZeneca. He also serves as a non-paid consultant for VIDA.

William Janssen, MD

Assistant Professor of Medicine

National Jewish Medical and Research Center

University of Colorado Health Sciences Center

Denver

CO

Disclosures

WJ declares that he has no competing interests.

Francis Thien, MD, FRACP, FCCP

Associate Professor

Director of Respiratory Medicine

Eastern Health & Monash University

Victoria

Australia

Disclosures

FT declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2025 report. 2025 [internet publication].Full text

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

Nici L, Mammen MJ, Charbek E, et al. Pharmacologic management of chronic obstructive pulmonary disease. An official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med. 2020 May 1;201(9):e56-69.Full text  Abstract

Jacobs SS, Krishnan JA, Lederer DJ, et al. Home oxygen therapy for adults with chronic lung disease. An official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med. 2020 Nov 15;202(10):e121-41. [Erratum in: Am J Respir Crit Care Med. 2021 Apr 15;203(8):1045-6.]Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available here.

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