Summary
Definition
History and exam
Key diagnostic factors
- dispneia
- tosse
- sibilo
- mudanças no volume/coloração/espessura da expectoração
- taquipneia
- cianose
Other diagnostic factors
- história médica pregressa de DPOC
- Tabagismo
- história clínica prévia de refluxo gastroesofágico e/ou disfunção da deglutição
- mal-estar e fadiga
- constrição torácica
- características do cor pulmonale
- exposição a poluentes ambientais/ocupacionais ou poeira
- alteração do estado mental
- febre
- uso dos músculos acessórios
- movimentos paradoxais do abdome
Risk factors
- infecção viral
- infecção bacteriana
- refluxo gastroesofágico e/ou disfunção da deglutição
- tabagismo
- poluentes aéreos
- infecção bacteriana atípica
- mudança climática
Diagnostic investigations
1st investigations to order
- saturação de oxigênio à oximetria de pulso
- radiografia torácica
- eletrocardiograma (ECG)
- gasometria arterial
- Hemograma completo com diferencial
- contagem de eosinófilos
- proteína C-reativa
- perfil metabólico básico para eletrólitos, ureia + creatinina
Investigations to consider
- cultura + coloração de Gram da expectoração
- diagnóstico de vírus respiratório
- troponina cardíaca
- peptídeo natriurético do tipo B (PNB)
- TC do tórax
Treatment algorithm
Contributors
Authors
Carolyn L. Rochester, MD
Professor of Medicine
Yale School of Medicine
New Haven
VA Connecticut Healthcare System
West Haven
CT
Disclosures
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
CT
Disclosures
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
TX
Disclosures
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.
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
Key articles
Global Initiative for Chronic Obstructive Lung Disease. Global strategy for prevention, diagnosis and management of COPD (2024 report). 2024 [internet publication].Full text
Stevermer JJ, Fisher L, Lin KW, et al. Pharmacologic Management of COPD Exacerbations: A Clinical Practice Guideline from the AAFP. Am Fam Physician. 2021 Jul 1;104(1):Online.Full text Abstract
Spruit MA, Singh SJ, Garvey C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013 Oct 15;188(8):e13-64. Abstract
Reference articles
A full list of sources referenced in this topic is available here.
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