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Last reviewed: 17 Aug 2025
Last updated: 16 May 2025

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

Emerging tests

  • procalcitonina
  • vitamina D
  • imunoglobulinas

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

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. 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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