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{{Chronic obstructive pulmonary disease}}
{{Chronic obstructive pulmonary disease}}
{{CMG}}; [[Philip Marcus, M.D., M.P.H.]] [mailto:pmarcus192@aol.com]; {{AOEIC}} {{CZ}}
{{CMG}}; [[Philip Marcus, M.D., M.P.H.]] [mailto:pmarcus192@aol.com]; {{AE}} {{CZ}}


==Overview==
==Overview==
Chronic obstructive pulmonary disease is a group of diseases that can present with symptoms such as shortness of breath, wheezing, persistent cough and sputum production.
Chronic obstructive pulmonary disease is a group of diseases (bronchitis and emphysema) that can present with symptoms such as [[Shortness of breath|dyspnea (shortness of breath)]], [[wheezing]], persistent [[cough]], and [[sputum]] production. Some clinical features can help distinguish between the types of COPD. Patients with [[chronic bronchitis]] present with productive [[cough]] with gradual progression to intermittent [[Shortness of breath|dyspnea (shortness of breath)]], recurrent pulmonary infections, and in later stage progressive [[Cardiac failure|cardiac]] or [[respiratory failure]] presenting with [[edema]] and [[weight gain]]. Classic findings in patients with [[emphysema]] include a long history of progressive [[Shortness of breath|dyspnea (shortness of breath)]] with late onset of [[productive cough]], usually [[mucopurulent]], and eventual decrease in appetite and [[respiratory failure]].


==History==
==History==
The patient may present with a chronic history (lasting for years) of progressive shortness of breath. History may involve patients doing life style modifications to deal with the shortness of breath.
The patient may present with a chronic history (spanning over years) of progressive [[Shortness of breath|dyspnea (shortness of breath)]] mainly due to [[emphysema]], or [[productive cough]] ([[chronic bronchitis]]). Significant history of life style modifications to deal with the [[Shortness of breath|dyspnea (shortness of breath)]] may be found. History of chronic smoking (usually more than 40 pack years) is also commonly found.
 
The following aspects are very helpful in the diagnosis of COPD:<ref name="pmid21810710" />
* Self-reported smoking history of more than 55 pack-year
 
* [[Wheezing]] on auscultation
 
* Self-reported [[wheezing]]
 
==Symptoms==
==Symptoms==
The main [[symptoms]] of COPD include:
COPD includes [[bronchitis|chronic bronchitis]], [[emphysema]], and a range of other pulmonary disorders. This leads to a limitation of the flow of air to and from the lungs, causing [[Shortness of breath|dyspnea (shortness of breath)]]. In clinical practice, COPD is defined by its characteristically low airflow on [[lung function tests]].<ref name="Nathell">{{cite doi|10.1186/1465-9921-8-89}} [http://respiratory-research.com/content/8/1/89]</ref> In contrast to [[asthma]], this limitation is poorly reversible and usually gets progressively worse over time.
* Prolonged [[Dyspnea| Dyspnea (shortness of breath)]] lasting for months or perhaps years that may present as exercise intolerance.
* Advanced COPD can lead to complications beyond the lungs, such as [[weight loss]] ([[cachexia]]), [[pulmonary hypertension]] and [[right-sided heart failure]] ([[cor pulmonale]]). [[Osteoporosis]], [[heart disease]], [[muscle wasting]] and [[Major depressive disorder|depression]] are all more common in people with COPD.<ref name="pmid17507545">{{cite journal |author=Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, Zielinski J |title=Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary |journal=[[American Journal of Respiratory and Critical Care Medicine]] |volume=176 |issue=6 |pages=532–55 |pmid=17507545 |doi=10.1164/rccm.200703-456SO |url=http://ajrccm.atsjournals.org/cgi/pmidlookup?view=long&pmid=17507545 |accessdate=2012-03-02}}</ref>
:* Possibly, accompanied by [[wheezing]]
===Chronic Bronchitis===
*  Persistent [[cough]] with [[sputum]] production.<ref>[http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_SignsAndSymptoms.html U.S. National Heart Lung and Blood Institute - Signs and Symptoms]</ref> It is possible the sputum may contain blood ([[hemoptysis]]), usually due to damage of the blood vessels of the airways. An acute exacerbation may present as productive cough or an acute chest illness is common. The cough usually is worse in the mornings and produces a small amount of colorless sputum. The frequency and severity of acute exacerbation usually increases as the disease progresses.
The hallmark of [[chronic bronchitis]] is [[dyspnea]]. A positive history of chronic productive [[cough]] and [[dyspnea|shortness of breath]] is suggestive of [[chronic bronchitis]]. Some patients describe the dyspnea as air hunger because of sensation of gasping for air.<ref name="pmid24485129">{{cite journal |vauthors=Festic E, Bansal V, Gajic O, Lee AS |title=Prehospital use of inhaled corticosteroids and point prevalence of pneumonia at the time of hospital admission: secondary analysis of a multicenter cohort study |journal=Mayo Clin. Proc. |volume=89 |issue=2 |pages=154–62 |year=2014 |pmid=24485129 |pmc=3989069 |doi=10.1016/j.mayocp.2013.10.028 |url=}}</ref>
* Productive cough with gradual progression to intermittent shortness of breath. <ref>[http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_SignsAndSymptoms.html U.S. National Heart Lung and Blood Institute - Signs and Symptoms]</ref> It is possible the sputum may contain blood ([[hemoptysis]]), usually due to damage of the blood vessels of the airways. An acute exacerbation may present as productive cough or an acute chest illness. The cough usually is worse in the mornings and produces a small amount of colorless sputum. The frequency and severity of acute exacerbation usually increases as the disease progresses.
* In later stages progressive cardiac/respiratory failure may present with [[edema]] and weight gain.
 
=====Common Symptoms=====
* Productive cough with gradual progression to intermittent shortness of breath.<ref>[http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_SignsAndSymptoms.html U.S. National Heart Lung and Blood Institute - Signs and Symptoms]</ref>
* [[Sputum]] may contain blood ([[hemoptysis]]), usually due to damage of the blood vessels of the airways.
* An acute exacerbation may present as productive cough or an acute chest illness.
* The cough typically is worse in the mornings and produces a small amount of colorless sputum.
* The frequency and severity of acute exacerbation usually increases as the disease progresses.
* In later stages progressive cardiac/respiratory failure may present with [[edema]] and weight gain.
=====Other Symptoms=====
*[[Chest discomfort]]
*[[Fatigue]]
*[[Fever]] (typically low-grade)
*[[Wheezing]]
===Severe Bronchitis===
In extreme cases it could lead to [[cor pulmonale]] due the extra work required by the heart to get blood to flow through the lungs which may present as:
* [[Chest discomfort]] (typically in the front of the chest)
* [[Exercise intolerance]]
* [[Shortness of breath]]
* [[Swelling of the feet or ankles]]
* Symptoms of underlying disorders ([[wheezing]], [[coughing]])
 
*  [[Cyanosis]] (typically in the lips and fingers) caused by [[hypoxemia]]
* Patient may have confusion indicating an alteration of mental status
* Depression may be seen
* Decreased fat-free mass
* Impaired systemic muscle function (systemic manifestation)
 
===Emphysema===
Most patients seek medical attention late in the course of their disease as the disease is gradual in onset and progressive.
* The most important aspects of history taking in patients suspected for emphysema include:
** A long history of progressive shortness of breath with late onset of nonproductive cough
** Cough is mainly mucopurulent
** The cough usually is worse in the morning
** Cough is accompanied by eventual decrease in appetite (mainly due to [[respiratory failure]])
** Dyspnea start to manifest mostly around 60 years of age


Severe COPD could lead to:
====Symptoms of Severe Emphysema====
* [[Cyanosis]] (bluish decolorization usually in the lips and fingers) caused by a lack of [[oxygen]] in the blood
In extreme cases it could lead to [[cor pulmonale]] due the extra work required by the heart to get blood to flow through the lungs which may present as:
* [[Chest discomfort]], usually in the front of the chest
* [[Shortness of breath]]
* [[Swelling of the feet or ankles]]
* Symptoms of underlying disorders ([[wheezing]], [[coughing]])
* [[Cyanosis]] (bluish decolorization usually in the lips and fingers) caused by a lack of [[oxygen]] in the blood
* Patient may have confusion indicating an alteration of mental status
* Patient may have confusion indicating an alteration of mental status
* In extreme cases it could lead to [[cor pulmonale]] due the extra work required by the heart to get blood to flow through the lungs.
* Depression may be seen
* Decreased fat-free mass, impaired systemic muscle function (systemic manifestation)
* Decreased fat-free mass, impaired systemic muscle function (systemic manifestation)
* Depression
The most helpful information in diagnosis of COPD is provided by a combination of the following 3 signs {{cite journal |author=Qaseem A, Wilt TJ, Weinberger SE, ''et al.'' |title=Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society |journal=Ann. Intern. Med. |volume=155 |issue=3 |pages=179–91 |year=2011 |month=August |pmid=21810710 |doi=10.1059/0003-4819-155-3-201108020-00008 |url=}}:


'''The most helpful information in diagnosis of COPD is provided by a combination of the following 3 signs:''' <ref name="pmid21810710">{{cite journal |author=Qaseem A, Wilt TJ, Weinberger SE, Hanania NA, Criner G, van der Molen T, Marciniuk DD, Denberg T, Schünemann H, Wedzicha W, MacDonald R, Shekelle P |title=Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society |journal=[[Annals of Internal Medicine]] |volume=155 |issue=3 |pages=179–91 |pmid=21810710 |doi=10.1059/0003-4819-155-3-201108020-00008 |url= |accessdate=2012-03-02}}</ref>
* Self-reported smoking history of more than 55 pack-year
* Self-reported smoking history of more than 55 pack-year
* Wheezing on auscultation
* Self-reported wheezing


* Wheezing on auscultation
===Severe COPD===
* In extreme cases it could lead to [[cor pulmonale]] due the extra work required by the heart to get blood to flow through the lungs which may present as:
** [[Chest discomfort]], usually in the front of the chest
** [[Exercise intolerance]]
** [[Shortness of breath]]
** [[Swelling of the feet or ankles]]
** Symptoms of underlying disorders ([[wheezing]], [[coughing]])
*  [[Cyanosis]] (bluish decolorization usually in the lips and fingers) caused by a lack of [[oxygen]] in the blood
* May present with [[confusion]] indicating an alteration of mental status
* [[Depression]] may be seen
* Decreased fat-free mass, impaired systemic muscle function (systemic manifestation)
===Acute Exacerbations of COPD===
An acute exacerbation of COPD is a sudden worsening of COPD symptoms ([[Shortness of breath|dyspnea [shortness of breath]]], quantity and color of phlegm) that typically lasts for several days. It may be triggered by an infection with [[bacteria]] or [[viruses]] or by environmental pollutants. Typically, infections cause 75% or more of the exacerbations; [[bacteria]] can be found in roughly 25% of cases, [[viruses]] in another 25%, and both [[viruses]] and [[bacteria]] in another 25%. [[Pulmonary Embolism|Pulmonary emboli]] can also cause exacerbations of COPD. Airway inflammation is increased during the exacerbation, resulting in increased hyperinflation, reduced expiratory air flow and worsening of gas transfer. This can also lead to [[hypoventilation]] and eventually [[hypoxia]], insufficient tissue perfusion, and then cell necrosis.<ref name="pmid17507545" />
 
===Symptoms for Admission to Emergency Department===
* [[Confusion]]
 
* [[Lethargy]]
 
* Labored breathing (respiratory muscle fatigue)
 
* [[Cyanosis|Blue discoloration of skin]] (indicating worsening [[hypoxemia]])


* Self-reported wheezing.
* Worsening [[respiratory acidosis]] (pH < 7.30)


==References==
==References==
{{reflist|2}}
{{reflist|2}}
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Revision as of 20:58, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Philip Marcus, M.D., M.P.H. [3]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [4]

Overview

Chronic obstructive pulmonary disease is a group of diseases (bronchitis and emphysema) that can present with symptoms such as dyspnea (shortness of breath), wheezing, persistent cough, and sputum production. Some clinical features can help distinguish between the types of COPD. Patients with chronic bronchitis present with productive cough with gradual progression to intermittent dyspnea (shortness of breath), recurrent pulmonary infections, and in later stage progressive cardiac or respiratory failure presenting with edema and weight gain. Classic findings in patients with emphysema include a long history of progressive dyspnea (shortness of breath) with late onset of productive cough, usually mucopurulent, and eventual decrease in appetite and respiratory failure.

History

The patient may present with a chronic history (spanning over years) of progressive dyspnea (shortness of breath) mainly due to emphysema, or productive cough (chronic bronchitis). Significant history of life style modifications to deal with the dyspnea (shortness of breath) may be found. History of chronic smoking (usually more than 40 pack years) is also commonly found.

The following aspects are very helpful in the diagnosis of COPD:[1]

  • Self-reported smoking history of more than 55 pack-year

Symptoms

COPD includes chronic bronchitis, emphysema, and a range of other pulmonary disorders. This leads to a limitation of the flow of air to and from the lungs, causing dyspnea (shortness of breath). In clinical practice, COPD is defined by its characteristically low airflow on lung function tests.[2] In contrast to asthma, this limitation is poorly reversible and usually gets progressively worse over time.

Chronic Bronchitis

The hallmark of chronic bronchitis is dyspnea. A positive history of chronic productive cough and shortness of breath is suggestive of chronic bronchitis. Some patients describe the dyspnea as air hunger because of sensation of gasping for air.[4]

  • Productive cough with gradual progression to intermittent shortness of breath. [5] It is possible the sputum may contain blood (hemoptysis), usually due to damage of the blood vessels of the airways. An acute exacerbation may present as productive cough or an acute chest illness. The cough usually is worse in the mornings and produces a small amount of colorless sputum. The frequency and severity of acute exacerbation usually increases as the disease progresses.
  • In later stages progressive cardiac/respiratory failure may present with edema and weight gain.
Common Symptoms
  • Productive cough with gradual progression to intermittent shortness of breath.[6]
  • Sputum may contain blood (hemoptysis), usually due to damage of the blood vessels of the airways.
  • An acute exacerbation may present as productive cough or an acute chest illness.
  • The cough typically is worse in the mornings and produces a small amount of colorless sputum.
  • The frequency and severity of acute exacerbation usually increases as the disease progresses.
  • In later stages progressive cardiac/respiratory failure may present with edema and weight gain.
Other Symptoms

Severe Bronchitis

In extreme cases it could lead to cor pulmonale due the extra work required by the heart to get blood to flow through the lungs which may present as:

  • Cyanosis (typically in the lips and fingers) caused by hypoxemia
  • Patient may have confusion indicating an alteration of mental status
  • Depression may be seen
  • Decreased fat-free mass
  • Impaired systemic muscle function (systemic manifestation)

Emphysema

Most patients seek medical attention late in the course of their disease as the disease is gradual in onset and progressive.

  • The most important aspects of history taking in patients suspected for emphysema include:
    • A long history of progressive shortness of breath with late onset of nonproductive cough
    • Cough is mainly mucopurulent
    • The cough usually is worse in the morning
    • Cough is accompanied by eventual decrease in appetite (mainly due to respiratory failure)
    • Dyspnea start to manifest mostly around 60 years of age

Symptoms of Severe Emphysema

In extreme cases it could lead to cor pulmonale due the extra work required by the heart to get blood to flow through the lungs which may present as:

The most helpful information in diagnosis of COPD is provided by a combination of the following 3 signs: [1]

  • Self-reported smoking history of more than 55 pack-year
  • Wheezing on auscultation
  • Self-reported wheezing

Severe COPD

Acute Exacerbations of COPD

An acute exacerbation of COPD is a sudden worsening of COPD symptoms (dyspnea [shortness of breath], quantity and color of phlegm) that typically lasts for several days. It may be triggered by an infection with bacteria or viruses or by environmental pollutants. Typically, infections cause 75% or more of the exacerbations; bacteria can be found in roughly 25% of cases, viruses in another 25%, and both viruses and bacteria in another 25%. Pulmonary emboli can also cause exacerbations of COPD. Airway inflammation is increased during the exacerbation, resulting in increased hyperinflation, reduced expiratory air flow and worsening of gas transfer. This can also lead to hypoventilation and eventually hypoxia, insufficient tissue perfusion, and then cell necrosis.[3]

Symptoms for Admission to Emergency Department

  • Labored breathing (respiratory muscle fatigue)

References

  1. ↑ 1.0 1.1 Qaseem A, Wilt TJ, Weinberger SE, Hanania NA, Criner G, van der Molen T, Marciniuk DD, Denberg T, Schünemann H, Wedzicha W, MacDonald R, Shekelle P. "Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society". Annals of Internal Medicine. 155 (3): 179–91. doi:10.1059/0003-4819-155-3-201108020-00008. PMID 21810710. |access-date= requires |url= (help)
  2. ↑ Template:Cite doi [1]
  3. ↑ 3.0 3.1 Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, Zielinski J. "Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary". American Journal of Respiratory and Critical Care Medicine. 176 (6): 532–55. doi:10.1164/rccm.200703-456SO. PMID 17507545. Retrieved 2012-03-02.
  4. ↑ Festic E, Bansal V, Gajic O, Lee AS (2014). "Prehospital use of inhaled corticosteroids and point prevalence of pneumonia at the time of hospital admission: secondary analysis of a multicenter cohort study". Mayo Clin. Proc. 89 (2): 154–62. doi:10.1016/j.mayocp.2013.10.028. PMC 3989069. PMID 24485129.
  5. ↑ U.S. National Heart Lung and Blood Institute - Signs and Symptoms
  6. ↑ U.S. National Heart Lung and Blood Institute - Signs and Symptoms

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