Chronic obstructive pulmonary disease physical examination: Difference between revisions
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{{Chronic obstructive pulmonary disease}} | {{Chronic obstructive pulmonary disease}} | ||
{{CMG}}; [[Philip Marcus, M.D., M.P.H.]] [mailto:pmarcus192@aol.com]; {{ | {{CMG}}; [[Philip Marcus, M.D., M.P.H.]] [mailto:pmarcus192@aol.com]; {{AE}} {{CZ}} | ||
==Overview== | ==Overview== | ||
Chronic obstructive pulmonary disease can be diagnostically evaluated by physical examination through auscultation. Physical examination are quite specific and sensitive for severe disease. The signs are usually difficult to detect in cases of mild to moderate diseases. Findings on general physical examination can be cyanosis, tachypnea, use of accessory respiratory muscles, paradoxical indrawing of lower intercostal spaces is evident (known as the Hoover sign), elevated jugular venous pulse and peripheral edema. Pulmonary examination in can be barrel chest (emphysema), wheezing, hyperresonance, crackles and rhonchi | Chronic obstructive pulmonary disease can be diagnostically evaluated by physical examination through auscultation. Physical examination are quite specific and sensitive for severe disease. The signs are usually difficult to detect in cases of mild to moderate diseases. Findings on general physical examination can be [[cyanosis]], [[tachypnea]], use of accessory respiratory muscles, paradoxical indrawing of lower intercostal spaces is evident (known as the Hoover sign), elevated jugular venous pulse and peripheral edema. Pulmonary examination in can be barrel chest ([[emphysema]]), [[wheezing]], hyperresonance, [[crackles]] and [[rhonchi]] | ||
==Physical Examination== | ==Physical Examination== | ||
Physical examinations are quite specific and sensitive for severe disease. The signs are usually difficult to detect in cases of mild to moderate diseases. | Physical examinations are quite specific and sensitive for severe disease. The signs are usually difficult to detect in cases of mild to moderate diseases.<ref name="pmid27254942">{{cite journal |vauthors=Sato S, Mishima M |title=[Diagnosis and examination for COPD; medical interview/physical finding/ blood examination] |language=Japanese |journal=Nippon Rinsho |volume=74 |issue=5 |pages=757–62 |year=2016 |pmid=27254942 |doi= |url=}}</ref><ref name="pmid19547847">{{cite journal |vauthors=Mattos WL, Signori LG, Borges FK, Bergamin JA, Machado V |title=Accuracy of clinical examination findings in the diagnosis of COPD |journal=J Bras Pneumol |volume=35 |issue=5 |pages=404–8 |year=2009 |pmid=19547847 |doi= |url=}}</ref><ref name="pmid25556602">{{cite journal |vauthors=Burkhardt R, Pankow W |title=The diagnosis of chronic obstructive pulmonary disease |journal=Dtsch Arztebl Int |volume=111 |issue=49 |pages=834–45, quiz 846 |year=2014 |pmid=25556602 |pmc=4284520 |doi=10.3238/arztebl.2014.0834 |url=}}</ref><ref name="pmid21123639">{{cite journal |vauthors=Price DB, Yawn BP, Jones RC |title=Improving the differential diagnosis of chronic obstructive pulmonary disease in primary care |journal=Mayo Clin. Proc. |volume=85 |issue=12 |pages=1122–9 |year=2010 |pmid=21123639 |pmc=2996146 |doi=10.4065/mcp.2010.0389 |url=}}</ref><ref name="pmid24049265">{{cite journal |vauthors=Gupta D, Agarwal R, Aggarwal AN, Maturu VN, Dhooria S, Prasad KT, Sehgal IS, Yenge LB, Jindal A, Singh N, Ghoshal AG, Khilnani GC, Samaria JK, Gaur SN, Behera D |title=Guidelines for diagnosis and management of chronic obstructive pulmonary disease: Joint ICS/NCCP (I) recommendations |journal=Lung India |volume=30 |issue=3 |pages=228–67 |year=2013 |pmid=24049265 |pmc=3775210 |doi=10.4103/0970-2113.116248 |url=}}</ref> | ||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
* Cyanosis | * [[Cyanosis]] | ||
* Tachypnea | * [[Tachypnea]] | ||
* Respiratory distress indicated by use of accessory respiratory muscles. Hoover sign presenting as paradoxical indrawing of lower intercostal spaces is evident (known as the Hoover sign) | * [[Respiratory distress]] indicated by use of accessory respiratory muscles. [[Hoover sign]] presenting as paradoxical indrawing of lower intercostal spaces is evident (known as the Hoover sign) | ||
* Elevated jugular venous pulse (JVP) | * Elevated [[jugular venous pulse]] (JVP) | ||
* Peripheral edema can be observed. | * Peripheral [[edema]] can be observed. | ||
===Lungs=== | ===Lungs=== | ||
====Inspection==== | ====Inspection==== | ||
| Line 19: | Line 21: | ||
* Hyperresonance | * Hyperresonance | ||
====Auscultation==== | ====Auscultation==== | ||
* Prolonged expiration; wheezing | * Prolonged [[expiration]]; [[wheezing]] | ||
* Diffusely decreased breath sound | * Diffusely decreased breath sound | ||
* Additional sounds - coarse crackles with inspiration | * Additional sounds - coarse crackles with [[inspiration]] | ||
= | {| class="wikitable" | ||
! | |||
!Specific Features of Emphysema | |||
!Specific Features of Chronic Bronchitis | |||
|- | |||
!Appearance of the Patient | |||
| | |||
* General appearance: Pursed lips, adopting a tripod position, using accessory muscles. | * General appearance: Pursed lips, adopting a tripod position, using accessory muscles. | ||
* Thin patient with barrel chest | * Thin patient with barrel [[chest]] | ||
* Barrel chest may cause distant heart sound | * Barrel chest may cause distant heart sound | ||
* Pink puffers | * Pink puffers | ||
**This is because emphysema sufferers may hyperventilate to maintain adequate blood oxygen levels. Hyperventilation explains why mild emphysema patients do not appear [[Cyanosis|cyanotic]] as chronic [[bronchitis]] (another [[COPD]] disorder) sufferers often do; hence they are "pink puffers" (able to maintain almost normal blood gases through hyperventilation) and not "blue bloaters" ([[cyanosis]]; inadequate oxygen in the blood). However, any severely chronically obstructed (COPD) respiratory disease will result in hypoxia (decreased blood partial pressure of oxygen) and hypercapnia (increased blood partial pressure of Carbon Dioxide) | |||
| | |||
* Blue bloaters they are so named as they have almost normal ventilatory drive (due to decreased sensitivity to [[carbon dioxide]] secondary to chronic [[hypercapnia]]), are plethoric (red face/cheeks due to a polycythemia secondary to chronic [[hypoxia]]) and [[cyanotic]] (due to decreased [[hemoglobin]] saturation). | |||
* Signs of [[right heart failure]] or [[cor pulmonale]] such as [[edema]] and [[cyanosis]] can be seen. | |||
|- | |||
!Lungs | |||
| | |||
====Inspection==== | |||
*Hyperinflation (barrel chest) | |||
*Tachypnea | |||
*Respiratory distress indicated by use of accessory respiratory muscles. Hoover sign presenting as paradoxical indrawing of lower intercostal spaces is evident (known as the Hoover sign) | |||
====Percussion==== | |||
*Hyperresonance | |||
====Auscultation==== | |||
*Prolonged expiration; wheezing | |||
*Diffusely decreased breath sound | |||
*Additional sounds - coarse crackles with inspiration | |||
*Examination of the chest reveals increased percussion notes (particularly over the liver) and a difficult to palpate [[apex beat]] (all due to hyperinflation), decreased breath sounds, audible expiratory wheeze. Classically,clinical examination of an emphysematic patient reveals no overt crackles, however, in some patients the fine opening of airway 'popping' (dissimilar to the fine crackles of [[pulmonary fibrosis]] or coarse crackles of [[mucus|mucinous]] or [[edema|oedematous fluid]]) can be [[Auscultation|auscultated]]. This is known as "[[Barclay's sign]]". | |||
| | |||
====Inspection==== | |||
*Respiratory distress indicated by use of accessory respiratory muscles | |||
*[[Hoover's sign]], presenting as paradoxical indrawing of lower intercostal spaces, is evident | |||
====Auscultation==== | |||
*Prolonged expiration; [[wheezing]] | |||
*Diffusely decreased breath sound | |||
*Coarse [[crackles]] with inspiration | |||
*Coarse [[rhonchi]] | |||
|- | |||
!HEENT | |||
| | |||
* Elevated [[jugular venous pulse]] (JVP) | |||
| | |||
* Elevated [[jugular venous pulse]] (JVP) | |||
|- | |||
!Heart | |||
| | |||
*Signs of right heart failure | |||
*Muffled heart sounds | |||
**Due to overdistention of lungs | |||
| | |||
* Distant heart sounds, sometimes best heard in the epigastrium | |||
* Muffled heart sounds | |||
**Due to overdistention of lungs | |||
|- | |||
!Extremity | |||
| | |||
* Peripheral edema can be observed | |||
*Clinical signs on at the fingers include cigarette stains (although actually tar) and asterixis (metabolic flap) at the wrist if they are carbon dioxide retainers (NOTE: Finger clubbing is NOT a general feature of emphysema). | |||
*Cyanosis | |||
| | |||
* [[Peripheral edema]] | |||
|} | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WikiDoc Help Menu}} | |||
{{WikiDoc Sources}} | |||
[[Category:Pulmonology]] | [[Category:Pulmonology]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
Latest revision as of 20:58, 29 July 2020
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Differentiating Chronic obstructive pulmonary disease from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Philip Marcus, M.D., M.P.H. [2]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [3]
Overview
Chronic obstructive pulmonary disease can be diagnostically evaluated by physical examination through auscultation. Physical examination are quite specific and sensitive for severe disease. The signs are usually difficult to detect in cases of mild to moderate diseases. Findings on general physical examination can be cyanosis, tachypnea, use of accessory respiratory muscles, paradoxical indrawing of lower intercostal spaces is evident (known as the Hoover sign), elevated jugular venous pulse and peripheral edema. Pulmonary examination in can be barrel chest (emphysema), wheezing, hyperresonance, crackles and rhonchi
Physical Examination
Physical examinations are quite specific and sensitive for severe disease. The signs are usually difficult to detect in cases of mild to moderate diseases.[1][2][3][4][5]
Appearance of the Patient
- Cyanosis
- Tachypnea
- Respiratory distress indicated by use of accessory respiratory muscles. Hoover sign presenting as paradoxical indrawing of lower intercostal spaces is evident (known as the Hoover sign)
- Elevated jugular venous pulse (JVP)
- Peripheral edema can be observed.
Lungs
Inspection
- Hyperinflation (barrel chest)
Percussion
- Hyperresonance
Auscultation
- Prolonged expiration; wheezing
- Diffusely decreased breath sound
- Additional sounds - coarse crackles with inspiration
| Specific Features of Emphysema | Specific Features of Chronic Bronchitis | |
|---|---|---|
| Appearance of the Patient |
|
|
| Lungs |
Inspection
Percussion
Auscultation
|
Inspection
Auscultation |
| HEENT |
|
|
| Heart |
|
|
| Extremity |
|
References
- ↑ Sato S, Mishima M (2016). "[Diagnosis and examination for COPD; medical interview/physical finding/ blood examination]". Nippon Rinsho (in Japanese). 74 (5): 757–62. PMID 27254942.
- ↑ Mattos WL, Signori LG, Borges FK, Bergamin JA, Machado V (2009). "Accuracy of clinical examination findings in the diagnosis of COPD". J Bras Pneumol. 35 (5): 404–8. PMID 19547847.
- ↑ Burkhardt R, Pankow W (2014). "The diagnosis of chronic obstructive pulmonary disease". Dtsch Arztebl Int. 111 (49): 834–45, quiz 846. doi:10.3238/arztebl.2014.0834. PMC 4284520. PMID 25556602.
- ↑ Price DB, Yawn BP, Jones RC (2010). "Improving the differential diagnosis of chronic obstructive pulmonary disease in primary care". Mayo Clin. Proc. 85 (12): 1122–9. doi:10.4065/mcp.2010.0389. PMC 2996146. PMID 21123639.
- ↑ Gupta D, Agarwal R, Aggarwal AN, Maturu VN, Dhooria S, Prasad KT, Sehgal IS, Yenge LB, Jindal A, Singh N, Ghoshal AG, Khilnani GC, Samaria JK, Gaur SN, Behera D (2013). "Guidelines for diagnosis and management of chronic obstructive pulmonary disease: Joint ICS/NCCP (I) recommendations". Lung India. 30 (3): 228–67. doi:10.4103/0970-2113.116248. PMC 3775210. PMID 24049265.