Chronic obstructive pulmonary disease history and symptoms

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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 that can present with symptoms such as shortness of breath, wheezing, persistent cough and sputum production. Some clinical differences can help distinguish between the types of COPD. While chronic bronchitis patient present with productive cough with gradual progression to intermittent shortness of breath; recurrent pulmonary infections; and in later stage progressive cardiac/respiratory failure presenting with edema and weight gain. Classic findings for patients with emphysema include a long history of progressive shortness of breath with late onset of nonproductive cough; usually mucopurulent; and eventual decrease in appetite and respiratory failure.

History

The patient may present with a chronic history (lasting for years) of progressive shortness of breath (emphysema) or productive cough (chronic bronchitis). History may involve patient doing life style modifications to deal with the shortness of breath. History of being chronic smoker (usually more than 40 pack year) is also commonly found.

Symptoms

Acute Exacerbations of COPD

An acute exacerbation of COPD is a sudden worsening of COPD symptoms (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.[2]

Chronic Bronchitis

  • Productive cough with gradual progression to intermittent shortness of breath. [3] 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.

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: [4]

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

AAT Deficient Patients

  • Present earlier than other COPD patients.
  • Mainly affects the lungs and the liver.
  • Liver abnormalities can be seen in the first decade of life.
  • Patients who are homozygous (PIZZ) have following feature:
    • Early presentation (< 50 yrs)
    • Commonly involve the lung bases
    • Panacinar emphysema.

Severe COPD

Symptoms for Admission to Emergency Department

  • Labored breathing (respiratory muscle fatigue)

The most helpful information in diagnosis of COPD is provided by a combination of the following 3 signs [4]

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

References

  1. Template:Cite doi [1]
  2. 2.0 2.1 Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, Zielinski J (2007). "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. Unknown parameter |month= ignored (help)
  3. U.S. National Heart Lung and Blood Institute - Signs and Symptoms
  4. 4.0 4.1 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 (2011). "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. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)


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