Chronic obstructive pulmonary disease physical examination

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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

Physical examination are quite specific and sensitive for severe disease. The signs are usually difficult to detect in cases of mild to moderate diseases.

General physical examination

• 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.

Pulmonary system

Inspection

• Hyperinflation (barrel chest)

Percussion

• Hyperresonance

Auscultation

• Prolonged expiration; wheezing
• Diffusely decreased breath sound
• Additional sounds - coarse crackles with inspiration

Signs and symptoms

Template:Listen Essentials of diagnosis include:

• History of cigarette smoking.
• Chronic cough and sputum production (in chronic bronchitis)
• Dyspnea
• Rhonchi, decreased intensity of breath sounds, and prolonged expiration on physical examination
• Airflow limitation on pulmonary function testing that is not fully reversible and most often progressive.

One of the most common symptoms of COPD is shortness of breath (dyspnea). People with COPD commonly describe this as: "My breathing requires effort," "I feel out of breath," or "I can't get enough air in". People with COPD typically first notice dyspnea during vigorous exercise when the demands on the lungs are greatest. Over the years, dyspnea tends to get gradually worse so that it can occur during milder, everyday activities such as housework. In the advanced stages of COPD, dyspnea can become so bad that it occurs during rest and is constantly present.

Other symptoms of COPD are a persistent cough, sputum or mucus production, wheezing, chest tightness, and tiredness.

People with advanced (very severe) COPD sometimes develop respiratory failure. When this happens, cyanosis, a bluish discoloration of the lips caused by a lack of oxygen in the blood, can occur. An excess of carbon dioxide in the blood can cause headaches, drowsiness or twitching (asterixis). A complication of advanced COPD is cor pulmonale, a strain on the heart due to the extra work required by the heart to pump blood through the affected lungs. Symptoms of cor pulmonale are peripheral edema, seen as swelling of the ankles, and dyspnea.

There are a few signs of COPD that a healthcare worker may detect although they can be seen in other diseases. Some people have COPD and have none of these signs. Common signs are:

• tachypnea, a rapid breathing rate
• wheezing sounds or crackles in the lungs heard through a stethoscope
• breathing out taking a longer time than breathing in
• enlargement of the chest, particularly the front-to-back distance (hyperaeration)
• active use of muscles in the neck to help with breathing
• breathing through pursed lips
• increased anteroposterior to lateral ratio of the chest (i.e. barrel chest).

References

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