Imprimer Relier: RC.Neu-Chronic Obstructive Pulmonary Disease (COPD) 1 (enarm

1. Patients typically present with a combination of signs and symptoms of chronic bronchitis, emphysema, and reactive airway disease. Symptoms include the following:

2. While the sensitivity of physical examination in detecting mild-to-moderate COPD is relatively poor, the physical signs are quite specific and sensitive for severe disease. Findings in severe disease include the following:

3. Thoracic examination reveals the following:

4. Certain characteristics allow differentiation between disease that is predominantly chronic bronchitis and that which is predominantly emphysema. Chronic bronchitis characteristics include the following:

5. Emphysema characteristics include the following:

Coarse rhonchi and wheezing may be heard on auscultation

Elevated jugular venous pulse (JVP)

Breathlessness: The most significant symptom, but usually does not occur until the sixth decade of life

Cough, usually worse in the mornings and productive of a small amount of colorless sputum

Hyperresonance on percussion

Patients may be obese

The chest may be hyperresonant, and wheezing may be heard

Peripheral edema

Wheezing – Frequently heard on forced and unforced expiration

Cyanosis

Hyperinflation (barrel chest)

Patients may have signs of right heart failure (ie, cor pulmonale), such as edema and cyanosis

Wheezing: May occur in some patients, particularly during exertion and exacerbations

Diffusely decreased breath sounds

Frequent cough and expectoration are typical

Use of accessory muscles of respiration is common

Tachypnea and respiratory distress with simple activities

Use of accessory respiratory muscles and paradoxical indrawing of lower intercostal spaces (Hoover sign)

Prolonged expiration

Patients may be very thin with a barrel chest

Patients typically have little or no cough or expectoration

Coarse crackles beginning with inspiration in some cases

Heart sounds are very distant