Depending on the type of chronic obstructive pulmonary disease (COPD), physical examination findings may vary.
Chronic bronchitis (blue bloaters) findings may be as follows:
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Patients may be obese.
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Frequent cough and expectoration are typical.
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Use of accessory muscles of respiration is common.
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Coarse rhonchi and wheezing may be heard on auscultation.
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Patients may have signs of right heart failure (ie, cor pulmonale), such as edema and cyanosis.
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Because they share many of the same physical signs, COPD may be difficult to distinguish from congestive heart failure (CHF). One crude bedside test for distinguishing COPD from CHF is peak expiratory flow. If patients blow 150-200 mL or less, they are probably having a COPD exacerbation; higher flows indicate a probable CHF exacerbation.
Emphysema (pink puffers) findings may be as follows:
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Patients may be very thin with a barrel chest.
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They typically have little or no cough or expectoration.
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Breathing may be assisted by pursed lips and use of accessory respiratory muscles; they may adopt the tripod sitting position. In this manner, the patient is trying to maintain a certain amount of positive end-expiratory pressure (PEEP) at the end of expiration, to help keep their lungs open, owing to the loss of lung structure from the disease.
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The chest may be hyperresonant, and wheezing may be heard; heart sounds are very distant.
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Overall appearance is more like classic COPD exacerbation.
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Chronic obstructive pulmonary disease (COPD). Histopathology of chronic bronchitis showing hyperplasia of mucous glands and infiltration of the airway wall with inflammatory cells.
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Chronic obstructive pulmonary disease (COPD). Histopathology of chronic bronchitis showing hyperplasia of mucous glands and infiltration of the airway wall with inflammatory cells (high-powered view).
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Posteroanterior (PA) and lateral chest radiograph in a patient with severe chronic obstructive pulmonary disease (COPD). Hyperinflation, depressed diaphragms, increased retrosternal space, and hypovascularity of lung parenchyma is demonstrated.
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Chronic obstructive pulmonary disease (COPD). A lung with emphysema shows increased anteroposterior (AP) diameter, increased retrosternal airspace, and flattened diaphragms on lateral chest radiograph.
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Chronic obstructive pulmonary disease (COPD). A lung with emphysema shows increased anteroposterior (AP) diameter, increased retrosternal airspace, and flattened diaphragms on posteroanterior chest radiograph.
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Subcutaneous emphysema and pneumothorax.
