How do the physical findings suggestive of chronic obstructive pulmonary disease (COPD) vary between the two types?

Updated: Nov 13, 2020
  • Author: Paul Kleinschmidt, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Depending on the type of chronic obstructive pulmonary disease (COPD), physical examination findings may vary.

Chronic bronchitis (blue bloaters) findings may be as follows:

  • Patients may be obese.

  • Frequent cough and expectoration are typical.

  • Use of accessory muscles of respiration is common.

  • Coarse rhonchi and wheezing may be heard on auscultation.

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

  • 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:

  • Patients may be very thin with a barrel chest.

  • They typically have little or no cough or expectoration.

  • 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.

  • The chest may be hyperresonant, and wheezing may be heard; heart sounds are very distant.

  • Overall appearance is more like classic COPD exacerbation.

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