Chronic%20obstructive%20pulmonary%20disease Signs and Symptoms
Introduction
- Chronic Obstructive Pulmonary Disease (COPD) should be suspected in any patient who has chronic cough, sputum production or dyspnea with or without history of risk factors for the disease
Definition
- A preventable and treatable disease with overall severity contributed by exacerbations and comorbidities
- The persistent airflow limitation is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases
- The chronic airflow limitation is caused by a mixture of small airways disease and parenchymal destruction
Signs and Symptoms
A diagnosis of COPD should be considered in patients over 40 years of age who have a suggestive medical history (ie presence of risk factors) and who present with any of the following:
- Chronic cough (present intermittently or daily)
- Does not reflect the major impact of airflow limitation on the morbidity and mortality in patients with COPD
- Cough may be unproductive
- Exertional breathlessness, wheezing, pursed-lip breathing, dyspnea with or without wheezing
- Rhonchi, prolonged expiratory phase of respiration, chest hyperinflation, use of accessory muscles for respiration, decreased breath sounds
- Signs of cor pulmonale: Neck vein distention, increased pulmonic component of 2nd heart sound, lower extremity edema, hepatomegaly
- The absence of wheezing or chest tightness does not rule out a diagnosis of COPD
Risk Factors
Host Factors
- Airway hyper-responsiveness
- Includes asthma
- May also develop after exposure to tobacco smoke or other environmental insults
- Lung growth and development
- Individuals may have reduced maximal attained lung function due to processes during gestation and childhood
- Infections
- Reduced lung function can be associated with a history of severe childhood respiratory infections
- Previous tuberculosis
- Hereditary deficiency of alpha-1 antitrypsin
Exposures
- Tobacco smoke
- Most commonly encountered risk factor
- Includes history of tobacco use or prolonged exposure to second-hand smoke
- Smoking during pregnancy can put the fetus at risk
- Occupational dusts and chemicals
- Air pollution
- Smoke from home cooking and heating fuels
- Low socioeconomic status