Chronic%20obstructive%20pulmonary%20disease Signs and Symptoms

• 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

• 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

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

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