Clinical manifestations-chronic obstructive pulmonary disease

• Chronic cough, sputum production, dyspnea; later stages → freq exacerb, AM headache, wt loss

• Exacerbation triggers: infection, other cardiopulmonary disease, including PE

Infxn:

overt tracheobronchitis/pneumonia from viruses, S. pneumoniae, H. influenzae, M. catarrhalis or triggered by changes in strain of colonizers (NEJM 2008;359:2355)

Physical exam:

• ↑ AP diameter of chest (“barrel chest”),
• hyperresonance,
• ↓ diaphragmatic [excursion],
• ↓ breath sounds,
• ↑ expiratory phase,
• rhonchi, wheezes during exacerbation: tachypnea,
• accessory muscle use, pulsus paradoxus, cyanosis

Asthma-COPD overlap syndrome (ACOS; NEJM 2015;373:1241):

• features of both present. For example:
• reversibility of airway obstruction with bronchodilator in COPD;
• neutrophilic inflammation in asthma (more classic in COPD);
• eos in COPD.