Medical examination
Chest inspection may reveal contraction of the muscles between the ribs during inhalation and the use of accessory breathing muscles. Respiratory rate may be elevated, and wheezing may be heard through a stethoscope during quiet breathing or after forced expiration.
Signs of hyperinflation (e.g. barrel chest and poor diaphragmatic excursion at percussion, use of accessory respiration muscles) and a flattened diaphragm may be evident on an X-ray whereas a chest computerised tomography scan may indicate emphysema. Arterial blood gases can show hypoxaemia and high levels of carbon dioxide (respiratory acidosis).
Signs of smoking can include an odour of smoke or nicotine stained finger nails.
Medical examination may not be useful in differentiating between asthma and COPD but it can be useful in assessing the severity of exacerbations. It should also be noted that it is not unusual for clinical signs to be minimal or absent in a medical examination of a COPD patient.1,2,3,4
References
- American Thoracic Society, European Respiratory Society. Standards for the diagnosis and management of patients with COPD. 2004. http://www.thoracic.org/clinical/copd-guidelines/index.php.
- American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1995;152:S77-S121.
- Siafakas NM, Vermeire P, Pride NB, et al. Optimal assessment and management of chronic obstructive pulmonary disease (COPD). The European Respiratory Society Task Force. Eur Respir J 1995;8:1398-1420.
- Global Initiative for chronic obstructive lung disease: Global strategy for the diagnosis, management, and prevention of COPD. 2010. www.goldcopd.org.