Internal Medicine

0521779407-C02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

340 Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease...................

STEPHEN C. LAZARUS, MD

history & physical

History

■Cigarettes account for 80–90% of COPD

■Only 10–20% of smokers develop COPD

■Synergy between smoking and certain inhaled dusts

■More common in men (corrected for smoking)

Signs & Symptoms

■Cough, expectoration (usually scant), dyspnea

■May start as dyspnea with exertion

■Chronic bronchitis most common cause of hemoptysis

■Physical exam often normal

■Rhonchi, wheezes, crackles variably present

■Prolonged expiration common; >4 sec=significant obstruction

■Late: barrel chest, pursed lips, weight loss, tripod posture (leaning

forward supported on arms/elbows)

■Loud P2 suggests pulmonary hypertension

tests

■PFTs

➣All patients should have spirometry

➣Quantitate severity of obstruction

➣Assess reversibility

➣Follow/document progress/prognosis

➣Decreased FEV1, FEV1/FVC

➣TLC, RV may be increased

➣Decreased DLCO in emphysema

Imaging

■CXR:

➣Not specific for COPD; most useful for complications

➣Bronchial wall thickening, “tram-tracks” suggest chronic bron-

chitis

➣Hyperinflation, oligemia, bullae suggest emphysema

■CT can demonstrate emphysema, bronchiectasis