Clinical Presentation
A diagnosis of COPD should be considered in patients ≥35 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): Cough may be non-productive and does not reflect the major impact of airflow limitation on morbidity and mortality in patients with COPD.
- 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 second heart sound, lower extremity edema, hepatomegaly
- The absence of wheezing or chest tightness does not rule out a diagnosis of COPD.
History
A detailed medical history should include risk factors, past medical history (eg pre-existing illnesses, previous exacerbations or hospitalizations for other respiratory disorders), family history of COPD or other chronic respiratory diseases and presence of comorbidities (eg heart disease, osteoporosis, musculoskeletal disorders, anxiety, depression, malignancies).
Physical Examination
Physical examination should be part of standard patient care, but it is rarely diagnostic in COPD.