Chronic obstructive pulmonary disease: Clinical sciences

Chronic Obstructive Pulmonary Disease or COPD, is a condition characterized by progressive airflow obstruction resulting in chronic respiratory symptoms. This can occur due to airway inflammation, like in chronic bronchitis, or because of alveolar wall destruction, as in emphysema.

Tobacco use is the leading cause of COPD, while less commonly it is due to secondhand smoke or environmental exposures, or hereditary causes like alpha-1 antitrypsin deficiency.

Based on history findings, some patients can present with a new diagnosis of COPD, while others can present with a positive history of COPD and clinical manifestations. The clinical manifestations can range from mild COPD exacerbation to complicated COPD, such as severe COPD exacerbation, bacterial pneumonia, pulmonary hypertension, and even acute respiratory failure.

Now, if you suspect COPD, perform an ABCDE assessment to determine if your patient is unstable or stable. If the patient is unstable look for alarm signs and symptoms, history might suggest worsening dyspnea and an increased production of purulent sputum, while physical exam typically reveals rapid shallow breathing, decreased breath sounds, use of accessory respiratory muscles like the scalenes and intercostals, and even cyanosis. Pulse oximetry may reveal hypoxemia. In this case you’ll need to begin acute management.

First stabilize the airway, breathing, and circulation, which may require noninvasive or invasive mechanical ventilation, as well as obtaining IV access and starting continuous vital sign monitoring.

Ok, let’s return to the ABCDE assessment. If the patient is stable, obtain a focused history and physical examination. These patients typically report symptoms like increased cough, change in sputum production, and shortness of breath, and will usually have a history of smoking, second hand smoke exposure, or exposure to another occupational or environmental irritant.