Clinical Manifestations

Major symptoms of COPD (GOLD, 2011)

• Shortness of breath or dyspnea

• A chronic cough

• Sputum or mucus

• Wheezing

• Chest pain

• Lung infection

• Fatigue

• Fever

• Cyanosis

• Barrel chest

• Mood or memory problems

• Unexplained weight loss

• Swelling of the feet and ankles 

Major symptoms of emphysema (Schiffman, 2012)

• Shortness of breath.

• A long history of progressive dyspnea with late onset of nonproductive cough

• Dyspnea usually is most noticeable during increased physical activity, but as emphysema progresses, dyspnea occurs at rest.

• Occasional mucopurulent relapses

• eventual cachexia and respiratory failure

Major symptoms of chronic bronchitis (Schiffman, 2012)

• Chronic cough

• Clear and thick sputum

• Gradual progression to intermittent dyspnea

• Frequent and recurrent pulmonary infections which may cause:

• Fever

• Dyspnea

• Coughing

• Purulent (cloudy and discolored) sputum

• Wheezing (Wheezing is a high pitched noise produced in the lungs during exhalation when mucous, bronchospasm, or loss of lung elasticity obstructs airways.)

• Progressive cardiac/respiratory failure with edema and weight gain

Classification of the four stages of COPD severity (GOLD, 2011)

Figure 1. Spirometric classification of the four stages of COPD severity. (FEV₁=Forced Expiratory Volume, FVC=Forced Vital Capacity)

In the physical examination, the use of the fixed FEV₁/FVC ratio to define airflow limitation will result in more frequent diagnosis of COPD in the elderly, and less frequent diagnosis in adults younger than 45 years, especially of mild disease (GOLD, 2011). This is illustrated in Figure 1. Spirometry should be performed after the administration of an adequate dose of a short-acting inhaled bronchodilator in order to minimize variability (GOLD, 2011).

Sign and symptoms of a COPD flare-up (The Lung Association, 2011)

• an unusual increase in shortness of breath

• increased cough

• an increase in the amount, thickness or stickiness of mucus which may be more yellow, green or brown than usual

• fever

• symptoms of a commom cold

• headache

• runny nose

• sore throat

• swollen ankles

• feeling fatigued and generally unwell

Systemic Manifestations (Hanania et al., 2011)

• Decreased fat-free mass

• Impaired systemic muscle function

• Osteoporosis

• Anemia

• Depression

• Pulmonary hypertension

• Cor pulmonale

• Left-sided heart failure

• Depression is not uncommon in subjects with COPD
  

Warning signs of a severe COPD flare-up (The Lung Association, 2011)

When those sign occurs, CALL 911!

• chest pain
• blue lips or fingers
• confusion, can’t think clearly, or very agitated/upset
• drowsy
• extremely short of breath

With disease progression, intervals between acute exacerbations become shorter, and each exacerbation may be more severe (Hurst et al., 2010).