Chronic obstructive pulmonary disease physical examination


 * Philip Marcus, M.D., M.P.H. [mailto:pmarcus192@aol.com];

Overview
Chronic obstructive pulmonary disease can be diagnostically evaluated by physical examination through auscultation. Physical examination are quite specific and sensitive for severe disease. The signs are usually difficult to detect in cases of mild to moderate diseases. Findings on general physical examination can be cyanosis, tachypnea, use of accessory respiratory muscles, paradoxical indrawing of lower intercostal spaces is evident (known as the Hoover sign), elevated jugular venous pulse and peripheral edema. Pulmonary examination in can be barrel chest (emphysema), wheezing, hyperresonance, crackles and rhonchi

Physical Examination
Physical examination are quite specific and sensitive for severe disease. The signs are usually difficult to detect in cases of mild to moderate diseases.

General physical examination

 * Cyanosis
 * Tachypnea
 * Respiratory distress indicated by use of accessory respiratory muscles. Hoover sign presenting as paradoxical indrawing of lower intercostal spaces is evident (known as the Hoover sign)
 * Elevated jugular venous pulse (JVP)
 * Peripheral edema can be observed.

Inspection

 * Hyperinflation (barrel chest)

Percussion

 * Hyperresonance

Auscultation

 * Prolonged expiration; wheezing
 * Diffusely decreased breath sound
 * Additional sounds - coarse crackles with inspiration

General appearance

 * Blue bloaters they are so named as they have almost normal ventilatory drive (due to decreased sensitivity to carbon dioxide secondary to chronic hypercapnia), are plethoric (red face/cheeks due to a polycythemia secondary to chronic hypoxia) and cyanotic (due to decreased hemoglobin saturation).
 * Signs of right heart failure or cor pulmonale such as edema and cyanosis can be seen.

Ausculatation

 * Coarse rhonchi on auscultation

Specific features of emphysema

 * General appearance: Pursed lips, adopting a tripod position, using accessory muscles.
 * Thin patient with barrel chest
 * Barrel chest may cause distant heart sound
 * Pink puffers