From the Guidelines
Physical findings of COPD include weakened breath sounds, prolonged expiration, hyperresonance on thoracic percussion, engagement of accessory respiratory muscles, and polyphonic expiratory low-pitched wheezes, as well as signs of cor pulmonale in advanced cases. Management of COPD requires a comprehensive approach starting with smoking cessation, which is the most effective intervention to slow disease progression 1.
Key Physical Findings
- Weakened breath sounds
- Prolonged expiration
- Hyperresonance on thoracic percussion
- Engagement of accessory respiratory muscles
- Polyphonic expiratory low-pitched wheezes
- Signs of cor pulmonale in advanced cases, such as peripheral edema, raised jugular venous pressure, and hepatic enlargement 1
Management Approach
Bronchodilators form the cornerstone of pharmacological treatment, beginning with short-acting agents like albuterol (2 puffs every 4-6 hours as needed) and progressing to long-acting medications such as tiotropium (18 mcg once daily) or salmeterol (50 mcg twice daily) for persistent symptoms 1. Inhaled corticosteroids like fluticasone (250-500 mcg twice daily) are added for patients with frequent exacerbations. Oxygen therapy is prescribed for patients with resting hypoxemia (PaO2 ≤55 mmHg or SaO2 ≤88%) at 1-3 L/min to maintain oxygen saturation above 90% 1.
Additional Interventions
- Pulmonary rehabilitation improves exercise capacity and quality of life 1
- Vaccinations against influenza and pneumococcal disease are essential preventive measures
- Acute exacerbations require intensified bronchodilator therapy, systemic corticosteroids (prednisone 40 mg daily for 5 days), and antibiotics if purulent sputum is present 1 These interventions target the airflow limitation and inflammation that characterize COPD, aiming to reduce symptoms, prevent exacerbations, and slow disease progression.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Physical Findings in Chronic Obstructive Pulmonary Disease (COPD)
The physical findings in COPD include:
- Weakened breath sounds
- Prolonged expiration
- Hyperresonance on thoracic percussion
- Engagement of accessory respiratory muscles
- Polyphonic expiratory low-pitched wheezes
Management of COPD
The management of COPD involves:
- Pharmacotherapy, including long-acting beta-agonists (LABAs) and inhaled corticosteroids (ICS) 2, 3, 4, 5
- Smoking cessation 6
- Pulmonary rehabilitation 6
- Long-term oxygen therapy 6
- Surgery, in select patients 6
Treatment Options
Treatment options for COPD include:
- Monotherapy with an inhaled bronchodilator, stepping up to combination therapy as needed 6
- Combination of LABA and ICS, which has been shown to improve quality of life and lung function 2, 3, 5
- Long-acting muscarinic antagonists (LAMAs), which have been shown to be effective in improving lung function and reducing exacerbations 3, 5
Comparison of Treatment Options
A network meta-analysis comparing different treatment options for COPD found that:
- Combination LABA/ICS was the highest ranked intervention for improving quality of life and lung function 5
- LAMAs and LABAs were ranked second and third, respectively, for improving lung function 5
- ICSs were ranked fourth for improving lung function, but were associated with an increased risk of pneumonia 2, 5