From the Guidelines
Physical findings in chronic obstructive pulmonary disease (COPD) include weakened breath sounds, prolonged expiration, and engagement of accessory respiratory muscles, among other signs. The physical signs in patients with COPD depend on the degree of airflow limitation, the severity of pulmonary hyperinflation, and body build 1. Some key physical findings in COPD patients include:
- Weakened breath sounds
- Prolonged forced expiratory time (>5 s)
- Visible activity of accessory muscles (e.g. the sternomastoid)
- Pursed-lip breathing
- Hyperresonance on thoracic percussion is not typically a finding associated with COPD, as COPD is characterized by hyperinflation of the lungs, which would more likely result in hyperresonance, but this is not a specific or sensitive sign for COPD 1. Polyphonic expiratory low-pitched wheezes are not specifically mentioned in the provided evidence as a characteristic finding in COPD, although wheezing during tidal breathing is noted as a useful indicator of airflow limitation 1. It's worth noting that the sensitivity of physical examination for detecting or excluding moderately severe COPD is poor, and reproducibility of physical signs is variable 1.
From the Research
Physical Findings in Chronic Obstructive Pulmonary Disease (COPD)
The physical findings in COPD can be identified through various diagnostic strategies, including physical examination. According to 2, physical diagnosis is the quickest and requires no extra cost, making it a valuable tool for rapid diagnosis in primary care practice and emergency departments.
Common Physical Findings
Some common physical findings in COPD include:
- Weakened breath sounds
- Prolonged expiration
- Use of accessory respiratory muscles
- Barrel-shaped chest
- Hoover's sign
- Abdominal paradox
These findings are associated with the pathogenesis and clinical importance of COPD, as discussed in 3. The use of accessory respiratory muscles, such as the sternocleidomastoid and scalene muscles, is a common finding in COPD patients, indicating increased respiratory effort.
Other Physical Signs
Other physical signs that may be present in COPD patients include:
- Polyphonic expiratory low-pitched wheezes
- Purse-lip breathing
- Forced expiratory time
- Thoracic percussion findings, such as hyperresonance
These signs are related to the airflow limitation and lung hyperinflation characteristic of COPD, as mentioned in 3. However, the specific physical findings may vary depending on the severity and stage of the disease.
Importance of Physical Examination
Physical examination is a crucial component of COPD diagnosis and management, as emphasized in 3 and 2. It allows for the identification of physical signs and symptoms that can guide treatment decisions and monitor disease progression. While the provided evidence does not directly address the specific options listed in the question, it highlights the importance of physical examination in COPD diagnosis and management.