From the Guidelines
The most correct physical finding in chronic obstructive pulmonary disease (COPD) is prolonged expiration, which is a useful indicator of airflow limitation. This characteristic finding results from air trapping within the lungs due to the pathophysiological changes in COPD, including airway obstruction, loss of elastic recoil, and destruction of alveolar walls. Patients with advanced COPD typically demonstrate other physical findings such as:
- Decreased breath sounds
- Use of accessory respiratory muscles
- Sometimes wheezing or crackles on auscultation
- Hyperresonance on thoracic percussion
- Engagement of accessory respiratory muscles
According to the study by 1, wheezing during tidal breathing and prolonged forced expiratory time (>5 s) are useful indicators of airflow limitation. However, these signs are of no value as guides to severity, and their absence does not exclude COPD. The study also mentions that visible activity of accessory muscles or pursed-lip breathing usually implies severe airflow obstruction.
Other studies, such as 1, also support the idea that physical examination is common in mild COPD, with signs becoming apparent as the disease progresses. The study mentions that quiet breath sounds, a prolonged expiratory duration, and weight loss are examples of physical findings that may be present in patients with COPD.
It's worth noting that the diagnosis of COPD is usually suggested by symptoms, but can only be established firmly by an objective measurement indicating airflow obstruction, as stated in the study by 1. The study also mentions that a post-bronchodilator fixed ratio of FEV1/FVC less than 0.70 is the spirometric criterion for airflow limitation.
In terms of the options provided, B) Prolonged expiration is the most correct physical finding in COPD, as it is a direct consequence of the airflow limitation that characterizes the disease. The other options, while potentially present in patients with COPD, are not as directly related to the disease's pathophysiology.
From the Research
Physical Findings in Chronic Obstructive Pulmonary Disease (COPD)
The physical findings in COPD can be summarized as follows:
- Weakened breath sounds: This is a common finding in COPD patients, as stated in the study 2.
- Prolonged expiration: This is also a characteristic finding in COPD, but it is not explicitly mentioned in the provided studies.
- Hypersonism on thoracic percussion: There is no mention of this finding in the provided studies.
- Engagement of accessory respiratory muscles: This is a common finding in COPD patients, as they often use accessory muscles to breathe.
- Polyphonic expiratory low-pitched wheezes: Wheezing is a common symptom of COPD, but the specific characteristic of polyphonic expiratory low-pitched wheezes is not mentioned in the provided studies.
Most Correct Physical Finding
Based on the provided studies, the most correct physical finding in COPD is weakened breath sounds, as mentioned in the study 2. Additionally, the engagement of accessory respiratory muscles is also a common finding in COPD patients, as stated in the studies 3 and 4.
Some key points to consider:
- The study 3 emphasizes the importance of physical examination in diagnosing COPD, particularly in resource-constrained countries.
- The study 4 highlights the role of physical diagnosis in rapidly identifying COPD patients, allowing for timely intervention and treatment.
- The combination of clinical variables, including peak flow rate, diminished breath sounds, and smoking history, can be a good predictor of COPD, as stated in the study 2.