From the Guidelines
No, Chronic Obstructive Pulmonary Disease (COPD) does not typically present with rales, as the disease is characterized by airflow limitation and pulmonary hyperinflation, which usually results in diminished breath sounds, rather than the presence of rales 1.
Key Physical Findings in COPD
- Wheezing during tidal breathing and prolonged forced expiratory time (>5 s) are useful indicators of airflow limitation
- Diminished breath sounds, reduced ribcage expansion and diaphragmatic excursion, and hyperresonance may be elicited
- Visible activity of accessory muscles or pursed-lip breathing usually imply severe airflow obstruction
- Central cyanosis is seen with significant hypoxaemia ### Clinical Findings During Exacerbations
- Tachypnoea, tachycardia, use of accessory respiratory muscles, cyanosis, and evidence of respiratory muscle dysfunction or fatigue
- The severity of an exacerbation is assessed crudely by these clinical findings, but objective measurements are necessary for accurate assessment 1 Note that the presence of rales is not mentioned as a typical physical finding in COPD patients, suggesting that it is not a characteristic symptom of the disease 1.
From the Research
Presentation of COPD with Rales
- COPD can present with rales, although the prevalence and characteristics of these sounds may vary [(2, 3, 4)].
- Fine crackles (rales) were recorded in only 10 to 12 percent of patients with chronic obstructive pulmonary disease 2.
- Coarse crackles were not uncommon in patients with chronic bronchitis 2.
- The relationship between crackle characteristics and airway morphology in COPD is not well established, with some studies showing no statistically significant differences in crackle characteristics between COPD patients and healthy controls 3.
Diagnosis of COPD using Rales
- Bilateral basal inspiratory crackles can predict COPD with odds ratios of 2.59 and 3.20, adjusted for sex and age 4.
- Coarse bilateral crackles can predict COPD with odds ratios of 2.65 and 3.67 4.
- Early inspiratory crackles can predict COPD more strongly than coarse inspiratory crackles, with odds ratios of 6.88 and 7.63 4.
- The positive predictive value for COPD is 23% when early crackles are heard over one or both lungs 4.