Clinical features in COPD
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Symptoms
Initially, there may be few symptoms except for a “smoker’s cough” with sputum (productive cough). The frequency of the cough and the amount of sputum steadily increases as the disease progresses. At first, the attacks of productive cough occur in the winter after colds, but eventually, with increasing severity of the disease the cough is ever- present.
With progression of the disease, breathlessness on exertion occurs with morning cough, recurrent respiratory infections and a now constant “smoker’s cough”.
The person becomes increasingly disabled by exertional breathlessness, and eventually in severe cases may become breathless at rest. People with COPD are more susceptible to bacterial infections and breathlessness may be exacerbated by smoke, atmospheric pollutants and respiratory tract infections.
In severe cases the heart may enlarge under the strain (heart failure).
Signs
In the early stages there may be no abnormal signs, but rhonchi, (or wheeze - a high- pitched whistling or sighing sound) both on breathing in and breathing out may be heard, as well as crackles in the lower zones of the lungs.
In a person with severe disease, there will be the signs of breathlessness at rest, leaning forward, using extra muscles in the neck, abdomen and chest to breathe, reduced chest expansion and a hyper-inflated chest. Loss of weight is common and there may be cyanosis (blueness) and oedema (swelling) suggesting right heart failure.
The “Blue bloater” is often representative of a person with COPD
Poor respiratory drive with the following features evident:
- Relatively mild breathlessness (dyspnoea)
- Obese and plethoric (high colour)
- Oedema (swelling) and congestive heart failure
- Large volume sputum (productive cough)
- Hypoxia (low O2) and hypercapnia (raised CO2)
- Polycythaemia
- Sleep apnoea
- Unexpectedly well- preserved lung function
- No emphysema on X-Ray
- Poor prognosis with 70% 5-year mortality.
