Physical Examination
Posted by admin on May 12th, 2010Prolonged forced expiration may be the first measurable change in early or moderate COPD. Therefore, patients should be asked to inhale as deeply as possible, then exhale as rapidly and fully as possible. Auscultation allows the physician lo time the expiration (which should be < 4 sec) and to hear wheezing. Obvious inspiratory noises, heard with the unaided ear or with Ihe stethoscope over the trachea, are common in patients with bronchitis.
Two stereotypes of patients with severe COPD—Ihe pink puffer and the blue bloater—help define the extremes of the COPD spectrum. Actually, most patients have features of both stereotypes.
The pink puffer is typically an asthenic, barrel-chested emphysematous patient who exhibits pursed lips breathing and has no cyanosis or edema. Usually, such a patient uses extrathoracic muscles to breathe, produces minimal sputum, and experiences little fluctuation in the day-
to-day level of dyspnea. Diaphragmatic excursions are reduced, and breath and heart sounds are distant. Arterial blood gas studies show only mild to moderate hypoxemia and normal or slightly reduced PaCO>. The barrel-shaped chest is nonspecific because older persons commonly have increased lung compliance and larger resting lung volumes. The blue bloater is typically overweight, cyanotic, and edematous and exhibits a chronic productive cough (chronic bronchitis). Arlerial blood gas levels show hypoxemia and hypercapnia. Nocturnal hypoxemia may be profound. Elderly blue bloaters are uncommon because blue bloaters often have cor pulmonale, which rapidly leads lo death if not treated appropriately.
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