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Essentials of Diagnosis
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History of cigarette smoking or other chronic inhalational exposure
Chronic cough, dyspnea, and sputum production
Rhonchi, decreased intensity of breath sounds, and prolonged expiration on physical examination
Airflow limitation on pulmonary function testing
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General Considerations
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The term "COPD" has evolved from an umbrella term for chronic bronchitis and emphysema to one that refers to a clinical syndrome of chronic respiratory symptoms, structural pulmonary abnormalities (airways or alveoli) and impaired lung function, arising from multiple causes that result in airflow limitation that is not fully reversible
Cigarette smoking is by far the most important cause of COPD in North America and Western Europe
Other causes include exposures to
Environmental tobacco smoke
Occupational dusts and chemicals
Indoor air pollution from biomass fuel used for cooking and heating in poorly ventilated buildings
Outdoor air pollution, airway infection, environmental factors, and allergy have also been implicated, along with hereditary factors (most notably, deficiency of alpha-1-antiprotease [alpha-1-antitrypsin])
Atopy and bronchoconstriction in response to nonspecific airway stimuli may be important risk factors
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Presentation
Dyspnea initially occurs only with heavy exertion, progressing to symptoms at rest in severe disease
Exacerbation of symptoms beyond normal day-to-day variation, often including increased dyspnea, an increased frequency or severity of cough, increased sputum volume, or change in sputum character
Infections (viral more commonly than bacterial) precede exacerbations in most patients
Late-stage COPD characterized by
Hypoxemia
Pneumonia
Pulmonary hypertension
Cor pulmonale
Respiratory failure
Clinical findings may be absent early
Patients are often dichotomized as "pink puffers" or "blue bloaters" depending on whether emphysema or chronic bronchitis predominates (Table 9–6)
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