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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 that is not fully reversible and most often progressive
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General Considerations
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Airflow obstruction due to chronic bronchitis or emphysema; most patients have features of both
Obstruction
Chronic bronchitis is characterized by sputum production with productive cough for 3 months or more in at least 2 consecutive years
Emphysema is abnormal enlargement of air spaces distal to terminal bronchiole, with destruction of bronchial walls without fibrosis
Cigarette smoking is the most important cause
Air pollution, airway infection, environmental factors, and allergy have been implicated in chronic bronchitis
α1-Antitrypsin (α1-antiprotease) deficiency has been implicated in emphysema
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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 common than bacterial) precede exacerbations in most patients
Late-stage COPD characterized by
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 9–7)
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