| History |
| Risk factors |
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- Average amount smoked per day since initiation
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- Date when stopped smoking or a current smoker
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- The chronologically taken environmental history may disclose important risk factors for COPD
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| Symptoms |
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- Ask about the amount of effort required to induce uncomfortable breathing. Many individuals will deny symptoms of dyspnea, but will have reduced their activity levels substantially.
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- Cough with or without sputum production should be an indication for spirometric testing. The presence of chronic cough and sputum has been used to define chronic bronchitis.
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- Wheezing or squeaky noises occurring during breathing indicate the presence of airflow obstruction
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- Inquire about occurrence and frequency of episodes of increased cough and sputum with wheezing, dyspnea, or fever
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| Physical examination |
| Physical findings are generally present only with severe disease |
| Chest |
- The presence of emphysema (only when severe) is indicated by: overdistention of the lungs in the stable state (chest held near full inspiratory position at end of normal expiration, low diaphragmatic position), decreased intensity of breath and heart sounds, and prolonged expiratory phase
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- Evidence of airflow obstruction: wheezes during auscultation on slow or forced breathing and prolongation of forced expiratory time
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- Frequently observed with severe disease (characteristic, but not diagnostic): pursed-lip breathing, use of accessory respiratory muscles, retraction of lower interspaces
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| Other |
- Unusual positions to relieve dyspnea at rest
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- Digital clubbing is NOT typical in COPD (even with associated hypoxemia) and suggests other diagnoses (eg, lung cancer, bronchiectasis, pulmonary fibrosis)
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- Mild dependent edema may be seen in the absence of right heart failure
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