Certain clinical findings can help identify the patient who may have chronic obstructive pulmonary disease (COPD). These patients are candidates for spirometry which is used to establish and grade the diagnosis.


Key elements:

(1) chronic cough

(2) any amount of chronic sputum production

(3) dyspnea

(4) history of exposure to risk factors


Features of cough:

(1) present intermittently or every day

(2) often present throughout the day

(3) seldom only nocturnal


Features of dyspnea:

(1) progressive, worsening over time

(2) present every day (persistent)

(3) worse on exercise

(4) worse during a respiratory infection

(5) may be described by the patient as: air hunger, gasping, heaviness, increased effort required to breathe


Historical risk factors:

(1) tobacco smoking

(2) chronic exposure to occupational dusts or chemicals

(3) chronic exposure to smoke from fires (cooking, fuel fires, etc.)


The presence of multiple indicators increase the probability of COPD but spirometry is needed to establish the diagnosis.


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