Symptoms
When to consider COPD: if the patient is over 35 years, smokes, has a history of smoking or has occupational exposure. They will also have one or more of the following symptoms:
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Exertional breathlessness
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Chronic cough
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Regular sputum production
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Frequent winter bronchitis
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Wheeze
Other symptoms: weight loss, exercise intolerance, ankle swelling and fatigue.
COPD should also be considered if the person is less than 40 years with a family history of alpha-1-antitrypsin deficiency.
Physical symptoms: some patients show no physical signs at all, however others will present with physical symptoms including:
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Hyperinflated chest
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Pursed-lip breathing
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Peripheral oedema
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Cyanosis
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Underweight (although some are overweight/obese increasing breathlessness and causing obstructive sleep apnoea)
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Nicotine stained nails and fingers
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Clubbing of nails
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Use of accessory muscles e.g. holding chairs or tables to breathe
Measuring Breathlessness – The Medical Research Council (MRC) Dyspnoea Scale
This grades a patient’s level of breathlessness from 1 – 5 as follows:
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Grade 1: Not troubled by breathlessness except during strenuous exercise
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Grade 2: Short of breath when hurrying or walking up a slight hill
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Grade 3: Walks slower than normal because of breathlessness or has to stop for breath when walking at own pace
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Grade 4: Stops for breath after walking 100m or a few minutes
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Grade 5: Too breathless to leave the house, or breathless when dressing or undressing
Bibliography:
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http://cks.nice.org.uk/chronic-obstructive-pulmonary-disease#!diagnosissub
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CPPE – Chronic Obstructive Pulmonary Disease Book 1