A 66-year-old man with a 47-year smoking history of one pack per day presents with progressive shortness of breath and chronic cough producing yellow sputum for two years. On examination, he has signs of respiratory distress, barrel chest, poor air entry, and wheezing. Spirometry shows airflow limitation consistent with COPD. Tobacco smoking is the main risk factor for COPD, causing inflammation, cilia dysfunction, and oxidative injury in the lungs. Differential diagnoses include asthma, congestive heart failure, bronchiectasis, and tuberculosis.

1. Chronic Obstructive Pulmonary Disease
Abdullatiff Sami Al-Rashed
Block 4.1
College of Medicine, King Faisal University
Al-Ahsa, Saudi Arabia

2. Outline

3. Case
A 66-year-old man with a smoking history of one pack per day for the past 47
years presents with progressive shortness of breath and chronic cough,
productive of yellowish sputum, for the past 2 years.
On examination he appears cachectic and in moderate respiratory distress,
especially after walking to the examination room, and has pursed-lip breathing.
His neck veins are mildly distended. Lung examination reveals a barrel chest
and poor air entry bilaterally, with moderate inspiratory and expiratory
wheezing. Heart and abdominal examination are within normal limits. Lower
extremities exhibit scant pitting edema.

6. Introduction
• COPD is a preventable and treatable disease state characterized by
airflow limitation that is not fully reversible.
• It encompasses both emphysema and chronic bronchitis.
• The airflow limitation is usually progressive and is associated with
an abnormal inflammatory response of the lungs to noxious particles
or gases.

7. Introduction
• Tobacco smoking is by far the main risk factor for COPD.
• It is responsible for 90% of COPD cases and exerts its effect by
causing an inflammatory response, cilia dysfunction, and oxidative
injury.
• Air pollution and occupational exposure are other common
etiologies.

8. Diagnosis of copdDiagnosis of copd

9. History

10. History

11. Physical Examination
Early in the disease, the physical
examination may be normal, or may show
only prolonged expiration or wheezes on
forced exhalation.

12. Physical Examination

13. Physical Examination

14. Investigations
• Spirometer:
– Pulmonary function test:

15. Investigations

16. Investigations

17. Deferential diagnosesDeferential diagnoses

18. Deferential Diagnoses
Deferential Signs
Asthma • Onset is in early life.
• A personal or family hx of allergy,
rhinitis, and eczema.
• There is daily variability in
symptoms
• Wheezing that rapidly responds to
bronchodilators.
Congestive heart failure • Hx of cardiovascular diseases is
present.
• Orthopnea.
• Fine bibasilar inspiratory crackles
may be heard in auscultation.

19. Deferential Diagnoses
Deferential Signs
Bronchiectasis • Recurrent infection in childhood.
• Large volume of purulent sputum is
usually present.
• Coarse crackles may be heard on
auscultation.
• History of pertussis or tuberculosis
is a clue to diagnosis.
TB • A history of fever, night sweats,
weight loss, and chronic productive
cough is usually present.
• More common in immigrants to
non-endemic countries, and in
people living in endemic countries.

20. References