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Others viruses: SARS-CoV-2, influenza, RSV, parainfluenza, adenovirus Bacterial infections: e.g., Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae Symptoms of COPD Chronic cough with sputum production Breathlessness (initial on exertion, later continuous) Pursed lip breathing Prolonged expiratory phases Weight loss (in severe COPD) Cyanosis (due to hypoxia) Morning Headache (indicative of hypercapnia) Feature of complications of pneumothorax, right heart failure and respiratory failure Signs of COPD On inspection Barrel shaped chest Reduced chest movement bilaterally Tachycardia, Tachypnea, Cyanosis Pursed lip breathing, Prolonged expiratory phases Intercostal & suprasternal recession, Supraclavicular fullness Prominence of accessory respiratory muscles (Sternocleidomastoid, Trapezius) On Palpitation Tracheal Tug may present, Cricosternal distance reduced Apex beat shifted downward Chest expansion reduced bilaterally Vocal fremitus reduced On percussion Hyper-resonant over whole lung field Liver dullness displacement On Auscultation Vesicular breath sound with prolonged expiration with ronchi/wheeze Vocal resonance is diminished Feature of Complications Type 1 Respiratory Failure Cyanosis Decreased O2 saturation Type 2 Respiratory Failure Warm periphery Bounding pulse Flapping tremors Drowsiness Cor pulmonale means right ventricular hypertrophy with or without heart failure Right heart failure Pedal edema Raised JVP Tender hepatomegaly Ascites Pulmonary Hypertension - Palpable P2 and loud P2 Right ventricular hypertrophy - Left parasternal heave & Epigastric pulsation Investigation done in COPD 1
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