COPD

 

Thank you for asking me to examine Harry who presented with SOB. I would have like to have completed my examination by taking pulse oximetry and peak flow measurements.

 

My salient findings were a barrel-shaped chest with hyperinflation, reduced chest expansion, Hoover’s sign, hyper-resonance, and reduced breath sounds, which are suggestive of chronic obstructive pulmonary disease.

 

I will now present my findings in full before commenting on severity and complications.

 

The patient was comfortable at rest with normal/increased WOB with/without evidence of accessory muscle use and pursed lip breathing. There was / was not supplemental oxygen. The patient had a dry/loose/productive cough on prompting. There was / was no sputum cup at the bedside.

 

There was no evidence of CO2 narcosis with no asterixis.

 

On examination of the hands, there was / was not clubbing, nicotine staining, or peripheral cyanosis.

 

The respiratory rate was ___, and the pulse was ___ and regular/irregular.

 

On examination of the face, there was / was not conjunctive pallor, ptosis, or central cyanosis.

 

The trachea was midline / displaced with/without tracheal tug (sign of COPD). There was / was not cervical, supraclavicular or axillary lymphadenopathy.

 

On inspection of the chest, the patient appeared / did not appear barrel chested. There was / was no obvious deformity with / without kyphoscoliosis, pectus carinatum, pectus excavatum. There were / were not previous surgical scars. There were / were not radiotherapy skin changes.

 

Chest expansion was reduced / normal and symmetrical / asymmetrical (reduced in COPD). Hoover’s sign was positive.

 

Percussion showed hyperresonance. 

 

On auscultation, there were early inspiratory crepitations and decreased intensity of breath sounds throughout the lower / middle / upper lobes bilaterally with/with no added wheeze. Vocal resonance was / was not normal.

 

In regard to cardiovascular complications, there was / was not evidence of pulmonary hypertension and right heart dysfunction. More specifically, there was / was not a left parasternal heave, a palpable P2, an elevated JVP with prominent A-waves, or peripheral oedema.

 

In summary, Harry is a patient who presented with SOB. My findings are suggestive of chronic obstructive pulmonary disease with/without oxygen use, work of breathing, and cyanosis indicative of mild/moderate/severe disease, and with/without evidence of pulmonary hypertension or cor pulmonale.  

 

Differentials include:

• Asthma

• ILD

• Bronchiectasis

 

I would proceed from here by:

• Confirming the diagnosis with RFTs. I would also like a CXR to assess for hyperinflation and a HRCT for parenchymal changes.

• I would like to assess for severity with aforementioned RFTs, as well as an ABG

• If non-smoking, to assess for aetiology with an alpha-1 antitrypsin level.

• Completing an assessment of complications with:

  • An FBE to look for polcythaemia

  • ECG to screen for complications of chronic lung disease (right ventricular hypertrophy and multi-focal atrial tachycardia).