History and Physical Exam for COPD
Your medical history provides important clues that can help your doctor diagnose chronic obstructive pulmonary disease (COPD).
In taking your medical history, your doctor will ask questions about:
- Shortness of breath.
- When were you first short of breath (at exercise or at rest)?
- How often are you short of breath?
- How long have you been short of breath? Is it getting worse?
- How far can you walk, and how many steps can you climb before having to stop because of shortness of breath?
- How often and when do you cough?
- How long have you been coughing? Is it getting worse?
- Do you cough up mucus (sputum)? What color is it?
- Have you ever coughed up blood?
- Your and any housemate's use of tobacco: whether any of you smoke, how long you've smoked, how many cigarettes a day you smoke, how long ago you quit smoking, whether you feel you can quit smoking, and more.
- Exposure to airborne irritants, such as dust or chemicals, on the job.
- Childhood respiratory illnesses.
- Family history of respiratory disease.
- Other medical conditions you may have and their treatment.
- How your condition is affecting your quality of life: missed work, disrupted routines, and depression, for example.
- The name and dose of all of the medicines you take, including any inhalers you use.
- What type of family and social support you have.
During the physical exam, your doctor will examine your body for other clues that may explain the cause of your symptoms. A physical exam involves:
- Taking your temperature, weight, and body mass index (BMI), which measures weight for height and provides a way to estimate the effect of weight on health.
- Examining your ears, eyes, nose, and throat for signs of infection.
- Listening to your heart and lungs with a stethoscope.
- Checking for signs that blood is backing up in your neck veins, which may point to a heart problem such as cor pulmonale.
- Pressing or tapping on your abdomen (abdominal palpation).
- Examining your fingers and lips to see whether the skin has a blue tint (cyanosis).
- Checking your fingers to see if their ends swell and the nails bulge outward (clubbing).
- Evaluating your legs and feet for swelling (edema).
A physical exam is not painful, but parts of it (such as abdominal palpation) may feel slightly uncomfortable.
Why It Is Done
A history and physical exam help your doctor make a diagnosis. They are a routine and important part of any visit to a doctor.
Your history may reveal risk factors that suggest you have COPD or an increased risk for developing COPD, such as:
- Cigarette smoking.
- Family history of emphysema.
- Work-related hazards.
- Frequent, severe respiratory illnesses.
- Long-term (chronic) cough with or without mucus.
- Progressive shortness of breath.
Your physical exam may also suggest COPD. Findings indicating COPD include:
- An expanded chest (barrel chest).
- Wheezing during normal breathing.
- Taking longer to exhale fully.
- Decreased breath sounds or abnormal breath sounds such as crackles or wheezes.
Certain physical exam findings will help your doctor assess the severity of your condition. These include:
- The use of "accessory" muscles, such as the neck muscles, during quiet breathing.
- Breathing through pursed lips.
- The inability to complete full sentences without stopping to take a breath.
- Bluish discoloration of the fingertips or nail beds (cyanosis).
- Swelling in the legs or abdomen.
Any one or more of these findings may suggest severe impairment.
A careful history and examination of your heart should also be done to exclude heart disease that can either be associated with or cause symptoms similar to those of COPD. This is especially important, because smoking increases the risk for heart disease as well as for COPD. The heart exam may reveal a rapid heart rate or show signs of heart failure.
The liver may be increased in size, which sometimes can occur because of right-sided heart failure (cor pulmonale).
The result of the physical exam varies. Not every person will have all the possible symptoms or signs of COPD.
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