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<sup>1</sup> Lung volumes not essential to pt mgmt. DLCO helpful in pts w/ SOB out of proportion to airflow limitation. <br><br>
<sup>2</sup> A1AT-deficiency pts typically present <45 yo w/ lower lobe emphysema.
<br><br><sup>3</sup> Sx may vary day to day. Cough/sputum may precede airflow limitation by yrs. Airflow limitation may be independent of cough/sputum. Dyspnea = increased breathing effort, heaviness, air hunger, gasping, etc. May be progressive, persistent, worse w/ exercise. Cough may be intermittent, unproductive, or absent. Sputum ≥3 mo in each of 2 consecutive yrs = chronic bronchitis; however, sputum in COPD pts varies. Pts may swallow sputum; large sputum volumes may indicate bronchiectasis. Wheezing and chest tightness are nonspecific, and may or may not be present. Fatigue or anorexia may accompany severe dz. Cough DDx: Asthma, cancer, TB, CHF, CF, allergic rhinitis, UACS (postnasal drip), GERD, ACEI/other meds, etc.
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<sup>4</sup> <b>Exam:</b> Wheeze (laryngeal or chest) does not confirm asthma; absence does not exclude COPD. Ankle swelling may signal cor pulmonale.
<sup>2</sup> A1AT-deficiency pts typically present <45 yo w/ lower lobe emphysema.
<br><br><sup>3</sup> Sx may vary day to day. Cough/sputum may precede airflow limitation by yrs. Airflow limitation may be independent of cough/sputum. Dyspnea = increased breathing effort, heaviness, air hunger, gasping, etc. May be progressive, persistent, worse w/ exercise. Cough may be intermittent, unproductive, or absent. Sputum ≥3 mo in each of 2 consecutive yrs = chronic bronchitis; however, sputum in COPD pts varies. Pts may swallow sputum; large sputum volumes may indicate bronchiectasis. Wheezing and chest tightness are nonspecific, and may or may not be present. Fatigue or anorexia may accompany severe dz. Cough DDx: Asthma, cancer, TB, CHF, CF, allergic rhinitis, UACS (postnasal drip), GERD, ACEI/other meds, etc.
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<sup>4</sup> <b>Exam:</b> Wheeze (laryngeal or chest) does not confirm asthma; absence does not exclude COPD. Ankle swelling may signal cor pulmonale.
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Order spirometry<sup>1</sup> pre/post bronchodilator in pts >40 yo<sup>2</sup> w/ chronic sx<sup>3</sup> w/ risk-factor exposure