Chronic Obstructive Pulmonary Disease (COPD): Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

• General physical examination – including blood pressure, pulse, body weight, height; further:
  • Inspection (viewing) [central cyanosis (purplish-bluish discoloration of oral mucosa, tongue, lips, and conjunctiva due to decreased blood oxygen saturation), peripheral edema (water retention); ; barrel chest with horizontal ribs, distended clavicular fossae, and visible inspiratory (“during inspiration”) retractions in the flank area]
    • Skin and mucous membranes
    • Extremities
  • Auscultation (listening) of the heart [asthma cardiale (differential diagnosis); due topossible sequelae: Right heart failure (right heart failure)]
  • Examination of the lungs
    • Auscultation (listening) of the lungs [prolonged expirium (“breathing out”); expiratory wheezing, whistling breathing; inspiratory (“on inhalation”) free]; in the presence of emphysema:
      • Pink buffer (see symptoms below for definition): quiet breathing sounds, Silent chest/Silent lung.
      • Blue Bloater: distance gieing, moist rales]
    • Bronchophony (checking the transmission of high-frequency sounds; the patient is asked to pronounce the word “66” several times in a pointed voice while the doctor listens to the lungs)[increased sound conduction due to pulmonary infiltration/compaction of lung tissue (eg. e.g. in pneumonia (differential diagnosis)) the consequence is, the number “66” is better understood on the diseased side than on the healthy side; in case of decreased sound conduction (attenuated or absent): e.g. in pleural effusion, pneumothorax (differential diagnoses). The result is, the number “66” is barely audible to absent over the diseased part of the lung, because the high-frequency sounds are strongly attenuated]
    • Percussion (tapping) of the lungs [pulmonary emphysema: hypersonoric tapping sound: sound with very bright, full timbre; box tone in pneumothorax (differential diagnosis)]
    • Vocal fremitus (checking the conduction of low frequencies; the patient is asked to pronounce the word “99” several times in a low voice while the physician places his hands on the patient’s chest or back)[increased sound conduction due to pulmonary infiltration/compaction of lung tissue (e.g. e.g. in pneumonia) the consequence is, the number “99” is better understood on the diseased side than on the healthy side; in case of reduced sound conduction (strongly attenuated or absent: in case of pleural effusion, pneumothorax (differential diagnoses)). The result is, the number “99” is barely audible to absent over the diseased part of the lung, because the low-frequency sounds are strongly attenuated]
• Neurological examination [hyperventilation syndrome/dysfunction of breathing with ventilation of the lungs increased above the need, which occurs mainly in conflict situations (differential diagnosis); due topossible sequelae: Depression]
• Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.