The main symptoms of the disease are:
- Dyspnea – shortness of breath; initially on exertion (exertional dyspnea), later also at rest.
- Chronic cough as well as
- Increased mucus production or sputum/sputum production.
Therefore, it is also referred to as AHA symptoms.Approximately 40 percent of COPD patients have pronounced morning symptoms. Other symptoms may include:
- Chronic pulmonary hyperinflation – attenuated breath sounds, soft heart sounds, enlargement of the chest – so-called fassthorax.
- Whistling breath sounds
- Central cyanosis – purplish-bluish discoloration of the oral mucosa, tongue, lips and conjunctiva due to decreased oxygen saturation (SpO2) of the blood.
- Bronchial infections, prolonged
- Lack of concentration
- Nail symptoms:
- Drumstick finger – rounded distension of the finger end links (end phalanges) with soft tissue thickening.
- Clock glass nails – bulging nails.
- Decreased vigilance – Decreased attention.
- Weight loss (in the late stages)
- Peripheral edema (water retention)
- Insomnia
- Fatigue
Notice. In many patients, these symptoms occur after 50-70% of the functional lung tissue has already been destroyed.
Gender differences (gender medicine)
- Women are particularly sensitive to tobacco and other respiratory noxious agents; have averaged fewer pack years than male COPD patients with the same respiratory obstruction.
- Smoking leads to more rapid FEV1 loss in women and also to higher frequency of exacerbations (acute exacerbations in COPD). The reason for this is due to anatomical differences: due to the smaller surface area of the airways, the same amount of noxious substances can lead to greater damage.Note: The procedure for determining the FEV₁ (one-second capacity) is called Tiffeneau test or breath test.
- Even with the same FEV1, women suffer more dyspnea and cough. Thereby, dyspnea in women is more often associated with anxiety disorders/and or depression.
- Women with COPD are more likely to have a chronic bronchitis phenotype.
Key indicators for the diagnosis of COPD
| Consider COPD and perform spirometry if any of the following indicators occur in an individual over 40 years of age. Note: None of the indicators by itself has diagnostic value, but the occurrence of numerous key indicators increases the likelihood of a diagnosis of COPD. Spirometry is required to establish the diagnosis of COPD. | |
| Dyspnea (shortness of breath) |
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| Chronic cough |
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| Chronic sputum production |
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| Recurrent lower respiratory tract infection | |
| Presence of risk factors |
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| Family history of COPD and/or childhood factors. |
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Differentiation of COPD and bronchial asthma
| Age | < 40 years | 0 points |
| 40-60 years | 2 points | |
| > 60 years | 4 points | |
| Persistent shortness of breath | No: 0 pointsYes: 1 point | |
| Diurnal variation of shortness of breath. | Yes: 0 pointsNo: 1 point | |
| Changes in pulmonary emphysema | No: 0 pointsYes: 1 point |
Assessment:
- 0-2 points: Probability of bronchial asthma
- 3-4 points: difficult to differentiate
- 5 to 7 points: Probability of COPD
In chronic obstructive pulmonary disease (COPD), two types of emphysema (phenotypes/appearances) are distinguished:
| Blue Bloater | Pink Buffer | |
| Habitus (weight) | Overweight | slim to cachectic |
| Skin coloration | Cyanotic (bluish discoloration of the skin or mucous membranes) | Pale |
| Clinical symptoms | Suffers little dyspnea (shortness of breath) but a productive cough | Severe dyspnea and dry irritating cough |
| Physical examination (auscultation/listening). | Wet rales (wet RGs),expiratory wheezing (some distance wheezing). | Quiet breath sounds; silent chest (silent lung phenomenon). |
| Blood gas analysis (ABG) | Early respiratory global insufficiency(oxygen partial pressure: pO2 ↓ , carbon dioxide partial pressure: pCO2 ↑). | Respiratory partial insufficiency(pO2 ↓, pCO2 normal or ↓). |
| Complications(see also under sequelae). |
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