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==Physical exam==
==Physical exam==
A [[physical examination]] will often reveal decreased intensity of breath sounds, wheeze ([[rales]]) and prolonged [[Exhalation|expiration]].  Most doctors rely on the presence of a persistent dry or wet cough as evidence of bronchitis.
{{Chronic obstructive pulmonary disease}}
{{CMG}}; [[Philip Marcus, M.D., M.P.H.]] [mailto:pmarcus192@aol.com]; {{AOEIC}} {{CZ}}


A variety of tests may be performed in patients presenting with cough and shortness of breath:
==Overview==
* Pulmonary Function Tests (PFT) (or [[spirometry]]) must be performed in all patients presenting with chronic cough. An [[FEV1]]/[[FVC]] ratio below 0.7 that is not fully reversible after bronchodilator therapy indicates the presence of [[COPD]], that requires more aggressive therapy and carries a more severe prognosis than simple chronic bronchitis.  
Chronic obstructive pulmonary disease can be diagnostically evaluated by physical examination through auscultation.
* A sputum sample showing [[neutrophil granulocyte]]s (inflammatory white blood cells) and [[microbiological culture|culture]] showing that has pathogenic microorganisms such as [[Streptococcus|Streptococcus spp.]]
==Physical Examination==
* A [[blood test]] would indicate inflammation (as indicated by a raised [[white blood cell]] count and elevated [[C-reactive protein]]).
Physical examination are quite specific and sensitive for severe disease. The signs are usually difficult to detect in cases of mild to moderate diseases.
**Neutrophils infiltrate the lung tissue, aided by damage to the airways caused by irritation.
===General physical examination===
**Damage caused by irritation of the airways leads to inflammation and leads to neutrophils being present
* Cyanosis
**Mucosal hypersecretion is promoted by a substance released by neutrophils
* Tachypnea
**Further obstruction to the airways is caused by more goblet cells in the small airways. This is typical of chronic bronchitis
* Respiratory distress indicated by use of accessory respiratory muscles. Hoover sign presenting as paradoxical indrawing of lower intercostal spaces is evident (known as the Hoover sign)
**Although infection is not the reason or cause of chronic bronchitis it is seen to aid in sustaining the bronchitis.'''''
* Elevated jugular venous pulse (JVP)
* Peripheral edema can be observed.
===Pulmonary system===
====Inspection====
* Hyperinflation (barrel chest)
====Percussion====
* Hyperresonance
====Auscultation====
* Prolonged expiration; wheezing
* Diffusely decreased breath sound
* Additional sounds - coarse crackles with inspiration
==Specific features of Chronic bronchitis==
* General appearance: Overweight
* Coarse rhonchi
* Signs of right heart failure or cor pulmonale such as edema and cyanosis can be seen.
==Specific features of emphysema==
* General appearance: Pursed lips, adopting a tripod position, using accessory muscles.
* Thin patient with barrel chest
* Barrel chest may cause distant heart sound
 
==References==
{{reflist|2}}
 
[[Category:Disease]]
[[Category:Pulmonology]]
[[Category:Emergency medicine]]
[[Category:Intensive care medicine]]
[[Category:Mature chapter]]
 
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==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 21:19, 2 March 2012

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Patient Information

Overview

Historical Perspective

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Pathophysiology

Causes

Differentiating Chronic obstructive pulmonary disease from other Diseases

Epidemiology and Demographics

Risk Factors

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Secondary Prevention

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Chronic bronchitis physical examination On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Chronic bronchitis physical examination

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Chronic bronchitis physical examination

CDC on Chronic bronchitis physical examination

Chronic bronchitis physical examination in the news

Blogs on Chronic bronchitis physical examination

Directions to Hospitals Treating Chronic obstructive pulmonary disease

Risk calculators and risk factors for Chronic bronchitis physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Philip Marcus, M.D., M.P.H. [3]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [4]

Overview

Chronic obstructive pulmonary disease can be diagnostically evaluated by physical examination through auscultation.

Physical Examination

Physical examination are quite specific and sensitive for severe disease. The signs are usually difficult to detect in cases of mild to moderate diseases.

General physical examination

  • Cyanosis
  • Tachypnea
  • Respiratory distress indicated by use of accessory respiratory muscles. Hoover sign presenting as paradoxical indrawing of lower intercostal spaces is evident (known as the Hoover sign)
  • Elevated jugular venous pulse (JVP)
  • Peripheral edema can be observed.

Pulmonary system

Inspection

  • Hyperinflation (barrel chest)

Percussion

  • Hyperresonance

Auscultation

  • Prolonged expiration; wheezing
  • Diffusely decreased breath sound
  • Additional sounds - coarse crackles with inspiration

Specific features of Chronic bronchitis

  • General appearance: Overweight
  • Coarse rhonchi
  • Signs of right heart failure or cor pulmonale such as edema and cyanosis can be seen.

Specific features of emphysema

  • General appearance: Pursed lips, adopting a tripod position, using accessory muscles.
  • Thin patient with barrel chest
  • Barrel chest may cause distant heart sound

References


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References

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