Obstructive Lung Disease: Signs and Symptoms

00:01 Now, the cardinal signs and symptoms of COPD is dyspnea, shortness of breath. This dyspnea is usually worsened upon exertion. As the disease progresses, the patient becomes even dyspneic at rest. Doesn’t this kind of sound like angina? Same concept. And so therefore, if that pain occurs even at rest, we are in the realm of unstable angina and so therefore, the patient is at imminent deathly risk. Patients with chronic bronchitis will have a cough and this cough is productive. We will talk about the definition of chronic bronchitis in detail.

00:36 Physical examination. If it’s obstructive, you are having a hard time with airflow limitation and by this, we mean you are having a hard time with exhalation. So therefore, you will have more air that is stuck in your lungs. So therefore, you can expect there to be hyperinflation. If it is emphysema, that you are all too familiar with, you can only imagine that there the diaphragm then becomes depressed and there is the barrel chest that we are referring to is the fact that you have an increased in PA diameter. The cyanosis, this is something that you are going to then see immediately, in the nails or perhaps in the lips because of lack of proper oxygen, decreased air entry on auscultation, distant breath sounds, scattered wheezes or rhonchi on auscultation referring to the fact that you have issues down the alveoli. Sounds like cor pulmonale and that is a problem. At some point in time, if the disease process in general with COPD is severe enough then there might be a right ventricular dysfunction, welcome to cor pulmonale.

01:40 Now, what is COPD? Classically divided into three main categories. We’ll take a look at the emphysema. You will understand why these patients are called pink puffers when the time is right. Chronic bronchitis, these individuals are blue bloaters, mean to say that the cyanosis is taking place quite early. And then asthma. And these are the three major classifications we will take a look at. What we will do with bronchiectasis actually which is traditionally part of the four types of COPD's is truly understand that in the setting of infections. Bronchiectasis, the three major ones that you want to focus upon with COPD and current day practice are these three.

02:27 We will be spending quite a bit of time with these huge symptomatic circles. We will walk through each one of the numbers. I will show you as to what it means to be within this dashed box that we have here in which the three conditions of chronic bronchitis, emphysema and asthma is going to fall into play. Now, the area that you see shaded in green represents actual definition of COPD. If you have missed or you have neglected your definition of COPD, I highly recommend that this will be the time you go back and review your definition. At some point in time, this could be preventable, but understand that comorbidities may exist and so therefore, your patient is at risk of severity and secondary issues including cor pulmonale. The area in green here, as we go through, you will see the overlapping issues and which one of these numbers you want to pay attention to specifically. Let us now begin our discussion.

03:39 What is this? This is a Venn diagram in which, once again, the three major COPDs are listed.

03:44 The areas defined in green represent the COPD, chronic bronchitis, a symptom that you want to pay attention to here, by definition. It’s three months of chronic productive cough for two consecutive years. History. “Hey, doc, I have had cough. Are you bringing up anything?” “Matter of fact, I am. How long has it been going on?” “Oh, couple of months.” “And for how long?” “Well, duration? I don’t know, it seems like it’s been a long time.” Understand from your patient how they will express themselves will be rather layman in terms, but you have to be astute enough where you are picking up on the fact that this is a pattern, chronic bronchitis. What about emphysema? Emphysema, most notably, you are looking for a patient that has a history of smoking and upon exposure to smoke, we will walk through the two major patterns of emphysema, two major ones. One will be centrilobular, the other one is called panacinar type of emphysema. Ultimately, it’s a fact that your lung is being destroyed, the parenchyma. And so, therefore, you lose your surface area and hence, your diffusion capacity of carbon monoxide is going to be decreased. Let’s