Table 3

Differential diagnosis of chronic obstructive pulmonary disease (COPD)

Subjective assessmentObjective examination
COPD includes chronic bronchitis (increased airway resistance attributable to narrowing of the airways) and emphysema (decreased outflow pressure attributable to loss of elasticity in lung tissues)
History of:Hyper-inflated chest
    Previous diagnosis with recent exacerbationIncreased end tidal CO2, decreased Spo2 and cyanosis (bronchitis and late stage emphysema)
    Increasing wheeze and chest tightness
    Increased sputum production and purulenceNormal end tidal CO2 and Spo2 and pink colour (emphysema)
    New peripheral oedema
    Episodic deterioration in condition, possibly with hospital admissionIncreasing dyspnoea on exertion
Use of accessory muscles of respiration
    Smoking (common)Possible productive cough
    Family historyCrepitations or wheezes may be present
    Reducing mobilityCor pulmonale (right heart failure, for example, ankle swelling) is a sign of late stage COPD
    Increasing limitations in activities of daily living
    Occupational exposure to dusts, etcIncreasing pulse and respiratory rates indicate an exacerbation of COPD
    Asthma may also be present
Medications such as β2 agonists (inhaler or nebuliser), corticosteroids, and antibiotics may be evident
Chronic bronchitis is defined as a productive cough on most days for 3 months of the year for ⩾2 years