Clinical Features

Chronic cough with expectoration (expectoration typically occurs in the morning)

Dyspnea and tachypnea

• Initial stages: only on exertion

• Advanced stages: continuously

Pursed lip breathing

• The patient breathes in through the nose and breathes out slowly through pursed lips.

• This style of breathing increases airway pressure and prevents bronchial collapse during the last phase of expiration.

• More commonly seen in patients with emphysema

Prolonged expiratory phase, end-expiratory wheezing, crackles, muffled breath sounds, and/or coarse rhonchi on auscultation

Cyanosis due to hypoxemia

Tachycardia

Congested neck veins

Barrel chest: This deformity is most commonly seen in individuals with emphysema.

Asynchronous movement of the chest and abdomen during respiration

Use of accessory respiratory muscles due to diaphragmatic dysfunction

Hyperresonant lungs, reduced diaphragmatic excursion, and relative cardiac dullness on percussion

Decreased breath sounds on auscultation: “silent lung”

Peripheral edema (most often ankle edema)

Right ventricular hypertrophy with signs of right heart failure and cor pulmonale

Hepatomegaly

Often weight loss and cachexia

Secondary polycythemia

Confusion: due to hypoxemia and hypercapnia

Nail clubbing in the case of certain comorbidities (e.g., bronchiectasis, pulmonary fibrosis, lung cancer)

Age of onset is generally younger (< 60 years)

Also, often have hepatic signs and symptoms (jaundice) related to hepatitis or cirrhosis