Medical History And Physical Exam - Diagnosing Copd: Smoking Cessation

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Medical history and physical exam

The doctor will start by asking about your health history, and the first question will probably be whether you smoke. If you are a smoker or if you smoked for many years but have quit, your odds of having chronic obstructive pulmonary disease (COPD) are far greater than if you never smoked. Even if you quit smoking decades ago, your risk is higher than that of someone who never smoked. If you haven't smoked, the doctor may ask if your spouse smokes or if you have spent many years around someone else who smokes, because passive smoking also increases your risk. The doctor may also ask whether you have been exposed to toxic chemicals on the job, because breathing certain industrial pollutants can lead to emphysema or chronic bronchitis.

As part of your health history, the doctor will need to know how easily you become winded and under what circumstances. Do you have trouble climbing stairs? How long can you walk before you have to stop and rest?

Next, the doctor will listen to your chest through a stethoscope for telltale signs of COPD. Breathing that sounds weak and faint can be a sign of emphysema. A wheezing or gurgling sound can mean chronic bronchitis.

Common clinical presentations. Some people with lung disease have a bluish cast to their skin, a sign that they are not getting enough oxygen in their blood. These people tend to be overweight, and the lack of oxygen can lead to complications that cause edema, or swelling. These people are sometimes referred to as "blue bloaters." Other people have a pink coloration to their skin. These people are often very thin, a clue that they have lost weight from expending a huge amount of energy just to breathe and because their breathlessness has made it so hard to eat that they have cut back on meals. These people are sometimes known as "pink puffers."

When diagnosing COPD, doctors sometimes designate patients as either pink puffers or blue bloaters to characterize their main symptoms. Years ago, pink puffers were thought to have emphysema and blue bloaters, chronic bronchitis, because levels of oxygen in the blood tend to be lower with chronic bronchitis than with emphysema. But doctors have come to realize that these distinctions are too simplistic. While it's true that pink puffers more often have emphysema and blue bloaters tend more toward chronic bronchitis, many people have both conditions. To make a definitive diagnosis of emphysema, doctors need to see the results of tests, particularly pulmonary function tests and often x-rays.

Last updated:	May 23, 2007