COPD EXACERBATION AS A DIAGNOSIS OF EXCLUSION?

A patient a history of COPD presents with shortness of breath. Physical examination shows pursed lip breathing, prolonged exhalation, recruitment of accessory muscles, etc. COPD exacerbation, right?

 

Hold on. Have a COPD patient jog around the parking lot and they will look just the same. Anything that causes shortness of breath in a COPD patient will accentuate the physical signs of COPD. All those signs mean is that they are either having to breath harder, or deal with secretions.

 

The GOLD criteria for COPD emphasize a change in sputum character or quantity or dyspnea. A viral URI can do that. So can PE, metabolic acidosis, CHF, etc.

 

This is why I recommend thinking of COPD as a diagnosis of exclusion. If there are copious secretions then maybe that tells you the origin of the problem. But if it is just shortness of breath, then work it up the same way you would work up any patient with shortness of breath.

 

TAKE HOME POINTS

-Think of COPD as a diagnosis of exclusion- consider other causes like CHF, pneumonia, pulmonary embolism

-Be especially vigilant in the COPD patient who presents with shortness of breath and no change in secretions