Clinical Findings in Patient with COPD (Pink Puffers, Blue Bloaters)

 

Factors impacting the skin color of the patient:

(1) polycythemia imparts a reddish/pink color

(2) cyanosis imparts a bluish color

 

Body weight may be:

(1) decreased from anorexia, with cachexia

(2) increased from heart failure, with raised jugular venous pressure and peripheral edema ("bloat")

 

Other findings may include

(1) a barrel chest with an increased anteroposterior diameter (secondary to increased lung volume in emphysema caused by air trapping)

(2) breathing through pursed lips, often leaning forward

(3) dyspnea while talking or with minimal exertion

(4) chronic cough with sputum production, which may become purulent during exacerbations. Chronic bronchitis is defined as sputum production for >= 3 consecutive months for >= 2 consecutive years.

(5) maximum laryngeal height (distance from between the top of the thyroid cartilage and the suprasternal notch at the end of expiration, or crico-sternal distance) < 4 cm

(6) pulsus parodoxicus

(7) migration of the cardiac apex to the midline (subxyphoid) as measured by palpation

(8) expiration phase greater than inspiration

(9) inability to blow out a candle or match held at 10 cm during expiration (contraindicated for a patient breathing oxygen)

(10) using accessory muscles to breathe

(11) paradoxical movement of lower ribs

 

A cyanotic patient with heart failure may be referred to as a "blue bloater".

 

A ruddy patient who is hyperventilating may be referred to as a "pink puffer".

Physical Finding	Emphysema	Chronic Bronchitis
resonance on percussion	hyperresonant	resonant (normal)
breath sounds (stethoscope)	decreased	normal
spoken or whispered sounds (stethoscope)	faint or inaudible	normal
crackles, wheezes and/or rhonchi	may be absent	present

 

Measurement of FEV1 or the FEV1-to-FVC ratio can establish the diagnosis. With airflow limitation both will be below the 5th percentile or the ratio will be less than 0.7.