Examination

Important aspects of the clinical examination to note:

• Vital signs including oxygen saturations, HR, BP, RR, temperature:
  • In severe exacerbations patients will be more likely to be tachycardic and tachypneic
  • However a tiring patient may have a reduced respiratory rate
• Peripheral signs of respiratory disease such as:
  • Tar staining
  • Palmar erythema
  • Cyanosis
  • Asterixis
• Increased work of breathing:
• Use of accessory muscles
• The patient may be holding themselves in the ‘tripod’ posture
• Pursed lip breathing
• Reduced ability to speak in full sentences
• The presence or absence of cyanosis
• Presence of chest wall deformity or barrel shaped chest secondary to hyperinflation
• Reduced chest wall movement
• Chest percussion may show signs of hyper-resonance
• Chest auscultation may show reduced air entry, wheeze, a prolonged expiratory phase +/- crepitations
• Consciousness level may be normal or reduced
• Signs of right heart failure such as raised JVP, peripheral oedema, hepatomegaly
• Body mass index may be low secondary to reduced intake and increased calorie expenditure on work of breathing
• Sputum assessment