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Chronic Obstructive Pulmonary Disease (COPD) and Emphysema in Emergency Medicine Workup

  • Author: Paul Kleinschmidt, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
 
Updated: Jan 27, 2016
 

Laboratory Studies

See the list below:

  • Arterial blood gas
    • Arterial blood gas (ABG) analysis provides the best clues as to acuteness and severity.
    • In general, renal compensation occurs even in chronic CO2 retainers (ie, bronchitics); thus, pH usually is near normal.
    • Generally, consider any pH below 7.3 a sign of acute respiratory compromise.
  • Serum chemistry
    • These patients tend to retain sodium.
    • Diuretics, beta-adrenergic agonists, and theophylline act to lower potassium levels; thus, serum potassium should be monitored carefully.
    • Beta-adrenergic agonists also increase renal excretion of serum calcium and magnesium, which may be important in the presence of hypokalemia.
  • CBC - Polycythemia
  • BNP
    • Human BNP binds to particulate guanylate cyclase receptors of vascular smooth muscle and endothelial cells. Binding to the receptors causes an increase in cyclic guanosine monophosphate (GMP), which serves as a secondary messenger to dilate veins and arteries.
    • By measuring the BNP level, it was thought that the ability to differentiate between CHF and COPD exacerbations in blue bloaters would have become much easier. However, clinical observation and research demonstrated that, in the cases of mild CHF exacerbations, the ability to differentiate between CHF and COPD is still not straightforward. A mild elevation of a BNP level still must be taken in context with the overall clinical picture.
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Imaging Studies

See the list below:

  • Chest radiography
    • Chronic bronchitis is associated with increased bronchovascular markings and cardiomegaly.
    • Emphysema is associated with a small heart, hyperinflation, flat hemidiaphragms, and possible bullous changes. Typical findings are shown in the radiographs below.
      Chronic obstructive pulmonary disease (COPD). A luChronic obstructive pulmonary disease (COPD). A lung with emphysema shows increased anteroposterior (AP) diameter, increased retrosternal airspace, and flattened diaphragms on lateral chest radiograph.
      Chronic obstructive pulmonary disease (COPD). A luChronic obstructive pulmonary disease (COPD). A lung with emphysema shows increased anteroposterior (AP) diameter, increased retrosternal airspace, and flattened diaphragms on posteroanterior chest radiograph.
      Posteroanterior (PA) and lateral chest radiograph Posteroanterior (PA) and lateral chest radiograph in a patient with severe chronic obstructive pulmonary disease (COPD). Hyperinflation, depressed diaphragms, increased retrosternal space, and hypovascularity of lung parenchyma is demonstrated.
      Subcutaneous emphysema and pneumothorax. Subcutaneous emphysema and pneumothorax.
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Other Tests

See the list below:

  • Pulse oximetry
    • Pulse oximetry does not offer as much information as ABG analysis.
    • When combined with clinical observation, this test can be a powerful tool for instant feedback on the patient's status.
  • Electrocardiography
    • The presence of underlying cardiac disease is highly likely.
    • Establish that hypoxia is not resulting in ischemia.
    • Establish that the underlying cause of respiratory difficulty is not cardiac in nature.
  • Pulmonary function tests
    • Decreased forced expiratory volume in 1 second (FEV1) with concomitant reduction in FEV1/forced vital capacity (FVC) ratio
    • Poor/absent reversibility with bronchodilators
    • FVC normal or reduced
    • Normal or increased total lung capacity (TLC)
    • Increased residual volume (RV)
    • Normal or reduced diffusing capacity
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Contributor Information and Disclosures
Author

Paul Kleinschmidt, MD Consulting Staff, Department of Emergency Medicine, Womack Army Medical Center

Paul Kleinschmidt, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Received ownership interest from ScrubCast, INC for other.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Paul Blackburn, DO, FACOEP, FACEP Attending Physician, Department of Emergency Medicine, Maricopa Medical Center

Paul Blackburn, DO, FACOEP, FACEP is a member of the following medical societies: American College of Emergency Physicians, Arizona Medical Association, American College of Osteopathic Emergency Physicians, American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program Director for Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, Society for Academic Emergency Medicine, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians

Disclosure: Nothing to disclose.

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Chronic obstructive pulmonary disease (COPD). Histopathology of chronic bronchitis showing hyperplasia of mucous glands and infiltration of the airway wall with inflammatory cells.
Chronic obstructive pulmonary disease (COPD). Histopathology of chronic bronchitis showing hyperplasia of mucous glands and infiltration of the airway wall with inflammatory cells (high-powered view).
Posteroanterior (PA) and lateral chest radiograph in a patient with severe chronic obstructive pulmonary disease (COPD). Hyperinflation, depressed diaphragms, increased retrosternal space, and hypovascularity of lung parenchyma is demonstrated.
Chronic obstructive pulmonary disease (COPD). A lung with emphysema shows increased anteroposterior (AP) diameter, increased retrosternal airspace, and flattened diaphragms on lateral chest radiograph.
Chronic obstructive pulmonary disease (COPD). A lung with emphysema shows increased anteroposterior (AP) diameter, increased retrosternal airspace, and flattened diaphragms on posteroanterior chest radiograph.
Subcutaneous emphysema and pneumothorax.
 
 
 
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