C2.2 Physical examination

The sensitivity of physical examination for detecting mild to moderate COPD is poor (Badgett 1993). Wheezing is not an indicator of severity of disease and is often absent in stable, severe COPD. In more advanced disease, physical features com­monly found are hyperinflation of the chest, reduced chest expansion, hyperresonance to percussion, soft breath sounds and a prolonged expiratory phase. Right heart failure may complicate severe disease.

During an acute exacerbation, tachypnoea, tachycardia, use of accessory muscles, tracheal tug and cyanosis are common.

The presence and severity of airflow limitation are impos­sible to determine by clinical signs (Badgett 1993). Objective measure­ments such as spirometry are essential. Peak expiratory flow (PEF) is not a sensitive measure of airway function in COPD patients, as it is effort dependent and has a wide range of normal values (Kelly 1988).