Ecg

Variable

Variable

Often normal

CT scan

Emphysema

Normal lungs

Dilated bronchi

COPD, chronic obstructive pulmonary disease; CT, computed tomography; CXR, chest X-ray; ECG, electrocardiography; FEV1, forced expiratory volume in 1 s; LVF, left ventricular failure.

COPD, chronic obstructive pulmonary disease; CT, computed tomography; CXR, chest X-ray; ECG, electrocardiography; FEV1, forced expiratory volume in 1 s; LVF, left ventricular failure.

The overlap with bronchiectasis is different, and here it is the long history and the volume and colour of sputum that usually will distinguish it from COPD. Some auscultatory but scanty crackles are common in COPD and are not always present in mild or focal bronchiectasis. Similarly, the FEV1 can be abnormal in both, but the chest radiograph and particularly the computed tomography (CT) scan usually make the differentiation obvious.

The message from these examples is that sorting out a differential diagnosis in individual patients on the basis of history and clinical signs alone is often unreliable, so that the best management will almost always be dependent on further investigations. Once made, the diagnosis is likely to be unchanged for many years, and the costs of these investigations are therefore proportionately quite low compared with the benefits to the patient of getting the therapy correctly focused (Table 3.2).

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