What are sound on copd patient

Reading File

Finding Sources

Reading File

Here is a thorough breakdown of the auscultatory and physical sounds heard in a COPD patient:

Sounds in a COPD Patient

1. Breath Sounds on Auscultation

Sound	Details
Decreased/Diminished breath sounds	The most characteristic finding. Caused by air trapping and hyperinflation, which increases the distance between airways and the chest wall
Prolonged expiration	Forced expiratory time >6 seconds on maximal exhalation is a hallmark of airflow obstruction
Expiratory wheeze	High-pitched, musical sound from narrowed airways; may or may not be present
Rhonchi	Low-pitched, rattling sounds from secretions/mucus in larger airways; may or may not be present
Muffled heart sounds	Hyperinflated lungs interpose between the heart and chest wall, dampening cardiac auscultation

From The Washington Manual of Medical Therapeutics: "Auscultation in severe COPD may expose prolonged (i.e., >6 seconds) breath sounds on a maximal forced exhalation and decreased breath sounds. Expiratory wheezing and rhonchi may or may not be present."

2. Percussion Sound

Hyperresonance - Due to increased air in the lungs (emphysema). Diaphragmatic excursion is also reduced from hyperinflation.

3. Other Associated Physical Findings (on Inspection)

These are not sounds but are found alongside the auscultatory signs:

Barrel chest (increased AP diameter) from chronic air trapping
Pursed-lip breathing
Use of accessory muscles of respiration
Cyanosis (central and peripheral) in severe disease

4. Important Clinical Notes

Physical findings are insensitive - they typically only appear in advanced COPD (FEV1 < 50% predicted). Early COPD may have a completely normal examination.
Clubbing is NOT a feature of COPD - if present, look for another cause such as lung cancer, bronchiectasis, or asbestosis. (Fishman's Pulmonary Diseases and Disorders)
Muffled/distant heart sounds may mask signs of pulmonary hypertension and right heart failure (cor pulmonale), which can complicate advanced COPD.
A thyroid-to-sternal notch distance < 4 cm in a smoker over 45 years is highly suggestive of COPD.

Summary Table

Examination	Finding in COPD
Auscultation	Decreased breath sounds, prolonged expiration, wheeze, rhonchi
Percussion	Hyperresonant
Inspection	Barrel chest, pursed-lip breathing, accessory muscle use, cyanosis
Heart sounds	Muffled (due to hyperinflated lungs)
Clubbing	Absent (if present, seek another cause)

Sources: - The Washington Manual of Medical Therapeutics, p. 312 - Fishman's Pulmonary Diseases and Disorders, p. 726

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