Suspect in Smokers; seek a history of progressive dyspnea over the years.  Cough is not a component (but may occur as part of Chronic Bronchitis).

Physical Exam:  Classic barrel-chest, fine wheezes, prolonged expiratory phase (longer than inspiratory).

Chest X-Ray:  hyperinflated lung fields, flat diaphragms.

PFTs are essential for diagnosis: 1) Reduced FEV1 : FVC ratio which does not improve after nebulized albuterol (improvement = asthma or chronic bronchitis).  2) Reduced DLCO  (<40% of predicted = severe COPD with 1/3 4-year mortality; <30% of predicted = SSI criteria for disability).

Emphysema in Non-Smoker: order “alpha-1 antitrypsin” to look for deficiency.

See posting Chronic Dyspnea – 1.