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.