 Welcome to COPD Part 1. In this section, we'll discuss the history and physical in patients that you see with COPD exacerbation in the emergency department. Let's begin. Why is COPD bad? Patients with COPD, or chronic obstructive pulmonary disease, have a chronic inflammation of the entire tracheal bronchial tree. That inflammation leads to obstruction of airflow. That cause respiratory failure and death. COPD is mostly caused by smoking, and a minority of patients have COPD because of alpha 1 and 2-tripsin deficiency. In terms of the natural progression of COPD, their lung function declines after each acute exacerbation. As their lung function decline, patients might need home oxygen. To understand how to treat the patient appropriately in the emergency department, we need to know what usually triggers exacerbations. It could be a lung problem such as a superimposed infection or pulmonary embolus. It could also be a spontaneous pneumothorax from bleb rupture. It could also be from the patients running out of puffers or continuation of smoking. Therefore, if we're seeing a patient with a potential COPD exacerbation, these are the history questions we want to ask. We want to know something about their current attack, especially what had triggered the attack and how bad their COPD has been in the past. For the current exacerbation, we need to know when the patients start to feel unwell. What their symptoms are is it just shortness of breath, cough, exercise intolerance. It's also important to ask about other symptoms that might point to more of a cardiac cause of shortness of breath, such as PND, othopnea, or chest pain. Then we want to ask about the trigger questions. For pneumonia, we want to ask about fever, chills, change in color of sputum, or increased sputum production. For PE, we will ask about immobilization, previous venous thromboembolism, and so on. For pneumothorax, we need to ask whether the shortness of breath happened abruptly. For the non-lung question, did the patient run out of puffers? Have they increased their amount of smoking? For baseline history, we need to know what their function is normally. Are they able to go for a walk around the block? Can they do stairs? Are they dependent on oxygen? Is it only on exertion, at rest, and how much of oxygen flow? What puffers do they use? We need to know the name and frequency of use, and whether there is any changes in the past. In terms of previous attacks, we need to know the frequency of exacerbations, particularly when the last exacerbation was. When the patient was last put on steroids? It is also useful for us to find out their usual course of exacerbation. How many days do they usually stay? Do they stay on the ward, or do they need to go to the ICU? Have they ever been intubated? The sick of their previous attacks, the more worried we are about their current one. The physical examination patients with COPD exacerbation is similar to the patient that have shortness of breath as a chief complaint. We will focus on the vital signs, cardiac and respiratory exam. Patients with COPD exacerbation can be hypoxic. They also tend to be tachycardic. Patients with pneumonia as a trigger might have a fever. We want to specifically look for signs of respiratory distress, that include tripodding. When the patient sits upright and lean forward, we look for cyanosis, tracheotugging, intercostal in-drawing, and abdominal breathing. On the cardiac exam, we want to listen for normal heart sounds and extra heart sounds. We want to look for the apex of the heart and also measure the JVP. For the lungs, we want to listen for air entry to ensure it is symmetrical. We want to listen for any other sounds such as crackles, rails, wheezes, and pleural rub. Since PE is a trigger for COPD exacerbation, we need to look for signs of DBT in the legs. And since congestive heart failure can mimic COPD exacerbation, we also want to look for any signs of peripheral edema in the patient's legs. In summary, we discussed the history and physical impatience with the COPD exacerbation. We discussed the common triggers such as infection, PE, pneumothorax, lack of puffers, and continued smoking. We also want to know a little bit about the patient's baseline COPD. In the next section, we will discuss the investigation and management. Thank you for watching.