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Condition/Disorder Synonyms

  • Non-septic obstructive airway disease

  • Septic obstructive airway disease

ICD-9-CM Codes

  • 490 Bronchitis, not specified as acute or chronic

  • 491 Chronic bronchitis

  • 492 Emphysema

  • 493 Asthma

  • 494 Bronchiectasis

  • 495 Extrinsic allergic alveolitis

  • 496 Chronic airway obstruction, not elsewhere classified

Associated Physical Therapy Diagnoses

  • 780.7 Malaise and fatigue

  • 786.0 Dyspnea and respiratory abnormalities

  • 786.05 Shortness of breath

ICD-10-CM Codes

  • F17 Nicotine dependence

  • J44 Other chronic obstructive pulmonary disease

  • J41 Chronic simple and mucopurulent chronic bronchitis

  • J42 Unspecified chronic bronchitis

  • J43 Emphysema

  • J45 Asthma

  • J47 Bronchiectasis

  • Z57.31 Occupational exposure to environmental tobacco smoke

  • Z72.0 Tobacco use

  • Z77.22 Exposure to environmental tobacco smoke

  • Z87.891 Personal history of nicotine dependence

Preferred Practice Pattern

Key Features


  • A cluster of chronic lung diseases that cause air to be trapped in lungs and hyperinflation

  • Afflicted individuals usually have both emphysema and chronic bronchitis

  • Chronic airflow limitation, narrowing of airways (not fully reversible)

  • Disorders

    • Chronic bronchitis: inflammation of airway with increased mucus production

    • Obstructive bronchiolitis

    • Emphysema: damaged air sacs and small tubes of the lungs

    • Chronic obstructive lung disease (COLD)

    • Chronic obstructive airway disease (COAD)

    • Chronic airflow limitation (CAL)

    • Chronic obstructive respiratory disease (CORD)

  • Subdivided into septic and non-septic 3

    • Non-septic

      • Cough is productive

      • Breathing sounds: rales, wheezing

    • Septic

      • Cough can be variable

      • Breathing sounds decreased

Essentials of Diagnosis

  • Most individuals have lost 50% lung function when diagnosed

  • Diagnostic guidelines

    • GOLD (the Global Initiative for Chronic Obstructive Lung Disease)

    • Guidelines from American Thoracic Society and European Respiratory Society

  • Diagnosis

    • Physical examination

    • Air-flow limitation on pulmonary function test (spirometer)

      • Spirometer measures compared to predicted values for age, height, body weight, gender

      • Expressed as FEV (function expiratory volume)

    • Chronic cough

    • Hypoxemia

    • Hypercapnia

General Considerations

  • Mortality rates increase with repeated exposure to irritant or causative factors

  • Most cases include cigarette smoking

    • Acute exacerbations often caused by lung infection, exposure to air pollution, smoke, cold air temperature, dust, chemical smells

  • Adults with asthma are 12 times more likely to develop COPD than adults without asthma

  • Must monitor oxygen levels in patients with COPD; can become apneic

  • Loss of airflow usually due to

    • Lost elasticity in airways and air sacs

    • Increased mucus production

    • Damage to air sac

    • Inflammation, thickening of airway walls


  • Most commonly presents at age 55 to 60 years

  • More common in men than women in middle age

  • Increasing prevalence among women (associated with increased smoking among women)

Clinical Findings

Signs and Symptoms

  • Chest tightness...

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