There is an increased risk of lung cancer among first-degree relatives, indicating a

genetic susceptibility.
Candidate gene studies have identified several enzymes in the cytochrome P-
450 system as risk factors for lung cancer. One such gene is CYP1A1, which codes for aryl
hydrocarbon hydroxylase. Certain alleles of CYP1A1 are thought to increase the risk of lung
cancer through increased metabolic activation of procarcinogens derived from cigarette
smoke.

Most chronic obstructive pulmonary disease is associated with smoking, but

occupational exposure to irritants and air pollution also are important risk factors.
Patients with chronic obstructive pulmonary disease typically present with coughing,
sputum production, and dyspnea on exertion. However, none of these findings alone is
diagnostic. The Global Initiative for Chronic Obstructive Lung Disease diagnostic criterion
for chronic obstructive pulmonary disease is a forced expiratory volume in one
second/forced vital capacity ratio of less than 70 percent of the predicted value. Severity
is further stratified based on forced expiratory volume in one second and symptoms.
Chest radiography may rule out alternative diagnoses and comorbid conditions. Selected
patients should be tested for 1-antitrypsin deficiency. Arterial blood gas testing is
recommended for patients presenting with signs of severe disease, right-sided heart
failure, or significant hypoxemia. Chronic obstructive pulmonary disease also is a
systemic disorder with weight loss and dysfunction of respiratory and skeletal muscles
Inspection[edit]
Look for cyanosis

Central - look at lips, oral mucosa and tongue

Peripheral - nails, hands and feet

Look at fingers for cigarette tar stains and clubbing of fingernails

Shape of chest

Chest wall deformities or trauma

Asymmetries of shape or movement

Barrel chest has increased AP diameter - common in COPD

Look for intercostal, subcostal and supraclavicular indrawing

Palpation[edit]
Feel for tracheal position and presence of a downward tug

Feel for range and symmetry of movement on inspiration - decreased range with
hyperinflated lungs of COPD

Feel for tactile fremitus - decreased in COPD

Percussion[edit]
Percuss anterior and posterior, comparing left to right - hyperresonance with COPD
 Estimate diaphragmatic excursion by noting the difference in the level of dullness on
percussion with inspiration and expiration - normal is 5-6cm, but is decreased with
hyperinflated lungs of COPD

Auscultation[edit]
listen to each of the five lung lobes and compare findings between sides

Air entry - decreased in COPD

Adventitious sounds

wheezes, crackles, other

generalized versus localized

loud vs soft