ABSTRACT
Chronic obstructive pulmonary disease (COPD) is defined in terms of spirometry (1). Obstruction is thought to be of importance by the patient when there are associated symptoms, and in fact this is when the patient frequently comes to the attention of the physician and the diagnosis is made. Patients older than 40 years usually present with COPD (1). The cardinal symptoms of COPD are dyspnea of effort, cough, and sputum production (1). Other symptoms though present are not thought to be as important, and these include wheeze and chest discomfort. Pedal edema portends right ventricular dysfunction and is an indicator of severity (1).
