# COPD vs. Pneumonia



## slewy (Jan 17, 2013)

They have mostly the same symptoms but what's the difference. 

So recently, I have been applying for EMT jobs and on all the tests it will have a question like " you have PT who is coughing up mucus and says it helps him breathe better sitting up etc... what is wrong with pt?"


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## Anjel (Jan 17, 2013)

What color is the mucus? Is there a fever? 

With COPD there will be no fever.

And with pneumonia they will most likely have thick green mucusy grossness. 

Also you can usually pick out COPD with hx taking.


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## PaddyWagon (Jan 17, 2013)

COPD wheezes and pneumonia crackles when auscultated.


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## Anjel (Jan 17, 2013)

PaddyWagon said:


> COPD wheezes and pneumonia crackles when auscultated.



I hear more rhonci than wheezes and crackles.


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## Clare (Jan 17, 2013)

pneumonia is more likely to have unilateral crackles whereas COPD will have wheeze 

You can tell the difference between the two with a good history and exam


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## leoemt (Jan 17, 2013)

Crackles are very common in patients with Pneumonia since Pneumonia fills the alveoli sacs with fluid. 

Crackles can also occur in a CHF patient. 

To differentiate in the field is difficult as Pneumonia requires a chest x-ray to positively confirm.

You need to ask your SAMPLE questions and obtain a history. Patient can have chest pains and SOB for both. Pneumonia can also present with a fever and a productive cough. Shaking chills, nausea and vomiting as well as joint pain may also be present. 

http://upload.wikimedia.org/wikiped...monia.svg/300px-Symptoms_of_pneumonia.svg.png

A patient with CHF may present with shortness of breath caused by pulmonary edema, lower extremity edema or chest pain. A CHF patient may also have Pneumonia. 

http://en.wikipedia.org/wiki/File:Heartfailure.jpg

Regardless, patient needs to go to appropriate hospital.

Here is a good website to listen to different lung sounds: http://www.easyauscultation.com/lung-sounds-reference-guide.aspx


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## slewy (Jan 17, 2013)

So to sum up what you guys all said, COPD is going to have wheezes and pneumonia will have crackles. COPD and Pneumonia are both infections in the lungs but pneumonia will have more cold like symptoms too. So technically in both patients laying them down will make it harder to breathe? COPD PT's would probably be prescribed a bronchodilator right?

With a CHF the patient will have pulmonary edema in the lungs because there is a fluid build from the heart failing. A CHF patient would have crackles when auscultating do to the fluid build up in lungs.


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## WTEngel (Jan 17, 2013)

slewy said:


> COPD and Pneumonia are both infections in the lungs



Incorrect. The correct definition should be easy enough to look up online...but infections they both are not.


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## Brandon O (Jan 17, 2013)

slewy said:


> So technically in both patients laying them down will make it harder to breathe? COPD PT's would probably be prescribed a bronchodilator right?



Most respiratory patients have an easier time sitting up in general, but neither COPD nor pneumonia should be orthopneic in the same way as a CHF patient.

And yes, COPD usually buys bronchodilators. Pneumonia also might; although bronchoconstriction isn't their main problem, opening things up a little can still ease their breathing. But antibiotics will usually address the underlying infection.

Of course, pneumonia can exacerbate COPD...


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## Aidey (Jan 17, 2013)

Brandon Oto said:


> Of course, pneumonia can exacerbate COPD...



And we all know patients never have COPD, CHF and pneumonia at the same time.


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## VFlutter (Jan 17, 2013)

Aidey said:


> And we all know patients never have COPD, CHF and pneumonia at the same time.



Try writing a care plan for that patient :blink:


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## Veneficus (Jan 17, 2013)

Chase said:


> Try writing a care plan for that patient :blink:



it's not that bad...

Try writing a diet plan for a diabetic, renal failure patient, with CHF.


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## mycrofft (Jan 17, 2013)

Chase said:


> Try writing a care plan for that patient :blink:



I've had 'em, and in our infirmary level of care, it was just a matter of watching until we could justify releasing them or sending them to a hospital. 
("Catch!").

OP,
The difference between COPD and pneumonia is elementary. Crack the books and read the context.

Sidebars: 

Most people with dyspnea, unless too tired, will want to sit up, some even want to stand, and when they are anoxic but still have the energy, may even deliriously try to get up and walk away.

Pneumonia may include disorientation and hallucinations especially in us elderly.

If the COPD is longstanding enough you may have "amphoric" sounds (look it up). They will also tend to become "colonized" (chronically infected but not always clinically apparent).

RESIST, at all costs, calling COPD or pneumonia or bronchitis "a URI", whch means a cold in the nose or sinus or pharynx.


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## mycrofft (Jan 17, 2013)

Veneficus said:


> it's not that bad...
> 
> Try writing a diet plan for a diabetic, renal failure patient, with CHF.



Done that too. AND drug addicted. And sociopathic.


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## Veneficus (Jan 17, 2013)

mycrofft said:


> RESIST, at all costs, calling COPD or pneumonia or bronchitis "a URI", whch means a cold in the nose or sinus or pharynx.



Given that all of the structures involved in Bronchitis, Emphysema, COPD, and Pneumonia are in the lower airway, calling it an "upper respiratory infection" just makes you look like you don't know what you are talking about.


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## Household6 (Jan 30, 2013)

We did some COPD/O2 discussions in class yesterday... I'm doing some studying today, could anyone please tell me if this video presents accurate adventitious sounds? 

http://www.youtube.com/watch?v=5JA6D1Mguh0


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## Brandon O (Jan 30, 2013)

Household6 said:


> We did some COPD/O2 discussions in class yesterday... I'm doing some studying today, could anyone please tell me if this video presents accurate adventitious sounds?
> 
> http://www.youtube.com/watch?v=5JA6D1Mguh0



Pretty good. Kind of an unclear example of ronchi.


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## Household6 (Jan 30, 2013)

Brandon Oto said:


> Pretty good. Kind of an unclear example of ronchi.



It seems like it's one of those learned skills that require a field trip to the ICU..<_<  "Hey Charge Nurse! I don't work here and you don't know me, but do ya mind if I poke around at your pneumonia patients?"


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## NomadicMedic (Jan 30, 2013)

Household6 said:


> It seems like it's one of those learned skills that require a field trip to the ICU..<_<  "Hey Charge Nurse! I don't work here and you don't know me, but do ya mind if I poke around at your pneumonia patients?"



Or spend a couple of hours in the ED listening to lungs. The only way you get experience is to actually get experience. This time of year, in just about every ED, there's a lot of adventitious breath sounds to be heard.


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## Brandon O (Jan 30, 2013)

Household6 said:


> It seems like it's one of those learned skills that require a field trip to the ICU..<_<  "Hey Charge Nurse! I don't work here and you don't know me, but do ya mind if I poke around at your pneumonia patients?"



Kinda. There's definitely potential value in good recordings, although it seems needlessly hard to find good ones. But it's always a little different in real people, and there's a psychomotor skill to learn as well -- positioning the patient, dealing with clothing, finding the right locations, etc.


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## ThadeusJ (Jan 30, 2013)

Of course, COPD by definition is a chronic condition with exacerbations whereas pneumonia is more of an acute (but persistent) thing.  Pneumonia can be wet or dry (i.e. with or without secretions).  Pneumocystis or fungal pneumonias tend to be "dry", for example.  Different forms of COPD such as bronchiectasis have copious secretions when "normal" or stable.

Also, many of these can be limited to a particular lobe, so you may get adventitious breath sounds in some areas but not others.  With a chronic condition, chances are you see some compensatory mechanisms on their bloodwork as well, such as an elevated bicarb.  And as AIDEY mentioned (above) these all can be piled on top of one another.


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## Rykielz (Jan 30, 2013)

Crackles!? Better go with the nitro!!! *rolls eyes*


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## Shishkabob (Jan 30, 2013)

History, until proven otherwise.


They have a history of COPD?  It's probably COPD.  They have no history of COPD but have been otherwise 'sick' lately?  Probably pneumonia.


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