Clinical features

• a barrel chest
• subxyphoid cardiac apical pulse
• decreased cardiac dullness on percussion
• decreased breath sounds
• wheezing
• crackles
• hyperresonance 

Why?

Wheezing, a barrel chest and decreased cardiac dullness make COPD more likely

Patient	Target Disorder and Reference Standard	Diagnostic Test	LR+ (95% CI)	Post-test Probability	LR- (95% CI)	Post-test Probability
suspected COPD a (pre-test probability: 9%)	COPD (spirometry)	wheezing on examination	12 (1.7 to 98)	54%	0.87 (0.79 to 0.96)	8%
suspected COPD a (pre-test probability: 9%)	COPD (spirometry)	barrel chest	10	50%	0.90	8%
		decreased cardiac dullness	10	50%	0.88	8%
		crackles	5.9	37%	0.95	9%
		hyperresonance	4.8	32%	0.73	7%
		subxyphoid cardiac apical impulse	4.6	31%	0.94	7%
		decreased breath sounds	3.7	27%	0.70	9%