• Observation of the patient may reveal use of accessory muscles of respiration (manifested as paradoxical movements of the chest and abdomen, in a "seesaw"-type motion), pursed-lips breathing, and hyperinflation of the chest with increased anterior-posterior diameter ("barrel chest").

• On auscultation of the lungs, patients may have distant breath sounds, wheezing, a prolonged expiratory phase of respiration, and rhonchi.

• In advanced COPD, signs of hypoxemia may include cyanosis and tachycardia.

• Signs of cor pulmonale include increased pulmonic component of the second heart sound, jugular venous distention (JVD), lower extremity edema, and hepatomegaly.

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