A nurse is assessing an older adult with a history of chronic obstructive pulmonary disease (COPD). Which chest wall configuration should the nurse expect to find?

Clients with chronic obstructive pulmonary disease (COPD) develop a characteristic barrel chest, which is defined as an increase in the anteroposterior (AP) diameter of the chest. Normally the ratio of the AP diameter to the lateral diameter is approximately 1:2, but in COPD the AP diameter increases toward a 1:1 ratio due to chronic air trapping, hyperinflation of the lungs, and loss of elastic recoil. The diaphragm becomes flattened and the chest assumes a rounded, barrel-like appearance. This is the expected physical finding in a client with a long-standing history of COPD. A funnel-shaped chest with the sternum depressed inward describes pectus excavatum, which is a congenital chest wall deformity unrelated to COPD. A lateral curvature of the spine describes scoliosis, a musculoskeletal condition. Protrusion of the sternum and adjacent ribs outward describes pectus carinatum (pigeon chest), another congenital deformity. None of these alternative findings are characteristic of COPD. The nurse should anticipate the barrel chest with an increased AP diameter as the hallmark chest wall change in this population.