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A fourth character provides greater specificity to this code: J44 Other chronic obstructive pulmonary disease includes asthma with COPD, chronic asthmatic bronchitis, and chronic obstructive asthma, among other diagnoses J44.0 COPD with (acute) lower respiratory infection used to report cases where a patient with COPD develops an acute infection in the lower respiratory tract, such as bronchitis or pneumonia J44.1 COPD with (acute) exacerbation used when the patient experiences worsening COPD symptoms (e.g., increased dyspnea, wheezing) without an infection J44.0 and J44.1 are assigned together when documentation shows a patient with an acute lower respiratory infection as well as an acute exacerbation

Adolescents with anxiety disorders have been found to have increased rates of smoking and nicotine dependence (Nelson and Wittchen 1998