Which of the following is not a sign of advanced COPD?

Advanced disease may be accompanied by cachexia, with significant weight loss, bitemporal wasting, and diffuse loss of subcutaneous adipose tissue.Some patients with advanced disease have paradoxical inward movement of the rib cage with inspiration (Hoover's sign)Signs of ove right hea failure termed cor pulmonale might be seen, are now relatively infrequent since the advent of supplemental oxygen therapy (in developed countries).Clubbing of the digits is not a sign of COPD, and its presence should ale the clinician to initiate an investigation for causes of clubbing. In this population, the development of lung cancer is the most likely explanation for newly developed clubbing.Ref: Harrison 19e pg: 1704