Can moderate chronic obstructive pulmonary disease be diagnosed by historical and physical findings alone?
ABSTRACT The value of the history and physical examination in diagnosing chronic obstructive pulmonary disease (COPD) is uncertain. This study was undertaken to determine the best clinical predictors of COPD and to define the incremental changes in the ability to diagnose COPD that occur when the physical examination findings and then the peak flowmeter results are added to the pulmonary history.
Ninety-two outpatients with a self-reported history of cigarette smoking or COPD completed a pulmonary history questionnaire and received peak flow and spirometric testing. The subjects were independently examined for 12 physical signs by 4 internists blinded to all other results. Multivariate analyses identified independent predictors of clinically significant, moderate COPD, defined as a forced expiratory volume in 1 second (FEV1) less than 60% of the predicted value or a FEV1/FVC (forced vital capacity) less than 60%.
Fifteen subjects (16%) had moderate COPD. Two historical variables from the questionnaire--previous diagnosis of COPD and smoking (70 or more pack-years)--significantly entered a logistic regression model that diagnosed COPD with a sensitivity of 40% and a specificity of 100%. Only the physical sign of diminished breath sounds significantly added to the historical model to yield a mean sensitivity of 67% and a mean specificity of 98%. The peak flow result (best cutoff value was less than 200 L/min) significantly added to the models of only one of the four physicians for a mean final sensitivity of 77% and a specificity of 95%. Subjects with none of the three historical and physical variables had a 3% prevalence of COPD; this prevalence was unchanged by adding the peak flow results.
Diminished breath sounds were the best predictor of moderate COPD. A sequential increase in sensitivity and a minimal decrease in specificity occurred when the quality of breath sounds was added first to the medical history, followed by the peak flow result. The chance of COPD was very unlikely with a normal history and physical examination.
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ABSTRACT: Broekhuizen BDL, Sachs APE, Hoes AW, Verheij JM, Moons KGM. Cough and the diagnosis of COPD. Huisarts Wet 2012;55(1):30-3. Guidelines recommend the early diagnosis of COPD in patients presenting with respiratory symptoms. However, it is difficult to diagnose COPD in an early, mild stage, and the independent diagnostic value of symptoms, signs, and test results is not known. In a study conducted between 2006 and 2009, we investigated 400 middleaged or older patients who had consulted their general practitioner for persistent cough and in whom COPD had not yet been diagnosed. They underwent extensive diagnostic screening for COPD, and a consensus panel used available information to diagnose COPD or other disorders. A substantial proportion of the patients were diagnosed with COPD (29%), especially in an early, mild, stage, and some had asthma (7%). A brief medical history and physical examination were helpful in determining the risk of COPD. The level of C-reactive protein and a 14-day trial with oral prednisolone were not of additional diagnostic value. Office spirometry provided substantial diagnostic information additional to that provided by the patient history and physical examination. Little is known about the effect of treatment of mild COPD, but the undoubted beneficial effect of stopping smoking on the prognosis is an argument for the early detection and diagnosis of COPD.Huisarts en wetenschap 01/2012; 55(1). DOI:10.1007/s12445-012-0013-y
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ABSTRACT: Objective: Airway obstruction can be clinically quantifi ed at the bedside by measuring the time taken for forced expiration. The aim of this study was to examine the accuracy of the forced expiratory time in detecting airfl ow limitation, and small airway disease when compared with simple spirometry as a gold standard test. Method: Simple spirometry and forced expiratory time were performed on 201 subjects (age range; 12-81 years), referred to a pulmonary function laboratory at a tertiary care hospital. The diagnostic accuracy of forced expiratory time and its correlation with spirometric parameters were tested. Forced expiratory time > 6 seconds was regarded as abnormal, and the ratio of forced expiratory volume in the fi rst second to forced vital capacity of < 70% was considered indicative of an airfl ow limitation. Results: Forced expiratory time was found to correlate weakly with spirometric parameters. Forced expiratory time at a cut-off value of ≥ 6 seconds had a sensitivity of 61% and a specifi city of 79% in predicting obstructive airway disease when compared with simple spirometry. On the other hand, the sensitivity and the specifi city of forced expiratory time in predicting small airway disease were 47% and 86%, respectively.
Archivos de Bronconeumología 01/2012; 48(extraordinario 1):1-84. · 1.82 Impact Factor