Can moderate obstructive pulmonary disease 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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- "These results should be considered in the context of other means for selecting patients for screening spirometry. Several physical signs have been evaluated for the detection of COPD, and some of them alone or in association with medical history data may be very useful for this purpose     "
ABSTRACT: Aim: To investigate whether the measurement of arterial oxygen saturation (SpO(2)) with pulse oximetry can identify those patients for whom spirometric screening for COPD would be useful, and those patients for whom spirometric assessment would not be useful. Methods: Two hundred and ten patients, aged over 40, without significant dyspnoea, referred by their primary care physicians to the outpatient pulmonary clinic. The value of SpO(2) was recorded with a finger clip pulse oximeter sensor. Diagnostic values were obtained in order to diagnose COPD (defined as an FEV(1)/FVC ratio <0.70), and in order to detect patients with an FEV(1) <80% of predicted value. Results: With SpO(2) <98%, sensitivity for detecting COPD was 79% and specificity 37%. Similar values were obtained for detecting patients with FEV(1) <80%. When only patients with FEV(1) <50% were considered, using a value of <98% for SpO2, sensitivity was 77%. Conclusion: Pulse oximetry is not a useful test for selecting patients for screening spirometry in order to diagnose COPD.Primary Care Respiratory Journal 10/2004; 13(3):155-8. DOI:10.1016/j.pcrj.2003.11.006 · 2.50 Impact Factor
- "However, the concept that clinical identification of underlying lung disease is equivalent to laboratory testing is flawed. Several studies suggest that clinical identification of pre-existing chronic lung disease is inadequate for the purposes of risk assessment  . Some asthmatic patients are unaware of significant changes in their lung function, and in these patients symptoms are unreliable for assessing severity and optimization of function . "
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ABSTRACT: Understanding the risk factors for the development of PPCs allows targeted interventions aimed at reducing the frequency and severity of PPCs. The broad categories of what increases the likelihood of developing a PPC are understood but specific understanding of how individual risk factors act to cause PPCs is lacking,and there is little information regarding the interaction or synergy between risk factors. Further research is needed to define the nature of risk factors and develop better predictive models of patients at risk for developing PPCs. It is clear that anesthetic agents produce significant changes in the respiratory system but further information is needed to define how such changes contribute, if at all, to the subsequent development of PPCs. The ongoing controversy regarding the value of regional analgesia or anesthetic techniques, especially epidural analgesia and anesthesia, in reducing or preventing PPCs requires well-done randomized clinical trials. Further research is also needed in the area of postoperative care such as interventions in patients with OSA or the use of inventive spirometric techniques.Anesthesiology Clinics of North America 04/2004; 22(1):77-91. DOI:10.1016/S0889-8537(03)00112-3
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