Accuracy of symptoms, signs, and C-reactive protein for early chronic obstructive pulmonary disease

Broekhuizen, Berna D L; Sachs, A. P. E.; Verheij, Theo; Janssen, Kristel J.M.; Asma, Gerard; Lammers, Jan‐Willem J.; Hage, René; Lammers, Ernst; Hoes, Arno W.; Moons, Karel G.M.

doi:10.3399/bjgp12x654605

Cited by 8 publications

(11 citation statements)

References 32 publications

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“…Associations between wheezes/rhonchi and bronchial obstruction have been demonstrated in several studies,9,10,17,18,23,24 and LRs between 2 and 3, as in the present study, have been found, also among patients without known bronchial obstruction 11,17,18. Crackles were not a significant predictor in our study, in contrast to what has been found in previous studies 7,11…”

Section: Discussioncontrasting

confidence: 67%

“…In a recent study from primary care of patients with persistent cough, diminished breath sounds significantly predicted FEV 1 /FVC < 0.7 in univariate analysis (sensitivity 0.16 and specificity 0.91), but not in multivariate analysis 18. The considerable variation in diagnostic properties of this variable probably reflects that it is particularly susceptible to interobserver variability.…”

Section: Discussionmentioning

confidence: 93%

“…Ideally, we should have recruited unselected patients above 40 years of age. Only a few studies have focused on adults without known bronchial obstruction 11,17,18. There is a tendency of decreasing frequency of chest signs in COPD patients (sensitivity) with decreasing prevalence of COPD in the study sample.…”

Section: Discussionmentioning

confidence: 99%

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Should chest examination be reinstated in the early diagnosis of chronic obstructive pulmonary disease?

Oshaug¹,

Halvorsen²,

Melbye³

2013

COPD

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BackgroundAlthough proven to be associated with bronchial obstruction, chest signs are not listed among cues that should prompt spirometry in the early diagnosis of chronic obstructive pulmonary disease (COPD) in established guidelines.AimsWe aimed to explore how chest findings add to respiratory symptoms and a history of smoking in the diagnosis of COPD.MethodsIn a cross-sectional study, patients aged 40 years or older, previously diagnosed with either asthma or COPD in primary care, answered questionnaires and underwent physical chest examination and spirometry.ResultsAmong the 375 patients included, 39.7% had forced expiratory volume in 1 second/forced vital capacity <0.7. Hyperresonance to percussion was the strongest predictor of COPD, with a sensitivity of 20.8, a specificity of 97.8, and likelihood ratio of 9.5. In multivariate logistic regression, where pack-years, shortness of breath, and chest findings were among the explanatory variables, three physical chest findings were independent predictors of COPD. Hyperresonance to percussion yielded the highest odds ratio (OR = 6.7), followed by diminished breath sounds (OR = 5.0), and thirdly wheezes (OR = 2.3). These three chest signs also gave significant diagnostic information when added to shortness of breath and pack-years in receiver operating-characteristic curve analysis.ConclusionWe found that chest signs may add to respiratory symptoms and a history of smoking in the diagnosis of COPD, and we conclude that chest signs should be reinstated as cues to early diagnosis of COPD in patients 40 years or older.

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Section: Discussioncontrasting

confidence: 67%

Section: Discussionmentioning

confidence: 93%

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Should chest examination be reinstated in the early diagnosis of chronic obstructive pulmonary disease?

Oshaug¹,

Halvorsen²,

Melbye³

2013

COPD

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“…We have not found studies evaluating wheezing, as experienced by patients, as a sign of drop in lung function, only as an independent predictor of COPD in general 17. Wheezing is not one of the items in score sheets for health status in COPD patients, such as the CCQ12 and the COPD assessment test (CAT)18 and neither in the exacerbations of chronic pulmonary disease tool (EXACT) 19…”

Section: Comparisons With Existing Literaturementioning

confidence: 97%

Drop in lung function during asthma and COPD exacerbations – can it be assessed without spirometry?

Melbye

Al-ani

Spigt

2016

COPD

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BackgroundWhen assessing patients with exacerbation of asthma or COPD, it may be useful to know the drop in forced expiratory volume in 1 second (FEV1) compared with stable state, in particular when considering treatment with oral corticosteroids. The objective of the study was to identify indicators of drop in FEV1 during exacerbations.MethodsIn this prospective multicenter study from primary care, patients diagnosed with asthma or COPD were examined at stable state and during exacerbations the following year. Symptoms, chest findings, and pulse oximetry were recorded, and spirometry was performed. A fixed drop in FEV1 (10% and ≥200 mL) and percentage change in FEV1 were outcomes when possible indicators were evaluated.ResultsThree hundred and eighty patients attended baseline examination, and 88 with a subsequent exacerbation were included in the analysis. Thirty (34%) had a significant drop in FEV1 (10% and 200 mL). Increased wheezing was the only symptom associated with this drop with a likelihood ratio of 6.4 (95% confidence interval, 1.9–21.7). Crackles and any new auscultation finding were also associated with a significant drop in FEV1, as was a ≥2% drop in oxygen saturation (SpO2) to ≤92% in the subgroup diagnosed with COPD. Very bothersome wheezing and severe decrease in SpO2 were also very strong predictors of change in FEV1 in linear regression adjusted for age, gender, and baseline FEV1% predicted.ConclusionIncreased wheezing, as experienced by the patient, and a decreased SpO2 value strongly indicated a drop in lung function during asthma and COPD exacerbations and should probably be taken into account when treatment with oral corticosteroids is considered.

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“…Various symptoms and exploratory signs of COPD have been studied, 2,3 but findings from a physical examination are rarely diagnostic. 4 Questionnaires, such as a COPD diagnostic questionnaire 5,6 (which addresses allergies and lower respiratory track symptoms, as well as cough, age, smoking pack-year, body mass index) and the Lung Function Questionnaire 7 (which addresses age, smoking history, frequency of productive cough, chest sounds, and breathing difficulty during physical activity), have been proposed to select individuals for spirometry because of their validity and simple application in family medicine practice. In 2000 laryngeal height began to be evaluated as a diagnostic sign 8 without much continuity.…”

mentioning

confidence: 99%

Laryngeal Measurements and Diagnostic Tools for Diagnosis of Chronic Obstructive Pulmonary Disease

Casado

Navarro

Alvarez

et al. 2015

The Annals of Family Medicine

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PURPOSE The purpose of this study was to evaluate sensitivity, specificity, and positive and negative likelihood ratios of laryngeal height, lung function, and diagnostic questionnaires for screening and diagnosis of chronic obstructive pulmonary disease (COPD). METHODSWe undertook a cross-sectional study of 233 people aged between 40 and 75 years. Measured variables were age, sex, weight, height, body mass index, tobacco use, maximum laryngeal height, and spirometry, and we administered a COPD questionnaire and the Lung Function Questionnaire.RESULTS For laryngeal height, we found a positive likelihood ratio of 5.21, and for the Lung Function Questionnaire, we found a negative likelihood ratio of 0.10. Combining a maximum laryngeal height of ≤4 cm with Lung Function Questionnaire findings of ≤18 yielded a positive likelihood ratio of 29.06, and a negative likelihood ratio of 0.26. CONCLUSIONSThe intrinsic validity of the lung function questionnaire makes it useful for screening. Combining Lung Function Questionnaire results and laryngeal height can help confirm or dismiss COPD. INTRODUCTIONI n addition to having a major socioeconomic impact, 1 chronic obstructive pulmonary disease (COPD) is associated with high morbidity and high mortality. Various symptoms and exploratory signs of COPD have been studied, 2,3 but findings from a physical examination are rarely diagnostic. 4 Questionnaires, such as a COPD diagnostic questionnaire 5,6 (which addresses allergies and lower respiratory track symptoms, as well as cough, age, smoking pack-year, body mass index) and the Lung Function Questionnaire 7 (which addresses age, smoking history, frequency of productive cough, chest sounds, and breathing difficulty during physical activity), have been proposed to select individuals for spirometry because of their validity and simple application in family medicine practice. In 2000 laryngeal height began to be evaluated as a diagnostic sign 8 without much continuity. 9 Because sternal elevation produced by the thoracic hyperinsufflation found in this disease is thought to decrease laryngeal and tracheal heights, laryngeal height, tracheal height, and laryngeal descent are also thought to be diagnostic signs of COPD.Although the validity of examinations that facilitate screening and diagnosis has demonstrated their usefulness, research on exploratory tests is scarce. Our objective was to evaluate the sensitivity, specificity, and positive and negative likelihood ratios of maximum laryngeal height, the Lung Function Questionnaire, and the COPD diagnostic questionnaire for screening and diagnosis in a primary health care population. For this study, we used the maximum laryngeal height, measured from the suprasternal notch to the top of thyroid cartilage at the end of an expiration, as proposed by Strauss and colleagues. 8,9 Verónica Casado, MD METHODSA cross-sectional investigational study was conducted using a random sampling of a general population aged between 40 to 75 years in a basic health area of 26,108 inhabitant...

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Accuracy of symptoms, signs, and C-reactive protein for early chronic obstructive pulmonary disease

Cited by 8 publications

References 32 publications

Should chest examination be reinstated in the early diagnosis of chronic obstructive pulmonary disease?

Should chest examination be reinstated in the early diagnosis of chronic obstructive pulmonary disease?

Drop in lung function during asthma and COPD exacerbations – can it be assessed without spirometry?

Laryngeal Measurements and Diagnostic Tools for Diagnosis of Chronic Obstructive Pulmonary Disease

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Accuracy of symptoms, signs, and C-reactive protein for early chronic obstructive pulmonary disease

Cited by 8 publications

References 32 publications

Should chest examination be reinstated in the early diagnosis of chronic obstructive pulmonary disease?

Should chest examination be reinstated in the early diagnosis of chronic obstructive pulmonary disease?

Drop in lung function during asthma and COPD exacerbations &ndash; can it be assessed without spirometry?

Laryngeal Measurements and Diagnostic Tools for Diagnosis of Chronic Obstructive Pulmonary Disease

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Product

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Drop in lung function during asthma and COPD exacerbations – can it be assessed without spirometry?