Can moderate chronic obstructive pulmonary disease be diagnosed by historical and physical findings alone?

Badgett, Robert G.; Tanaka, David J.; Hunt, Debra K.; Jelley, Martina J.; Feinberg, Lawrence E.; Steiner, John F.; Petty, Thomas L.

doi:10.1016/0002-9343(93)90182-o

Cited by 142 publications

(86 citation statements)

References 34 publications

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“…On the other hand, a history of smoking and wheezing may be a good predictor of airflow obstruction (19). However, it is difficult to diagnose COPD in its moderate stage on the grounds of clinical evaluation alone without spirometry (20)(21)(22) because COPD symptoms are mostly nonspecific and the diagnosis may be delayed. Respiratory symptoms such as chronic cough and expectoration very often are not considered to be important by the patients and may even be neglected by physicians for years.…”

Section: Discussionmentioning

confidence: 99%

Chronic obstructive pulmonary disease is underdiagnosed and undertreated in São Paulo (Brazil): results of the PLATINO study

Nascimento

Camelier

Rosa

et al. 2007

Braz J Med Biol Res

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Section: Discussionmentioning

confidence: 99%

Chronic obstructive pulmonary disease is underdiagnosed and undertreated in São Paulo (Brazil): results of the PLATINO study

Nascimento

Camelier

Rosa

et al. 2007

Braz J Med Biol Res

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“…Nevertheless, the identification of an abnormality in the clinical examination can function at least as a motivation to seek diagnostic confirmation of the COPD. For example, in a study of twelve physical examination signs, (8) only reduced breath sounds was found to add diagnostic power to a smoking history ≥ 70 pack-years, showing that the most important factor for diagnostic suspicion is the identification of the presence of smoking. However, the diagnosis of COPD was confirmed in only 8 of the patients studied, another 19 patients being classified as probable cases of COPD, which made it impossible to perform an appropriate statistical analysis for the twelve variables simultaneously.…”

Section: Resultsmentioning

confidence: 99%

“…(5) The use of spirometry findings as diagnostic criteria made it possible to evaluate the accuracy of various clinical signs for the diagnosis of COPD. Fine inspiratory rales, (6,7) absence of cardiac dullness to percussion, (8) reduced breath sounds, (9,10) heart sounds over the xiphoid process, (8,11) Hoover's sign, (12)(13)(14) wheezing during spontaneous breathing, (8,11,15) chest hyperresonance, (8) barrel chest (16) and pulsus paradoxus, (17) as well as increased forced expiratory time, (18) have been identified as predictors of COPD. Normal breath sound intensity (9,10) and a forced expiratory time less than 3 s (17) have been found to be negative predictors of COPD.…”

Section: Methodsmentioning

confidence: 99%

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Acurácia do exame clínico no diagnóstico da DPOC

et al. 2009

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Objective: Simple diagnostic methods can facilitate the diagnosis of COPD, which is a major public health problem. The objective of this study was to investigate the accuracy of clinical variables in the diagnosis of COPD. Methods: Patients with COPD and control subjects were prospectively evaluated by two investigators regarding nine clinical variables. The likelihood ratio for the diagnosis of COPD was determined using a logistic regression model. Results: The study comprised 98 patients with COPD (mean age, 62.3 ± 12.3 years; mean FEV 1 , 48.3 ± 21.6%) and 102 controls. The likelihood ratios (95% CIs) for the diagnosis of COPD were as follows: 4.75 (2.29-9.82; p < 0.0001) for accessory muscle recruitment; 5.05 (2.72-9.39; p < 0.0001) for pursed-lip breathing; 2.58 (1.45-4.57; p < 0.001) for barrel chest; 3.65 (2.01-6.62; p < 0.0001) for decreased chest expansion; 7.17 (3.75-13.73; p < 0.0001) for reduced breath sounds; 2.17 (1.01-4.67; p < 0.05) for a thoracic index ≥ 0.9; 2.36 (1.22-4.58; p < 0.05) for laryngeal height ≤ 5.5 cm; 3.44 (1.92-6.16; p < 0.0001) for forced expiratory time ≥ 4 s; and 4.78 (2.13-10.70; p < 0.0001) for lower liver edge ≥ 4 cm from lower costal edge. Inter-rater reliability for those same variables was, respectively, 0.57, 0.45, 0.62, 0.32, 0.53, 0.32, 0.59, 0.52 and 0.44 (p < 0.0001 for all). Conclusions: Various clinical examination findings could be used as diagnostic tests for COPD.Keywords: Physical examination; Diagnosis; Pulmonary disease, chronic obstructive. ResumoObjetivo: A DPOC é um problema de saúde pública, e métodos diagnósticos simples podem ser úteis para facilitar o diagnóstico desta doença. O objetivo deste estudo foi avaliar a acurácia de variáveis clínicas para o diagnóstico de DPOC. Métodos: Pacientes com DPOC e controles foram prospectivamente avaliados por dois examinadores quanto a nove variáveis clínicas. A razão de verossimilhança para o diagnóstico de DPOC foi determinada utilizando-se o modelo de regressão logística. Resultados: Foram incluídos 98 pacientes com DPOC (idade média, 62,3 ± 12,3 anos; VEF 1 médio, 48,3 ± 21,6%) e 102 controles. A razão de verossimilhança e IC95% para o diagnóstico de DPOC foram: 4,75 (2,29-9,82; p < 0,0001) para uso da musculatura acessória; 5,05 (2,72-9,39; p < 0,0001) para respiração com os lábios semicerrados; 2,58 (1,45-4,57; p < 0,001) para tórax em barril; 3,65 (2,01-6,62; p < 0,0001) para redução da expansibilidade torácica; 7,17 (3,75-13,73; p < 0,0001) para redução do murmúrio vesicular; 2,17 (1,01-4,67; p < 0,05) para índice torácico ≥ 0,9; 2,36 (1,22-4,58; p < 0,05) para comprimento laríngeo ≤ 5,5 cm; 3,44 (1,92-6,16; p < 0,0001) para tempo expiratório forçado ≥ 4 s; e 4,78 (2,13-10,70; p < 0.0001) para limite inferior do fígado ≥ 4 cm abaixo do rebordo costal. A concordância entre observadores para as mesmas variáveis foi, respectivamente, 0,57, 0,45, 0,62, 0,32, 0,53, 0,32, 0,59, 0,52 e 0,44 (p < 0,0001 para todas). Conclusões: Vários achados do exame clínico podem ser utilizados como testes diagnóstico...

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“…In auscultation, patients with COPD often present with diminished lung sounds, prolonged expiratory time, and expiratory wheezing that initially may occur only on forced and unforced expiration (27,41) (43,44). Another study stated that diminished breath sounds are also the best predictor of moderate-to-severe COPD (36).…”

Section: Auscultationmentioning

confidence: 99%