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

Abstract

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...

Diagnostic accuracy of screening tools for chronic obstructive pulmonary disease in primary health care

“…We thus added five new studies[ 17 18 19 20 21 ] to the existing 10 studies[ 7 8 9 10 11 12 13 14 15 16 ] of the systematic review by Haroon et al . [ 6 ] Figure 1 depicts the study selection process in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.…”

“…Relevant outcome data were extracted and tabulated from selected reviews. A narrative synthesis was presented that addressed the review question documenting the relevant data and findings from all[ 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 ] the included studies. The findings of meta-analyses conducted in the existing systematic review[ 6 ] were presented, wherever relevant.…”

“…The findings of meta-analyses conducted in the existing systematic review[ 6 ] were presented, wherever relevant. On account of considerable heterogeneity, additional five[ 17 18 19 20 21 ] studies were precluded from meta-analyses.…”

Physical signs in patients with chronic obstructive pulmonary disease

“…The positive LR of laryngeal height is 5.21, and when it is combined with lung function questionnaire, the positive LR becomes 29.06. [69] In the Straus et al series, maximum laryngeal height of ≤4 cm has an LR of 3.6 for the diagnosis of COPD. [70] The laryngeal height is shorter in COPD due to two reasons: clavicles and sternum are placed at a higher level due to hyperinflation.…”

In This Issue: Policy and Practice

“…6 Another clinical study finds that the combination of laryngeal height measurement and a lung function questionnaire is useful for screening for COPD. 7 In a prospective case series, ultrasound imaging appears to be useful in diagnosing acute shoulder pain and potentially for providing tailored treatment for people seen in family practice. 8 A health care policy study shows a substantial decline in the percent of uninsured patients seen in community health centers since the Medicaid expansion supported by the Affordable Care Act.…”