Mannino DM, Homa DM, Akinbami LJ, Ford ES, Redd SC. 5, 6, 29 Although some experts have proposed periodic FEV 1 testing for high-risk patients older than 45 years to facilitate risk factor reduction counseling, no evidence exists to support this recommendation. A patient with severe disease has a FEV 1 of less than 50 percent of the predicted value values below 30 percent of the predicted value represent very severe disease. 5 Severity is further stratified based on symptoms and FEV 1 values. According to the GOLD criteria, a FEV 1/FVC ratio of less than 70 percent in a patient with a postbronchodilator FEV 1 of less than 80 percent of the predicted value is diagnostic for COPD. Key spirometric measures may be obtained with a portable office spirometer and should include forced vital capacity (FVC) and FEV 1.Patients with COPD typically present with obstructive airflow. The GOLD guidelines 5 characterize the severity of COPD according to clinical and spirometric measures (Table 4 5). The best diagnostic test for evaluating patients with suspected COPD is lung function measured with spirometry. Sweat chloride test (diagnostic), Bacterial sputum culture Predictive cough with purulent sputum, dyspnea, and wheezing Usually early-life onset progressive with exacerbations associated with pancreatic disease, failure to thrive, intestinal obstruction, cirrhosis, and steatorrhea Infiltrate, nodular lesions, hilar adenopathy Productive cough, hemoptysis, fever, and weight loss Onset at any age associated with history of exposure Increased heart size, pulmonary vascular congestion, pleural effusionsĮchocardiography, BNP measurement, electrocardiography cardiac catheterization in selected patients Midlife to late-life onset associated with risk factors such as hypertension and coronary artery diseaseįatigue, exertional and paroxysmal nocturnal dyspnea, and peripheral edemaĭecreased DLCO, predominantly used to exclude other diagnoses Multifocal, bilateral alveolar infiltrates Often subacute presentation with dyspnea, cough, and feverĭecreased vital capacity, decreased DLCO, usually no obstructive component Onset at any age may be associated with history of flu-like illness, collagen vascular disease, or toxic exposure Obstructive airflow limitation, both fixed and reversibleįocal pneumonia, atelectasis dilated, thickened airways (ring shadow)īacterial, microbacterial, and fungal sputum culture, chest CT Productive cough with thick, purulent sputum dypsnea and wheezing Usually midlife onset progressive with exacerbations Predominantly reversible airflow obstruction, normal DLCO Usually early-life onset episodic associated with other allergic disorders and family history Α 1-Antitrypsin testing, ABG testing, and chest CT in selected patients Hyperinflation, increased basilar markings, bronchial thickening Predominantly fixed airflow obstruction, decreased DLCO Midlife to late-life onset steadily progressive with exacerbations associated with smoking historyĬhronic productive cough, dyspnea, and wheezing Chronic obstructive pulmonary disease also is a systemic disorder with weight loss and dysfunction of respiratory and skeletal muscles. Arterial blood gas testing is recommended for patients presenting with signs of severe disease, right-sided heart failure, or significant hypoxemia. Selected patients should be tested for α 1-antitrypsin deficiency. Chest radiography may rule out alternative diagnoses and comorbid conditions. Severity is further stratified based on forced expiratory volume in one second and symptoms. The Global Initiative for Chronic Obstructive Lung Disease diagnostic criterion for chronic obstructive pulmonary disease is a forced expiratory volume in one second/forced vital capacity ratio of less than 70 percent of the predicted value. However, none of these findings alone is diagnostic. Patients with chronic obstructive pulmonary disease typically present with coughing, sputum production, and dyspnea on exertion. Most chronic obstructive pulmonary disease is associated with smoking, but occupational exposure to irritants and air pollution also are important risk factors. Chronic obstructive pulmonary disease is characterized by the gradual progression of irreversible airflow obstruction and increased inflammation in the airways and lung parenchyma that is generally distinguishable from the inflammation caused by asthma.
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