Chronic obstructive pulmonary disease other diagnostic studies: Difference between revisions
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==Overview== | ==Overview== | ||
Six minute walk tests act as a predictor of mortality in patients with moderate COPD (patients who desaturate have worse mortality compared with those who don't desaturate.) | |||
==Other Diagnostic Studies== | ==Other Diagnostic Studies== | ||
===Pulmonary Function Test / Spirometry=== | ===Pulmonary Function Test / Spirometry=== | ||
* COPD is particularly characterized if a ratio of forced expiratory volume over 1 second ([[FEV1|FEV<sub>1</sub>]]) to [[forced vital capacity]] (FVC) being < 0.7 and the [[FEV1|FEV<sub>1</sub>]] < 70% of the predicted value when compared with a matched control. <ref>[http://www.patient.co.uk/showdoc/40002357/ PatientPlus - Spirometry]</ref>, <ref name="pmid22319804">{{cite journal |author= |title= |journal=[[]] |volume= |issue= |pages= |year= |pmid=22319804 |doi= |url= |accessdate=2012-03-05}}</ref> (see [[Spirometry]]). | |||
* Normally, at least 70% of the FVC comes out in the first second (i.e. the [[FEV1/FVC|FEV<sub>1</sub>/FVC ratio]] is >70%). A ratio less than normal defines the patient as having COPD. | *COPD is particularly characterized if a ratio of forced expiratory volume over 1 second ([[FEV1|FEV<sub>1</sub>]]) to [[forced vital capacity]] (FVC) being < 0.7 and the [[FEV1|FEV<sub>1</sub>]] < 70% of the predicted value when compared with a matched control. <ref>[http://www.patient.co.uk/showdoc/40002357/ PatientPlus - Spirometry]</ref>, <ref name="pmid22319804">{{cite journal |author= |title= |journal=[[]] |volume= |issue= |pages= |year= |pmid=22319804 |doi= |url= |accessdate=2012-03-05}}</ref> (see [[Spirometry]]). | ||
* More specifically, the diagnosis of COPD is made when the FEV<sub>1</sub>/FVC ratio is <70%. | *Normally, at least 70% of the FVC comes out in the first second (i.e. the [[FEV1/FVC|FEV<sub>1</sub>/FVC ratio]] is >70%). A ratio less than normal defines the patient as having COPD. | ||
* The GOLD criteria also require that values are after [[bronchodilator]] medication has been given to make the diagnosis, | *More specifically, the diagnosis of COPD is made when the FEV<sub>1</sub>/FVC ratio is <70%. | ||
* The NICE criteria also require FEV1%. | *The GOLD criteria also require that values are after [[bronchodilator]] medication has been given to make the diagnosis, | ||
* According to the ERS criteria, it is [[FEV1% predicted]] that defines when a patient has COPD, that is, when FEV1% predicted is < 88% for men, or < 89% for women. | *The NICE criteria also require FEV1%. | ||
* Spirometry can help to determine the severity of COPD.<ref name="pmid17507545">{{cite journal |author=Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, Zielinski J |title=Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary |journal=[[American Journal of Respiratory and Critical Care Medicine]] |volume=176 |issue=6 |pages=532–55 |year=2007 |month=September |pmid=17507545 |doi=10.1164/rccm.200703-456SO |url=http://ajrccm.atsjournals.org/cgi/pmidlookup?view=long&pmid=17507545 |accessdate=2012-03-02}}</ref> | *According to the ERS criteria, it is [[FEV1% predicted]] that defines when a patient has COPD, that is, when FEV1% predicted is < 88% for men, or < 89% for women. | ||
* | *Spirometry can help to determine the severity of COPD.<ref name="pmid17507545">{{cite journal |author=Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, Zielinski J |title=Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary |journal=[[American Journal of Respiratory and Critical Care Medicine]] |volume=176 |issue=6 |pages=532–55 |year=2007 |month=September |pmid=17507545 |doi=10.1164/rccm.200703-456SO |url=http://ajrccm.atsjournals.org/cgi/pmidlookup?view=long&pmid=17507545 |accessdate=2012-03-02}}</ref> | ||
* The severity of COPD also depends on the severity of dyspnea and exercise limitation. These and other factors can be combined with spirometry results to obtain a COPD severity score that takes multiple dimensions of the disease into account.<ref name=Celli04>{{cite journal |author=Celli BR, Cote CG, Marin JM, ''et al.'' |title=The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease |journal=N. Engl. J. Med. |volume=350 |issue=10 |pages=1005–12 |year=2004 |month=March |pmid=14999112 |doi=10.1056/NEJMoa021322 }}</ref> | *The FEV<sub>1</sub> (measured after bronchodilator medication) is expressed as a percentage of a predicted "normal" value based on a person's age, gender, height and weight: | ||
*The severity of COPD also depends on the severity of dyspnea and exercise limitation. These and other factors can be combined with spirometry results to obtain a COPD severity score that takes multiple dimensions of the disease into account.<ref name="Celli04">{{cite journal |author=Celli BR, Cote CG, Marin JM, ''et al.'' |title=The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease |journal=N. Engl. J. Med. |volume=350 |issue=10 |pages=1005–12 |year=2004 |month=March |pmid=14999112 |doi=10.1056/NEJMoa021322 }}</ref> | |||
===COPD Severity=== | ===COPD Severity=== | ||
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{| class="wikitable" style="text-align:center;width:75%;" | {| class="wikitable" style="text-align:center;width:75%;" | ||
|- | |- | ||
! Severity !! Post-bronchodilator FEV1| FEV<sub>1</sub> /FVC !! FEV<sub>1</sub> % predicted | !Severity!! Post-bronchodilator FEV1 |FEV<sub>1</sub> /FVC!!FEV<sub>1</sub> % predicted | ||
|- | |- | ||
| At risk || >0.7 || ≥80 | |At risk||>0.7||≥80 | ||
|- | |- | ||
| Mild COPD || ≤0.7 || ≥80 | |Mild COPD||≤0.7||≥80 | ||
|- | |- | ||
| Moderate COPD || ≤0.7 || 50-80 | |Moderate COPD||≤0.7||50-80 | ||
|- | |- | ||
| Severe COPD || ≤0.7 || 30-50 | |Severe COPD||≤0.7||30-50 | ||
|- | |- | ||
| Very Severe COPD || ≤0.7 || <30 '''or''' 30-50 with Chronic Respiratory Failure symptoms | |Very Severe COPD||≤0.7||<30 '''or''' 30-50 with Chronic Respiratory Failure symptoms | ||
|} | |} | ||
===Six Minute Walking Distance=== | ===Six Minute Walking Distance=== | ||
* It act as a good predictor of mortality in patients with [[COPD]]. | |||
* Patients who desaturate during 6MWD have higher mortality compared to those who doesn't desaturate. | *It act as a good predictor of mortality in patients with [[COPD]]. | ||
* This test is a part of BODE index which is used as a mortality predictor for patients with COPD. | *Patients who desaturate during 6MWD have higher mortality compared to those who doesn't desaturate. | ||
* The [[BODE index]] has the following component | *This test is a part of BODE index which is used as a mortality predictor for patients with COPD. | ||
** [[Body mass index]] | *The [[BODE index]] has the following component | ||
** Obstruction (FEV1) | **[[Body mass index]] | ||
** [[Dyspnea]] (MMRC dyspnea scale) | **Obstruction (FEV1) | ||
** 6 minute walking distance. | **[[Dyspnea]] (MMRC dyspnea scale) | ||
**6 minute walking distance. | |||
===Right Sided Heart Catheterization=== | ===Right Sided Heart Catheterization=== | ||
* It is not routinely done. However, in cases when [[pulmonary hypertension]] is suspected clinically and on [[echocardiography]] then a right heart catheterization can be done to measure [[pulmonary artery pressure]] and see the response of [[vasodilator]]s | |||
*It is not routinely done. However, in cases when [[pulmonary hypertension]] is suspected clinically and on [[echocardiography]] then a right heart catheterization can be done to measure [[pulmonary artery pressure]] and see the response of [[vasodilator]]s | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WikiDoc Help Menu}} | |||
{{WikiDoc Sources}} | |||
[[Category:Pulmonology]] | [[Category:Pulmonology]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
Latest revision as of 15:55, 12 January 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Philip Marcus, M.D., M.P.H. [2]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [3]
Overview
Six minute walk tests act as a predictor of mortality in patients with moderate COPD (patients who desaturate have worse mortality compared with those who don't desaturate.)
Other Diagnostic Studies
Pulmonary Function Test / Spirometry
- COPD is particularly characterized if a ratio of forced expiratory volume over 1 second (FEV1) to forced vital capacity (FVC) being < 0.7 and the FEV1 < 70% of the predicted value when compared with a matched control. [1], [2] (see Spirometry).
- Normally, at least 70% of the FVC comes out in the first second (i.e. the FEV1/FVC ratio is >70%). A ratio less than normal defines the patient as having COPD.
- More specifically, the diagnosis of COPD is made when the FEV1/FVC ratio is <70%.
- The GOLD criteria also require that values are after bronchodilator medication has been given to make the diagnosis,
- The NICE criteria also require FEV1%.
- According to the ERS criteria, it is FEV1% predicted that defines when a patient has COPD, that is, when FEV1% predicted is < 88% for men, or < 89% for women.
- Spirometry can help to determine the severity of COPD.[3]
- The FEV1 (measured after bronchodilator medication) is expressed as a percentage of a predicted "normal" value based on a person's age, gender, height and weight:
- The severity of COPD also depends on the severity of dyspnea and exercise limitation. These and other factors can be combined with spirometry results to obtain a COPD severity score that takes multiple dimensions of the disease into account.[4]
COPD Severity
The severity of COPD can be classified as follows using spirometry
| Severity | FEV1 /FVC | FEV1 % predicted |
|---|---|---|
| At risk | >0.7 | ≥80 |
| Mild COPD | ≤0.7 | ≥80 |
| Moderate COPD | ≤0.7 | 50-80 |
| Severe COPD | ≤0.7 | 30-50 |
| Very Severe COPD | ≤0.7 | <30 or 30-50 with Chronic Respiratory Failure symptoms |
Six Minute Walking Distance
- It act as a good predictor of mortality in patients with COPD.
- Patients who desaturate during 6MWD have higher mortality compared to those who doesn't desaturate.
- This test is a part of BODE index which is used as a mortality predictor for patients with COPD.
- The BODE index has the following component
- Body mass index
- Obstruction (FEV1)
- Dyspnea (MMRC dyspnea scale)
- 6 minute walking distance.
Right Sided Heart Catheterization
- It is not routinely done. However, in cases when pulmonary hypertension is suspected clinically and on echocardiography then a right heart catheterization can be done to measure pulmonary artery pressure and see the response of vasodilators
References
- ↑ PatientPlus - Spirometry
- ↑ [[]]. PMID 22319804. Missing or empty
|title=(help);|access-date=requires|url=(help) - ↑ Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, Zielinski J (2007). "Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary". American Journal of Respiratory and Critical Care Medicine. 176 (6): 532–55. doi:10.1164/rccm.200703-456SO. PMID 17507545. Retrieved 2012-03-02. Unknown parameter
|month=ignored (help) - ↑ Celli BR, Cote CG, Marin JM; et al. (2004). "The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease". N. Engl. J. Med. 350 (10): 1005–12. doi:10.1056/NEJMoa021322. PMID 14999112. Unknown parameter
|month=ignored (help)