Chronic obstructive pulmonary disease study of choice: Difference between revisions
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==Overview== | ==Overview== | ||
The diagnosis of COPD is confirmed by [[spirometry]], a test that measures the forced expiratory volume in one second (FEV<sub>1</sub>), which is the greatest volume of air that can be breathed out in the first second of a large breath. Spirometry also measures the forced vital capacity (FVC), which is the greatest volume of air that can be breathed out in a whole large breath. 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. Six minute walk tests act as an predictor of mortality in patients with moderate COPD (patients who desaturate have worse mortality compared with those who don't desaturate.) | |||
==Diagnostic Study of Choice== | ==Diagnostic Study of Choice== | ||
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===Pulmonary Function Test / Spirometry=== | ===Pulmonary Function Test / Spirometry=== | ||
*Many patients labeled as having airway obstruction do not have obstruction when tested<ref name="pmid30711480">{{cite journal| author=Sator L, Horner A, Studnicka M, Lamprecht B, Kaiser B, McBurnie MA et al.| title=Overdiagnosis of COPD in Subjects With Unobstructed Spirometry: A BOLD Analysis. | journal=Chest | year= 2019 | volume= 156 | issue= 2 | pages= 277-288 | pmid=30711480 | doi=10.1016/j.chest.2019.01.015 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30711480 }} </ref>. | |||
*COPD is particularly characterized if a ratio of forced expiratory volume over 1 second ([https://www.wikidoc.org/index.php/FEV1 FEV<sub>1</sub>]) to [https://www.wikidoc.org/index.php/Forced_vital_capacity forced vital capacity] (FVC) being < 0.7 and the [https://www.wikidoc.org/index.php/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]]). | *COPD is particularly characterized if a ratio of forced expiratory volume over 1 second ([https://www.wikidoc.org/index.php/FEV1 FEV<sub>1</sub>]) to [https://www.wikidoc.org/index.php/Forced_vital_capacity forced vital capacity] (FVC) being < 0.7 and the [https://www.wikidoc.org/index.php/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]]).<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> | ||
*Normally, at least 70% of the FVC comes out in the first second (i.e. the [https://www.wikidoc.org/index.php/FEV1/FVC FEV<sub>1</sub>/FVC ratio] is >70%). A ratio less than normal defines the patient as having COPD. | *Normally, at least 70% of the FVC comes out in the first second (i.e. the [https://www.wikidoc.org/index.php/FEV1/FVC FEV<sub>1</sub>/FVC ratio] is >70%). A ratio less than normal defines the patient as having COPD. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
The diagnosis of COPD is confirmed by spirometry, a test that measures the forced expiratory volume in one second (FEV1), which is the greatest volume of air that can be breathed out in the first second of a large breath. Spirometry also measures the forced vital capacity (FVC), which is the greatest volume of air that can be breathed out in a whole large breath. 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. Six minute walk tests act as an predictor of mortality in patients with moderate COPD (patients who desaturate have worse mortality compared with those who don't desaturate.)
Diagnostic Study of Choice
Study of choice
Pulmonary Function Test / Spirometry
- Many patients labeled as having airway obstruction do not have obstruction when tested[1].
- 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. [2], [3] (see Spirometry).[4]
- 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.[4]
- 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.[5]
References
- ↑ Sator L, Horner A, Studnicka M, Lamprecht B, Kaiser B, McBurnie MA; et al. (2019). "Overdiagnosis of COPD in Subjects With Unobstructed Spirometry: A BOLD Analysis". Chest. 156 (2): 277–288. doi:10.1016/j.chest.2019.01.015. PMID 30711480.
- ↑ PatientPlus - Spirometry
- ↑ [[]]. PMID 22319804. Missing or empty
|title=(help);|access-date=requires|url=(help) - ↑ 4.0 4.1 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)