Chronic obstructive pulmonary disease study of choice: Difference between revisions
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*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>. | *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= | *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=National Clinical Guideline Centre (UK)| title=Chronic Obstructive Pulmonary Disease: Management of Chronic Obstructive Pulmonary Disease in Adults in Primary and Secondary Care | journal=National Institute for Health and Clinical Excellence: Guidance | ||
| year= 2010 | volume= | issue= | pages= | pmid=22319804 | doi= | pmc= | url= }} </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.
Diagnostic 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
- ↑ National Clinical Guideline Centre (UK) (2010). "Chronic Obstructive Pulmonary Disease: Management of Chronic Obstructive Pulmonary Disease in Adults in Primary and Secondary Care". National Institute for Health and Clinical Excellence: Guidance. PMID 22319804.
- ↑ 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)