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==Spirometry==
==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]]).
* 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. More specifically, the diagnosis of COPD is made when the FEV<sub>1</sub>/FVC ratio is <70%. The GOLD criteria also require that values are after [[bronchodilator]] medication has been given to make the diagnosis, and 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.
* 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.
* More specifically, the diagnosis of COPD is made when the FEV<sub>1</sub>/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.<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 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>


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 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 can be classified as follows using spirometry===
 
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 severity of COPD can be classified as follows using spirometry (see above):
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Revision as of 18:33, 27 March 2012

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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

The diagnosis of COPD is confirmed by spirometry,[1] 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.

File:COPD.JPG
A chest X-ray demonstrating severe COPD. Note the small size of the heart in comparison to the lungs.

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. [2], [3] (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.[1]
  • 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]

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

Other tests

On chest x-ray, the classic signs of COPD are overexpanded lung (hyperinflation), a flattened diaphragm, increased retrosternal airspace, and bullae.[5] It can be useful to help exclude other lung diseases, such as pneumonia, pulmonary edema or a pneumothorax.[5] Complete pulmonary function tests with measurements of lung volumes and gas transfer may also show hyperinflation and can discriminate between COPD with emphysema and COPD without emphysema. A high-resolution computed tomography scan of the chest may show the distribution of emphysema throughout the lungs and can also be useful to exclude other lung diseases.

A blood sample taken from an artery, i.e. Arterial Blood Gas (ABG), can be tested for blood gas levels which may show low oxygen (hypoxaemia) and/or high carbon dioxide (respiratory acidosis if pH is also decreased). A blood sample taken from a vein may show a high blood count (reactive polycythemia), a reaction to long-term hypoxemia.

References

  1. ↑ 1.0 1.1 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)
  2. ↑ PatientPlus - Spirometry
  3. ↑ [[]]. PMID 22319804. Missing or empty |title= (help); |access-date= requires |url= (help)
  4. ↑ 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)
  5. ↑ 5.0 5.1 Torres M, Moayedi S (2007). "Evaluation of the acutely dyspneic elderly patient". Clin. Geriatr. Med. 23 (2): 307–25, vi. doi:10.1016/j.cger.2007.01.007. PMID 17462519. Unknown parameter |month= ignored (help)


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