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| 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
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==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 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.


==References==
==References==

Revision as of 19:11, 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

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 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.

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)


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