Chronic obstructive pulmonary disease other diagnostic studies: Difference between revisions
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{{Chronic obstructive pulmonary disease}} | {{Chronic obstructive pulmonary disease}} | ||
{{CMG}}; [[Philip Marcus, M.D., M.P.H.]] [mailto:pmarcus192@aol.com]; {{AOEIC}} {{CZ}} | {{CMG}}; [[Philip Marcus, M.D., M.P.H.]] [mailto:pmarcus192@aol.com]; {{AOEIC}} {{CZ}} | ||
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* 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 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 | ===COPD Severity=== | ||
The severity of COPD can be classified as follows using spirometry | The severity of COPD can be classified as follows using spirometry | ||
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[[Category:Intensive care medicine]] | [[Category:Intensive care medicine]] | ||
[[Category:Mature chapter]] | [[Category:Mature chapter]] | ||
[[Category:Primary care]] | |||
Revision as of 20:49, 26 February 2013
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Chronic obstructive pulmonary disease Microchapters |
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Differentiating Chronic obstructive pulmonary disease from other Diseases |
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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. 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.)
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. [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]
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
- ↑ 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) - ↑ PatientPlus - Spirometry
- ↑ [[]]. PMID 22319804. Missing or empty
|title=(help);|access-date=requires|url=(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)
- Pages with citations using unsupported parameters
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