Diagnosis of obstructive airways disease from the clinical examination.
OBJECTIVE
To determine the operating characteristics of history and physical examination items for pulmonary airflow obstruction.


METHODS
Prospective observational study.


METHODS
Medical Preoperative Evaluation Clinic at the Durham Veterans Affairs Medical Center.


METHODS
Consecutive patients referred for outpatient medical preoperative risk assessment.


METHODS
None.


RESULTS
Number of years the patient had smoked cigarettes, patient-reported wheezing [LR+ (likelihood ratio for finding present) = 3.1; LR- (likelihood ratio for finding absent) = 0.58], and auscultated wheezing (LR+ = 12; LR- = 0.87) were independent predictors of obstructive airways disease from the history and physical examination. Forced expiratory time and peak expiratory flow rate, both measured by the clinician at the bedside, were additional independent predictors of airflow obstruction. A nomogram using patient-reported wheezing, number of years the patient had smoked, and auscultated wheezing was developed and validated (area under receiver operating characteristic curve = 0.78; p = 0.0001) for the bedside prediction of obstructive airways disease. Peak expiratory flow rate can be substituted for auscultated wheezing with similar predictive ability.


CONCLUSIONS
The results of bedside clinical examinations predict the presence of obstructive airways disease. A nomogram based on a combination of four bedside findings predicts airflow obstruction as well as clinicians' overall clinical impressions.
Holleman
D R
DR
Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, North Carolina.
Simel
D L
DL
Goldberg
J S
JS
D000368:Aged; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012907:Smoking / Q000009:adverse effects / Q000503:physiopathology