title: Clinical implications of Hoover's sign in chronic obstructive pulmonary disease.
abstract: Background: The objective of the study was to evaluate whether Hoover's sign-the paradoxical inspiratory movement of the lateral rib margin-may have clinical implications in patients with COPD. Methods: The study included two groups of male patients with stable COPD-30 with and 30 without Hoover's sign-who were matched for age and smoking habits. Spirometric values were assessed for both groups. Degree of dyspnea, measured for normal activities with the Medical Research Council (MRC) scale and for climbing two flights of stairs with the Borg scale, and utilization of health resources, including hospitalization, were compared. Results: Patients with Hoover's sign had a higher degree of dyspnea [MRC 2.2 (S.D.: 1.2) and 1.0 (0.8), p<0.0001; Borg 5.6 (2.4) and 3.1 (2.3), p=0.0001] and a higher number of hospitalizations [0.87 (1.0) and 0.27 (0.5), p=0.005] and emergency visits [2.5 (2.3) and 0.9 (2.3), p=0.01] than patient's without it. FEV(1) significantly correlated with dyspnea scales only in patients with Hoover's sign (MRC r=0.48; Borg r=0.49; p<0.05). Conclusions: Our study shows that Hoover's sign in COPD identifies a group of patients with a higher level of dyspnea and a higher use of health care resources, regardless of the degree of functional impairment. Consequently, establishing the presence of Hoover's sign would appear to be valuable in treating patients with COPD.
authors.affiliation: Section of Pneumology, Department of Internal Medicine, Hospital General Universitario, E-03203 Elche, Alicante, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Garcia-Pachon
authors.forename: Isabel
authors.initials: I
authors.lastname: Padilla-Navas