The diagnostic value of history and physical examination for COPD in suspected or known cases: a systematic review.
BACKGROUND
According to current guidelines, spirometry should be performed in patients suspected of chronic obstructive pulmonary disease (COPD) by the results of history taking and physical examination. However, little is known about the diagnostic value of patient history and physical examination for COPD.


OBJECTIVE
To review the existing evidence on the diagnostic value of history taking and physical examination in recognizing COPD in patients suspected of COPD.


METHODS
A systematic literature search was performed in electronic medical databases. Studies were included after using defined inclusion and exclusion criteria and judged on their methodological quality by using the Quality Assessment of Diagnostic Accuracy Studies criteria. A formal meta-analysis was not performed because all studied items of history and physical examination were investigated in only in a maximum of three studies.


RESULTS
Six studies were included. The history items dyspnoea, wheezing, previous consultation for wheezing or cough, self-reported COPD, age and smoking and the physical examination items wheezing, forced expiratory time, laryngeal height and prolonged expiration were found to have diagnostic value for COPD. These items were studied in maximally three studies and study population studies were heterogenic. The reference test for COPD in five of the six studies concerned obstructive lung disease in general and not COPD.


CONCLUSIONS
There is insufficient evidence to assess the value of history taking and physical examination for diagnosing COPD.
Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. b.d.l.broekhuizen@umcutrecht.nl
Berna D L
BD
Broekhuizen
Alfred P E
AP
Sachs
Rimke
R
Oostvogels
Arno W
AW
Hoes
Theo J M
TJ
Verheij
Karel G M
KG
Moons
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D010808:Physical Examination; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000503:physiopathology; D055815:Young Adult