Accuracy of clinical examination findings in the diagnosis of COPD.
OBJECTIVE
Simple diagnostic methods can facilitate the diagnosis of COPD, which is a major public health problem. The objective of this study was to investigate the accuracy of clinical variables in the diagnosis of COPD.


METHODS
Patients with COPD and control subjects were prospectively evaluated by two investigators regarding nine clinical variables. The likelihood ratio for the diagnosis of COPD was determined using a logistic regression model.


RESULTS
The study comprised 98 patients with COPD (mean age, 62.3+/- 12.3 years; mean FEV1, 48.3 +/- 21.6%) and 102 controls. The likelihood ratios (95% CIs) for the diagnosis of COPD were as follows: 4.75 (2.29-9.82; p < 0.0001) for accessory muscle recruitment; 5.05 (2.72-9.39; p < 0.0001) for pursed-lip breathing; 2.58 (1.45-4.57; p < 0.001) for barrel chest; 3.65 (2.01-6.62; p < 0.0001) for decreased chest expansion; 7.17 (3.75-13.73; p < 0.0001) for reduced breath sounds; 2.17 (1.01-4.67; p < 0.05) for a thoracic index > or = 0.9; 2.36 (1.22-4.58; p < 0.05) for laryngeal height < or = 5.5 cm; 3.44 (1.92-6.16; p < 0.0001) for forced expiratory time > or = 4 s; and 4.78 (2.13-10.70; p < 0.0001) for lower liver edge > or = 4 cm from lower costal edge. Inter-rater reliability for those same variables was, respectively, 0.57, 0.45, 0.62, 0.32, 0.53, 0.32, 0.59, 0.52 and 0.44 (p < 0.0001 for all).


CONCLUSIONS
Various clinical examination findings could be used as diagnostic tests for COPD.
Mattos
Waldo Luís Leite Dias de
WL
Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil. waldomattos@uol.com.br
Signori
Leonardo Gilberto Haas
LG
Borges
Fernando Kessler
FK
Bergamin
Jorge Augusto
JA
Machado
Vivian
V
D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008046:Lip / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010808:Physical Examination / Q000145:classification; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis*; D015656:Respiratory Mechanics / Q000502:physiology; D012132:Respiratory Muscles / Q000502:physiology