title: Accuracy of clinical examination findings in the diagnosis of COPD.
abstract: 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.
authors: Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil. waldomattos@uol.com.br
authors: Waldo Luís Leite Dias de
authors: WL
authors: Mattos
authors: Leonardo Gilberto Haas
authors: LG
authors: Signori
authors: Fernando Kessler
authors: FK
authors: Borges
authors: Jorge Augusto
authors: JA
authors: Bergamin
authors: Vivian
authors: V
authors: Machado
mesh_terms: 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