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Diagnosing Obstructive Airways Disease From the Clinical Examination-Reply

Donald R. Holleman Jr, MD
JAMA. 1995;274(3):213-214. doi:10.1001/jama.1995.03530030033016.
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In Reply.  —We agree that all clinicians should strive to eliminate wasted efforts in their clinical examinations. This was the motivation for our critical review of the literature on the clinical diagnosis of airflow limitation.We wish to clarify a section of our article that may have contributed to the misconception that we recommend a skillful and time-wasting examination. In our section on "How to Elicit Symptoms and Signs of Airflow Limitation," we describe a complete pulmonary history and physical examination. We do not advocate that this entire process be performed on all patients. On the contrary, we recommend that clinicians carefully choose history and physical examination items using the data presented in the article and our recommendations in "The Bottom Line." We outline an examination that includes inquiring about cigarette smoking, a history of airflow limitation, and symptoms of wheezing; inspecting for a barrel chest; and auscultating for breath


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