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January 25, 1995, Vol 273, No. 4 >
ARTICLE | January 25, 1995

Does the Clinical Examination Predict Airflow Limitation? FREE

Donald R. Holleman, Jr, MD; David L. Simel, MD, MHS
[+] Author Affiliations

Reprint requests to Medical Service (111K), Lexington VAMC, 2250 Leestown Rd, Lexington, KY 40511 (Dr Holleman).

The Rational Clinical Examination section editors: David L. Simel, MD, MHS, Durham Veterans Affairs Medical Center and Duke University Medical Center, Durham, NC; Drummond Rennie, MD, Deputy Editor (West), JAMA.


JAMA. 1995;273(4):313-319. doi:10.1001/jama.1995.03520280059041
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References

CLINICAL SCENARIOS—DO THESE PATIENTS HAVE AIRFLOW LIMITATION?  In each of the following cases, the clinician needs to decide whether the patient has airflow limitation: In case 1, a 63-year-old man who has smoked two packs of cigarettes per day for the past 47 years presents with decreased exercise tolerance caused by shortness of breath. In case 2, a 35-year-old woman complains of coughing, wheezing, and shortness of breath every autumn. In case 3, an 18-year-old man is brought to an emergency department with extreme difficulty breathing that began earlier that evening.

WHY IS IT IMPORTANT TO DETECT AIRFLOW LIMITATION BY CLINICAL EXAMINATION?  Airflow limitation is a disorder known by many names, including airway obstruction and obstructive airways disease. Recognizing airflow limitation can lead to appropriate treatment and can yield important prognostic information. Patients with symptomatic airflow limitation may benefit by treatment with oral or inhaled bronchodilators, oral or inhaled glucocorticoids,

REFERENCES

1 +
Fisher M, ed. Guide to Clinical Preventive Services . Baltimore, Md: Williams & Wilkins; 1989;.
2 +
American Thoracic Society.  Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma. Am Rev Respir Dis . 1987;;136:225-243.
3 +
American Thoracic Society.  Lung function testing: selection of reference values and interpretative strategies. Am Rev Respir Dis . 1991;;144: 1202-1218.
4 +
Stubbing DG, Mathur PN, Roberts RS, Campbell EJM.  Some physical signs in patients with chronic airflow obstruction. Am Rev Respir Dis . 1982;;125:549-552.
5 +
Lal S, Ferguson AD, Campbell EJM.  Forced expiratory time: a simple test for airways obstruction. BMJ . 1964;;1:814-817.
6 +
Scheinhorn DJ.  Screening test for airflow limitation. South Med J . 1982;;75:434-438.
7 +
Catlett GF, Kidera GJ.  Detection of respiratory impairment in pilots. Aerospace Med . 1969;;40;1252-1257.
8 +
Govindaraj M.  Pulsus paradoxus in respiratory disease. Indian J Chest Dis . 1970;;12:110-115.
9 +
Workum P, Holford SK, Delbono EA, Murphy RLH.  The prevalence and character of crackles (rales) in young women without significant lung disease. Am Rev Respir Dis . 1982;;126:927-923.
10 +
Bohadana AB, Peslin R, Uffholtz H.  Breath sounds in the clinical assessment of airflow obstruction. Thorax . 1978;;33:345-351.
11 +
Kern DG, Patel SR.  Auscultated forced expiratory time as a clinical and epidemiologic test of airway obstruction. Chest . 1991;;100:636-639.
12 +
Macdonald JB, Cole TJ, Seaton A.  Forced expiratory time: its reliability as a lung function test. Thorax . 1975;;30:554-559.
13 +
Van Schayck CP, van Weel C, Harbers HJM, van Herwaarden CLA.  Do physical signs reflect the degree of airflow obstruction in patients with asthma or chronic obstructive pulmonary disease? Scand J Prim Health Care . 1991;;9:232-238.
14 +
Holleman DR, Simel DL, Goldberg JS.  Diagnosis of obstructive airways disease from the clinical examination. J Gen Intern Med . 1993;;8:63-68.
15 +
Suprenant EL, Vance JW.  Evaluation of methods for the early detection of chronic obstructive ventilatory diseases. Dis Chest . 1967;;52:760-766.
16 +
Marini JJ, Pierson DJ, Hudson LD, Lakshminarayan S.  The significance of wheezing in chronic airflow obstruction. Am Rev Respir Dis . 1979;;120: 1069-1072.
17 +
Badgett RG, Tanaka DJ, Hunt DK, et al.  Can moderate chronic obstructive pulmonary disease be diagnosed by historical and physical findings alone? Am J Med . 1993;;94:188-196.
18 +
Schapira RM, Schapira MM, Funahashi A, McAuliffe TL, Varkey B.  The value of the forced expiratory time in the physical diagnosis of obstructive airways disease. JAMA . 1993;;270:731-736.
19 +
Teklu B, Pierson DJ, Fair K, Schoene RB.  The match test revisited: blowing out a candle as a screening test for airflow obstruction. JFam Pract . 1990;;31:557-562.
20 +
Foxman B, Lohr KN, Brook RH, Goldberg GA, Rosenthal M, Sloss E. Conceptualization and Measurement of Physiologic Health for Adults: Chronic Obstructive Airway Disease . Santa Monica, Calif: RAND; 1982;. Publication R-2262/8-1-HHS.
21 +
King DK, Thompson BT, Johnson DC.  Wheezing on maximal forced exhalation in the diagnosis of atypical asthma: lack of sensitivity and specificity. Ann Intern Med . 1989;;110:451-455.
22 +
Mannino DM, Etzel RA, Flanders WD.  Do the medical history and physical examination predict low lung function? Arch Intern Med . 1993;;153:1892-1897.
23 +
Rebuck AS, Tomarken JL.  Pulsus paradoxus in asthmatic children. Can Med Assoc J . 1985;;112: 710-711.
24 +
Bilgi C, Jones RL, Sproule BJ.  Relation between pulsus paradoxus and pulmonary function in patients with chronic airways obstruction. Can Med Assoc J . 1977;;117:1389-1392.
25 +
Marks A, Bocles J.  The match test and its significance. South Med J . 1960;;53:1211-1216.
26 +
Snider TH, Stevens JP, Wilner FM, Lewis BM.  Simple bedside test of respiratory function. JAMA . 1959;;170:1631-1632.
27 +
Pardee NE, Martin CJ, Morgan EH.  A test of the practical value of estimating breath sound intensity. Chest . 1976;;70:341-344.
28 +
Pardee NE, Winterbauer RH, Morgan EH, Allen JD, Olson DE.  Combinations of four physical signs as indicators of ventilatory abnormality in obstructive pulmonary syndromes. Chest . 1980;;77: 354-358.
29 +
Nairn JR, Turner-Warwick M.  Breath sounds in emphysema. Br J Dis Chest . 1969;;63:29-37.
30 +
Thacker RE, Kraman SS.  The prevalence of auscultatory crackles in subjects without lung disease. Chest . 1982;;81:672-674.
31 +
Lefcoe NM, Wonnacott TH.  The prevalence of chronic respiratory disease in the male physicians of London, Ontario. Can Med Assoc J . 1970;;102: 381-385.
32 +
McNicol KN, Williams HE, Gillam GL.  Chest deformity, residual airways obstruction and hyper-inflation, and growth in children with asthma. Arch Dis Child . 1970;;45:783-798.
33 +
Fletcher CM.  The clinical diagnosis of pulmonary emphysema: an experimental study. Proc R Soc Med . 1952;;45:577-584.
34 +
Hepper NG, Hyatt RE, Fowler WS.  Detection of chronic obstructive lung disease. Arch Environ Health . 1969;;19:806-813.
35 +
Schilling RSF, Hughs JPW, Dingwall-Fordyce I.  Disagreement between observers in an epidemiological study of respiratory disease. BMJ . 1955;; 1:65-68.
36 +
Williams TJ, Ahmad D, Morgan WKC.  A clinical and roentgenographic correlation of diaphragmatic movement. Arch Intern Med . 1981;;141:878-880.
37 +
Bohadana AB, Mohankumar T.  Symptoms and signs in the assessment of chronic airflow obstruction. Indian J Chest Dis Allied Sci . 1982;;24:133-142.
38 +
Mulrow CD, Dolmatch BL, Delong ER, et al.  Observer variability in the pulmonary examination. J Gen Intern Med . 1986;;1:364-367.
39 +
Kilburn KH, Asmundsson T.  Anteroposterior chest diameter in emphysema: from maxim to measurement. Arch Intern Med . 1969;;123:379-382.
40 +
Forgacs P.  The functional basis of pulmonary sounds. Chest . 1978;;73:399-405.
41 +
Dodge R, Cline MG, Burrows B.  Comparisons of asthma, emphysema and chronic bronchitis diagnoses in a general population sample. Am Rev Respir Dis . 1986;;133:981-986.
42 +
Sherrill DL, Lebowitz MD, Knudson RJ, Burrows B.  Smoking and symptom effects on the curves of lung function growth and decline. Am Rev Respir Dis . 1991;;144:17-22.
43 +
Simel DL, Samsa GP, Matchar DB.  Likelihood ratios with confidence: sample size estimation for diagnostic test studies. J Clin Epidemiol . 1991;;44: 763-770.
44 +
Wilkins RL, Dexter JR, Murphy RL, DelBono EA.  Lung sound nomenclature survey. Chest . 1990;; 98:886-889.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Fisher M, ed. Guide to Clinical Preventive Services . Baltimore, Md: Williams & Wilkins; 1989;.
2 +
American Thoracic Society.  Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma. Am Rev Respir Dis . 1987;;136:225-243.
3 +
American Thoracic Society.  Lung function testing: selection of reference values and interpretative strategies. Am Rev Respir Dis . 1991;;144: 1202-1218.
4 +
Stubbing DG, Mathur PN, Roberts RS, Campbell EJM.  Some physical signs in patients with chronic airflow obstruction. Am Rev Respir Dis . 1982;;125:549-552.
5 +
Lal S, Ferguson AD, Campbell EJM.  Forced expiratory time: a simple test for airways obstruction. BMJ . 1964;;1:814-817.
6 +
Scheinhorn DJ.  Screening test for airflow limitation. South Med J . 1982;;75:434-438.
7 +
Catlett GF, Kidera GJ.  Detection of respiratory impairment in pilots. Aerospace Med . 1969;;40;1252-1257.
8 +
Govindaraj M.  Pulsus paradoxus in respiratory disease. Indian J Chest Dis . 1970;;12:110-115.
9 +
Workum P, Holford SK, Delbono EA, Murphy RLH.  The prevalence and character of crackles (rales) in young women without significant lung disease. Am Rev Respir Dis . 1982;;126:927-923.
10 +
Bohadana AB, Peslin R, Uffholtz H.  Breath sounds in the clinical assessment of airflow obstruction. Thorax . 1978;;33:345-351.
11 +
Kern DG, Patel SR.  Auscultated forced expiratory time as a clinical and epidemiologic test of airway obstruction. Chest . 1991;;100:636-639.
12 +
Macdonald JB, Cole TJ, Seaton A.  Forced expiratory time: its reliability as a lung function test. Thorax . 1975;;30:554-559.
13 +
Van Schayck CP, van Weel C, Harbers HJM, van Herwaarden CLA.  Do physical signs reflect the degree of airflow obstruction in patients with asthma or chronic obstructive pulmonary disease? Scand J Prim Health Care . 1991;;9:232-238.
14 +
Holleman DR, Simel DL, Goldberg JS.  Diagnosis of obstructive airways disease from the clinical examination. J Gen Intern Med . 1993;;8:63-68.
15 +
Suprenant EL, Vance JW.  Evaluation of methods for the early detection of chronic obstructive ventilatory diseases. Dis Chest . 1967;;52:760-766.
16 +
Marini JJ, Pierson DJ, Hudson LD, Lakshminarayan S.  The significance of wheezing in chronic airflow obstruction. Am Rev Respir Dis . 1979;;120: 1069-1072.
17 +
Badgett RG, Tanaka DJ, Hunt DK, et al.  Can moderate chronic obstructive pulmonary disease be diagnosed by historical and physical findings alone? Am J Med . 1993;;94:188-196.
18 +
Schapira RM, Schapira MM, Funahashi A, McAuliffe TL, Varkey B.  The value of the forced expiratory time in the physical diagnosis of obstructive airways disease. JAMA . 1993;;270:731-736.
19 +
Teklu B, Pierson DJ, Fair K, Schoene RB.  The match test revisited: blowing out a candle as a screening test for airflow obstruction. JFam Pract . 1990;;31:557-562.
20 +
Foxman B, Lohr KN, Brook RH, Goldberg GA, Rosenthal M, Sloss E. Conceptualization and Measurement of Physiologic Health for Adults: Chronic Obstructive Airway Disease . Santa Monica, Calif: RAND; 1982;. Publication R-2262/8-1-HHS.
21 +
King DK, Thompson BT, Johnson DC.  Wheezing on maximal forced exhalation in the diagnosis of atypical asthma: lack of sensitivity and specificity. Ann Intern Med . 1989;;110:451-455.
22 +
Mannino DM, Etzel RA, Flanders WD.  Do the medical history and physical examination predict low lung function? Arch Intern Med . 1993;;153:1892-1897.
23 +
Rebuck AS, Tomarken JL.  Pulsus paradoxus in asthmatic children. Can Med Assoc J . 1985;;112: 710-711.
24 +
Bilgi C, Jones RL, Sproule BJ.  Relation between pulsus paradoxus and pulmonary function in patients with chronic airways obstruction. Can Med Assoc J . 1977;;117:1389-1392.
25 +
Marks A, Bocles J.  The match test and its significance. South Med J . 1960;;53:1211-1216.
26 +
Snider TH, Stevens JP, Wilner FM, Lewis BM.  Simple bedside test of respiratory function. JAMA . 1959;;170:1631-1632.
27 +
Pardee NE, Martin CJ, Morgan EH.  A test of the practical value of estimating breath sound intensity. Chest . 1976;;70:341-344.
28 +
Pardee NE, Winterbauer RH, Morgan EH, Allen JD, Olson DE.  Combinations of four physical signs as indicators of ventilatory abnormality in obstructive pulmonary syndromes. Chest . 1980;;77: 354-358.
29 +
Nairn JR, Turner-Warwick M.  Breath sounds in emphysema. Br J Dis Chest . 1969;;63:29-37.
30 +
Thacker RE, Kraman SS.  The prevalence of auscultatory crackles in subjects without lung disease. Chest . 1982;;81:672-674.
31 +
Lefcoe NM, Wonnacott TH.  The prevalence of chronic respiratory disease in the male physicians of London, Ontario. Can Med Assoc J . 1970;;102: 381-385.
32 +
McNicol KN, Williams HE, Gillam GL.  Chest deformity, residual airways obstruction and hyper-inflation, and growth in children with asthma. Arch Dis Child . 1970;;45:783-798.
33 +
Fletcher CM.  The clinical diagnosis of pulmonary emphysema: an experimental study. Proc R Soc Med . 1952;;45:577-584.
34 +
Hepper NG, Hyatt RE, Fowler WS.  Detection of chronic obstructive lung disease. Arch Environ Health . 1969;;19:806-813.
35 +
Schilling RSF, Hughs JPW, Dingwall-Fordyce I.  Disagreement between observers in an epidemiological study of respiratory disease. BMJ . 1955;; 1:65-68.
36 +
Williams TJ, Ahmad D, Morgan WKC.  A clinical and roentgenographic correlation of diaphragmatic movement. Arch Intern Med . 1981;;141:878-880.
37 +
Bohadana AB, Mohankumar T.  Symptoms and signs in the assessment of chronic airflow obstruction. Indian J Chest Dis Allied Sci . 1982;;24:133-142.
38 +
Mulrow CD, Dolmatch BL, Delong ER, et al.  Observer variability in the pulmonary examination. J Gen Intern Med . 1986;;1:364-367.
39 +
Kilburn KH, Asmundsson T.  Anteroposterior chest diameter in emphysema: from maxim to measurement. Arch Intern Med . 1969;;123:379-382.
40 +
Forgacs P.  The functional basis of pulmonary sounds. Chest . 1978;;73:399-405.
41 +
Dodge R, Cline MG, Burrows B.  Comparisons of asthma, emphysema and chronic bronchitis diagnoses in a general population sample. Am Rev Respir Dis . 1986;;133:981-986.
42 +
Sherrill DL, Lebowitz MD, Knudson RJ, Burrows B.  Smoking and symptom effects on the curves of lung function growth and decline. Am Rev Respir Dis . 1991;;144:17-22.
43 +
Simel DL, Samsa GP, Matchar DB.  Likelihood ratios with confidence: sample size estimation for diagnostic test studies. J Clin Epidemiol . 1991;;44: 763-770.
44 +
Wilkins RL, Dexter JR, Murphy RL, DelBono EA.  Lung sound nomenclature survey. Chest . 1990;; 98:886-889.

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