ITEMS IN AFP WITH MESH TERM:
An Approach to Interpreting Spirometry - Article
ABSTRACT: Spirometry is a powerful tool that can be used to detect, follow, and manage patients with lung disorders. Technology advancements have made spirometry much more reliable and relatively simple to incorporate into a routine office visit. However, interpreting spirometry results can be challenging because the quality of the test is largely dependent on patient effort and cooperation, and the interpreter's knowledge of appropriate reference values. A simplified and stepwise method is key to interpreting spirometry. The first step is determining the validity of the test. Next, the determination of an obstructive or restrictive ventilatory patten is made. If a ventilatory pattern is identified, its severity is graded. In some patients, additional tests such as static lung volumes, diffusing capacity of the lung for carbon monoxide, and bronchodilator challenge testing are needed. These tests can further define lung processes but require more sophisticated equipment and expertise available only in a pulmonary function laboratory.
ABSTRACT: Despite increased scientific knowledge about asthma and improved therapeutic options, the disease continues to cause significant morbidity and mortality. The National Asthma Education and Prevention Program Expert Panel has updated its clinical guidelines on asthma medications, prevention of disease progression, and patient self-management. Diagnostic criteria have not changed, and identification of the disease relies on the physician's analysis of the patient's symptoms, family history, and spirometric measurements of lung function. Classification of asthma severity also has not changed, but many obstacles remain, including the variability of asthma and the classification system's inability to account for physical activity levels, which may result in significant underestimation of the severity of asthma. The National Asthma Education and Prevention Program recommends the use of written action plans with or without monitoring of peak expiratory flow, although evidence supporting these management techniques is inconclusive. Patients with asthma may benefit from earlier use of inhaled corticosteroids, which have been proven safe in the usual dosages. However, further studies are needed to determine whether inhaled corticosteroids can prevent the progression of asthma.
ABSTRACT: Chronic obstructive pulmonary disease is characterized by the gradual progression of irreversible airflow obstruction and increased inflammation in the airways and lung parenchyma that is generally distinguishable from the inflammation caused by asthma. Most chronic obstructive pulmonary disease is associated with smoking, but occupational exposure to irritants and air pollution also are important risk factors. Patients with chronic obstructive pulmonary disease typically present with coughing, sputum production, and dyspnea on exertion. However, none of these findings alone is diagnostic. The Global Initiative for Chronic Obstructive Lung Disease diagnostic criterion for chronic obstructive pulmonary disease is a forced expiratory volume in one second/forced vital capacity ratio of less than 70 percent of the predicted value. Severity is further stratified based on forced expiratory volume in one second and symptoms. Chest radiography may rule out alternative diagnoses and comorbid conditions. Selected patients should be tested for alpha1-antitrypsin deficiency. Arterial blood gas testing is recommended for patients presenting with signs of severe disease, right-sided heart failure, or significant hypoxemia. Chronic obstructive pulmonary disease also is a systemic disorder with weight loss and dysfunction of respiratory and skeletal muscles.
ABSTRACT: Chronic obstructive pulmonary disease affects more than 26 million adults in the United States. Family physicians provide care for most of these patients. Cigarette smoking is the leading risk factor for chronic obstructive pulmonary disease, although other risk factors, including occupational and environmental exposures, account for up to one in six cases. Patients presenting with chronic cough, increased sputum production, or progressive dyspnea should be evaluated for the disease. Asthma is the disease most often confused with chronic obstructive pulmonary disease. The diagnosis of chronic obstructive pulmonary disease is based on clinical suspicion and spirometry confirmation. A forced expiratory volume in one second/forced vital capacity ratio that is less than 70 percent, and that is incompletely reversible with the administration of an inhaled bronchodilator, suggests chronic obstructive pulmonary disease. Disease severity is classified by symptomatology and spirometry. Joint guidelines from the American Thoracic Society and the European Respiratory Society recommend a single quantitative test for alpha1-antitrypsin deficiency in patients diagnosed with chronic obstructive pulmonary disease who remain symptomatic despite bronchodilator therapy. Other advanced testing is usually not necessary.
NAEPP Updates Guidelines for the Diagnosis and Management of Asthma - Practice Guidelines
Screening for Chronic Obstructive Pulmonary Disease Using Spriometry - Putting Prevention into Practice
Screening for Chronic Obstructive Pulmonary Disease Using Spirometry: Recommendation Statement - U.S. Preventive Services Task Force
Diagnostic Evaluation of Dyspnea - Article
ABSTRACT: Dyspnea is a common symptom and, in most cases, can be effectively managed in the office by the family physician. The differential diagnosis is composed of four general categories: cardiac, pulmonary, mixed cardiac or pulmonary, and noncardiac or nonpulmonary. Most cases of dyspnea are due to cardiac or pulmonary disease, which is readily identified with a careful history and physical examination. Chest radiographs, electrocardiograph and screening spirometry are easily performed diagnostic tests that can provide valuable information. In selected cases where the test results are inconclusive or require clarification, complete pulmonary function testing, arterial blood gas measurement, echocardiography and standard exercise treadmill testing or complete cardiopulmonary exercise testing may be useful. A consultation with a pulmonologist or cardiologist may be helpful to guide the selection and interpretation of second-line testing.