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Airflow Limitat..

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Make the Diagnosis: Airflow Limitation

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Prior Probability

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A systematic review identified 32 sources of information from studies done worldwide on the prevalence of obstructive airways disease.13 Nine of the 32 studies used a spirometric reference standard, similar to what is advocated for clinical practice; 8 of these had data that allowed us to compare the overall prevalence and sex-specific prevalence. The summary overall prevalence was 7.1% (95% CI, 5.2%-9.3%). Men (11%; 95% CI, 8.5%-14%) had about twice the rate as women (6%; 95% CI, 3%-10%) (see Table 13-7).

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Table 13-7Prior Probability of Obstructive Airways Disease Differs by Sex
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Population for Whom Obstructive Airways Disease Should Be Considered

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All adults, especially those who smoke and are aged 45 years or older.

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Detecting the Likelihood of Obstructive Airways Disease

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Table 13-8Likelihood Ratios for Best Single Findings and for Multivariate Models
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Reference Standard Tests

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Spirometry using the pulmonary laboratories definition for the presence of obstructive airways disease.

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Original Article: Does the Clinical Examination Predict Airflow Limitation?

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Clinical Scenarios—Do These Patients Have Airflow Limitation?

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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 2 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.

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Why Is It Important to Detect Airflow Limitation by Clinical Examination?

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