Chronic obstructive pulmonary disease other diagnostic studies
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Philip Marcus, M.D., M.P.H. [2]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [3]
Overview
Six minute walk tests act as a predictor of mortality in patients with moderate COPD (patients who desaturate have worse mortality compared with those who don’t desaturate.)
Other Diagnostic Studies
Pulmonary Function Test / Spirometry
- COPD is particularly characterized if a ratio of forced expiratory volume over 1 second (FEV1) to forced vital capacity (FVC) being < 0.7 and the FEV1 < 70% of the predicted value when compared with a matched control. [1], [2] (see Spirometry).
- Normally, at least 70% of the FVC comes out in the first second (i.e. the FEV1/FVC ratio is >70%). A ratio less than normal defines the patient as having COPD.
- More specifically, the diagnosis of COPD is made when the FEV1/FVC ratio is <70%.
- The GOLD criteria also require that values are after bronchodilator medication has been given to make the diagnosis,
- The NICE criteria also require FEV1%.
- According to the ERS criteria, it is FEV1% predicted that defines when a patient has COPD, that is, when FEV1% predicted is < 88% for men, or < 89% for women.
- Spirometry can help to determine the severity of COPD.[3]
- The FEV1 (measured after bronchodilator medication) is expressed as a percentage of a predicted “normal” value based on a person’s age, gender, height and weight:
- The severity of COPD also depends on the severity of dyspnea and exercise limitation. These and other factors can be combined with spirometry results to obtain a COPD severity score that takes multiple dimensions of the disease into account.[4]
COPD Severity
The severity of COPD can be classified as follows using spirometry
| Severity | FEV1 /FVC | FEV1 % predicted |
|---|---|---|
| At risk | >0.7 | ≥80 |
| Mild COPD | ≤0.7 | ≥80 |
| Moderate COPD | ≤0.7 | 50-80 |
| Severe COPD | ≤0.7 | 30-50 |
| Very Severe COPD | ≤0.7 | <30 or 30-50 with Chronic Respiratory Failure symptoms |
Six Minute Walking Distance
- It act as a good predictor of mortality in patients with COPD.
- Patients who desaturate during 6MWD have higher mortality compared to those who doesn’t desaturate.
- This test is a part of BODE index which is used as a mortality predictor for patients with COPD.
- The BODE index has the following component
- Body mass index
- Obstruction (FEV1)
- Dyspnea (MMRC dyspnea scale)
- 6 minute walking distance.
Right Sided Heart Catheterization
- It is not routinely done. However, in cases when pulmonary hypertension is suspected clinically and on echocardiography then a right heart catheterization can be done to measure pulmonary artery pressure and see the response of vasodilators
References
- ↑ PatientPlus – Spirometry
- ↑ [[]]. PMID 22319804. Missing or empty
|title=(help);|access-date=requires|url=(help) - ↑ Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, Zielinski J (2007). “Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary”. American Journal of Respiratory and Critical Care Medicine. 176 (6): 532–55. doi:10.1164/rccm.200703-456SO. PMID 17507545. Retrieved 2012-03-02. Unknown parameter
|month=ignored (help) - ↑ Celli BR, Cote CG, Marin JM; et al. (2004). “The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease”. N. Engl. J. Med. 350 (10): 1005–12. doi:10.1056/NEJMoa021322. PMID 14999112. Unknown parameter
|month=ignored (help)
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