Journal of General Internal Medicine

, Volume 17, Issue 9, pp 684–688

Accuracy of history, wheezing, and forced expiratory time in the diagnosis of chronic obstructive pulmonary disease

  • Sharon E. Straus
  • Finlay A. McAlister
  • David L. Sackett
  • Jonathan J. Deeks
  • the CARE-COAD2 Group
Original Articles

DOI: 10.1046/j.1525-1497.2002.20102.x

Cite this article as:
Straus, S.E., McAlister, F.A., Sackett, D.L. et al. J GEN INTERN MED (2002) 17: 684. doi:10.1046/j.1525-1497.2002.20102.x


OBJECTIVE: To determine the accuracy of the history and selected elements of the physical examination in the diagnosis of chronic obstructive pulmonary disease (COPD).

DESIGN: Independent blind comparison of the standard clinical examination (evaluating the accuracy of history, wheezing, and forced expiratory time [FET]) with spirometry. The gold standard for diagnosis of COPD was a forced expiratory volume at 1 second (FEV1) below the fifth percentile (adjusted for patient height and age).

SETTING: Seven sites in 6 countries, including investigators from primary care and secondary care settings.

PARTICIPANTS: One hundred sixty-one consecutive patients with varying severity of disease (known COPD, suspected COPD, or no COPD) participated in the study.

MAIN RESULTS: One hundred sixty-one patients (mean age 65 years, 39% female, 41% with known COPD, 27% with suspected COPD, and 32% normal) were recruited. Mean (±SD) FEV1 and forced vital capacity were 1,720 (±830) mL and 2,520 (±970) mL. The likelihood ratios (LR) for the tested elements of the clinical examination (and their P values on x2 testing) were: self-reported history of COPD, 5.6 (P<.001); FET greater than 9 seconds, 6.7 (P<0.01); smoked longer than 40 pack years, 3.3 (P=.001); wheezing, 4.0 (P<.001); male gender, 1.6 (P<.001); and age over 65 years, 1.6 (P=.025). The accuracy of these elements was not appreciably different when reference standards other than FEV1 below the 5th percentile were applied. Only 3 elements of the clinical examination were significantly associated with the diagnosis of COPD on multivariate analysis: self-reported history of COPD (adjusted LR 4.4), wheezing (adjusted LR 2.9), and FET greater than 9 seconds (adjusted LR 4.6). Area under the receiver operating characteristic curve for the model incorporating these 3 factors was 0.86.

CONCLUSIONS: Less emphasis should be placed on the presence of isolated symptoms or signs in the diagnosis of COPD. While numerous elements of the clinical examination are associated with the diagnosis of COPD, only 3 are significant on multivariate analysis. Patients having all 3 of these findings have an LR of 59 (ruling in COPD); those with none have an LR of 0.3 (ruling out COPD).

Key words

chronic obstructive pulmonary disease clinical examination spirometry diagnosis 

Copyright information

© Society of General Internal Medicine 2002

Authors and Affiliations

  • Sharon E. Straus
    • 1
  • Finlay A. McAlister
    • 2
  • David L. Sackett
    • 3
  • Jonathan J. Deeks
    • 4
  • the CARE-COAD2 Group
  1. 1.Received from The Division of General Internal MedicineUniversity Health Network-Mount Sinai Hospital, University of TorontoTorontoCanada
  2. 2.The Division of General Internal MedicineUniversity of AlbertaEdmontonCanada
  3. 3.The Trout Research and Education Centre at Irish LakeInstitute of Health SciencesOxfordUnited Kingdom
  4. 4.The ICRF/NHS Centre for Statistics in MedicineInstitute of Health SciencesOxfordUnited Kingdom
  5. 5.Department of MedicineToronto General HospitalTorontoCanada

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