What is the most common laboratory test used for COPD?

1. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2163–2196. [PMC free article] [PubMed] [Google Scholar]

2. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2095–2128. [PubMed] [Google Scholar]

3. Ciba Foundation Guest Symposium Terminology, definitions, and classification of chronic pulmonary emphysema and related conditions a report of the conclusions of a Ciba guest symposium. Thorax. 1959;14:286–299. [Google Scholar]

4. Mannino DM. Chronic obstructive pulmonary disease: definition and epidemiology. Respir Care. 2003;48:1185–1193. [PubMed] [Google Scholar]

5. Tashkin DP. Variations in FEV1 decline over time in chronic obstructive pulmonary disease and its implications. Curr Opin Pulm Med. 2013;19:116–124. [PubMed] [Google Scholar]

6. Calverley PMA, Anderson JA, Celli B, et al. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med. 2007;356:775–789. [PubMed] [Google Scholar]

7. Hurst JR, Vestbo J, Anzueto A, et al. Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med. 2010;363:1128–1138. [PubMed] [Google Scholar]

8. Soriano JB, Zielinski J, Price D. Screening for and early detection of chronic obstructive pulmonary disease. Lancet. 2009;374:721–732. [PubMed] [Google Scholar]

9. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for diagnosis, management, and prevention of COPD. Updated 2014. www.goldcopd.org/uploads/users/files/GOLD_Report_2014_Jan23.pdf. 2010. (last accessed on 7 August 2014)

10. National Clinical Guideline Centre. Chronic obstructive pulmonary disease: management of chronic obstructive pulmonary disease in adults in primary and secondary care. www.nice.org.uk/guidance/cg101/resources/guidance-chronic-obstructive-pulmonary-disease-pdf. (last accessed on 7 August 2014) [PMC free article] [PubMed]

11. Qaseem A, Wilt TJ, Weinberger SE, et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Ann Intern Med. 2011;155:179–191. [PubMed] [Google Scholar]

12. Vogelmeier C, Buhl R, Criee CP, et al. Leitlinie der Deutschen Atemwegsliga und der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin zur Diagnostik und Therapie von Patienten mit chronisch obstruktiver Bronchitis und Lungenemphysem (COPD) Pneumologie. 2007;61:e1–#e40. [PubMed] [Google Scholar]

13. Hyatt RE, Scanlon PD, Nakamura M. a practical guide. 3rd edition. Philadelphia: Wolters Kluwer; 2008. Interpretation of pulmonary function tests. [Google Scholar]

14. Gibson GJ. 3rd edition. London: Hodder Arnold; 2009. Clinical tests of respiratory function. [Google Scholar]

15. Buist AS, McBurnie MA, Vollmer WM, et al. International variation in the prevalence of COPD (the BOLD study): a population-based prevalence study. Lancet. 2007;370:741–750. [PubMed] [Google Scholar]

16. Leung JM, Sin DD. COPD in never smokers: prognosis unveiled. Lancet Respir Med. 2013;1:502–504. [PubMed] [Google Scholar]

17. Lamprecht B, McBurnie MA, Vollmer WM, et al. COPD in never smokers: results from the population-based burden of obstructive lung disease study. Chest. 2011;139:752–763. [PMC free article] [PubMed] [Google Scholar]

18. Thomsen M, Nordestgaard BG, Vestbo J, Lange P. Characteristics and outcomes of chronic obstructive pulmonary disease in never smokers in Denmark: a prospective population study. Lancet Respir Med. 2013;1:543–550. [PubMed] [Google Scholar]

19. Salvi SS, Barnes PJ. Chronic obstructive pulmonary disease in non-smokers. Lancet. 2009;374:733–743. [PubMed] [Google Scholar]

20. Hogg JC, Chu F, Utokaparch S, et al. The nature of small-airway obstruction in chronic obstructive pulmonary disease. N Engl J Med. 2004;350:2645–2653. [PubMed] [Google Scholar]

21. Kessler R, Partridge MR, Miravitlles M, et al. Symptom variability in patients with severe COPD: a pan-European cross-sectional study. Eur Respir J. 2011;37:264–272. [PubMed] [Google Scholar]

22. Van Remoortel H, Hornikx M, Demeyer H, et al. Daily physical activity in subjects with newly diagnosed COPD. Thorax. 2013;68:962–963. [PMC free article] [PubMed] [Google Scholar]

23. Holleman D, Simel D. Does the clinical examination predict airflow limitation? JAMA. 1995;273:313–319. [PubMed] [Google Scholar]

24. Littmann® 3M. www.youtube.com/watch?v=O8OC7EiqBKQ&feature=kp. Physiological & pathological breath sounds. (last accessed on 7 August 2014) [Google Scholar]

25. Bohadana A, Izbicki G, Kraman SS. Fundamentals of lung auscultation. N Engl J Med. 2014;370:744–751. [PubMed] [Google Scholar]

26. Marciniuk D, Hernandez P, Balter M, et al. Alpha-1-antitrypsin deficiency targeted testing and augmentation therapy: A Canadian Thoracic Society clinical practice guideline. Can Respir J. 2012;19:109–116. [PMC free article] [PubMed] [Google Scholar]

27. Criée C-P, Berdel D, Heise D, et al. Empfehlungen der Deutschen Atemwegsliga zur Spirometrie. www.atemwegsliga.de/empfehlungen-positionspapiere.html. 2006 (last accessed on 7 August 2014) [PubMed] [Google Scholar]

28. Global Initiative for Chronic Obstructive Lung Disease (GOLD) Spirometry for health care providers. www.goldcopd.org/uploads/users/files/GOLD_Spirometry_2010.pdf. 2010. (last accessed on 7 August 2014)

29. Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests. Eur Respir J. 2005;26:948–968. [PubMed] [Google Scholar]

30. Swanney MP, Ruppel G, Enright PL, et al. Using the lower limit of normal for the FEV1/FVC ratio reduces the misclassification of airway obstruction. Thorax. 2008;63:1046–1051. [PubMed] [Google Scholar]

31. Cerveri I, Corsico AG, Accordini S, et al. Underestimation of airflow obstruction among young adults using FEV1/FVC <70% as a fixed cut-off: a longitudinal evaluation of clinical and functional outcomes. Thorax. 2008;63:1040–1045. [PubMed] [Google Scholar]

32. Quanjer PH, Stanojevic S, Cole TJ, et al. Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations. Eur Respir J. 2012;40:1324–1343. [PMC free article] [PubMed] [Google Scholar]

33. Bourbeau J, Tan WC, Benedetti A, et al. Canadian Cohort Obstructive Lung Disease (CanCOLD): Fulfilling the need for longitudinal observational studies in COPD COPD. J Chron Obstruct Pulmon Dis. 2014;11:125–132. [PubMed] [Google Scholar]

34. Thomas M, Decramer M, O’Donnell D. No room to breathe: the importance of lung hyperinflation in COPD. Prim Care Respir J. 2013;22:101–111. [PMC free article] [PubMed] [Google Scholar]

35. Celli BR, Cote CG, Marin JM, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004;350:1005–1012. [PubMed] [Google Scholar]

36. Agusti AA, Hurd S, Jones P, et al. FAQs about the GOLD 2011 assessment proposal of COPD: a comparative analysis of four different cohorts. Eur Respir J. 2013;42:1391–1401. [PubMed] [Google Scholar]

37. Miller MR, Hankinson J, Brusasco V, et al. Standardisation of spirometry. Eur Respir J. 2005;26:319–338. [PubMed] [Google Scholar]

38. Peters SP. When the chief complaint is (or should be) dyspnea in adults. J Allergy Clin Immunol Pract. 2013;1:129–136. [PubMed] [Google Scholar]

39. Wielpütz MO, Heußel CP, Herth FJF, Kauczor H-U. Radiological diagnosis in lung disease: factoring treatment options into the choice of diagnostic modality. Dtsch Arztebl International. 2014;111:181–187. [PMC free article] [PubMed] [Google Scholar]

40. Kroegel C, Costabel U. Stuttgart: Thieme; 2014. Klinische Pneumologie: das Referenzwerk für Klinik und Praxis. [Google Scholar]

e1. Gesundheitsberichterstattung des Bundes. Todesursachenstatistik, Statistik der Gestorbenen, Todesursache, Sterbefälle. www.gbe-bund.de/glossar/Todesursachenstatistik.html. 2014. (last accessed on 7 August 2014)

e2. Casanova C, Aguirre-Jaíme A, Torres JP de, et al. Longitudinal assessment in COPD patients: multidimensional variability and outcomes. Eur Respir J. 2014;43:745–753. [PubMed] [Google Scholar]

e3. Advisory Council for the Concerted Action in Health Care. Appropriateness and efficiency. Volume III: Overuse, underuse and misuse. www.svr-gesundheit.de/fileadmin/user_upload/Gutachten/2000-2001/Kurzf-engl01.pdf. 2001. (last accessed on 7 August 2014)

e4. Abholz H, Gillissen A, Magnussen H, et al. Nationale Versorgungsleitlinie COPD Langfassung Version 19, basierend auf der Fassung vom Februar 2006. www.versorgungsleitlinien.de/themen/copd/pdf/nvl-copd-lang-1.9.pdf. 2012 (last accessed on 7 August 2014) [Google Scholar]

e5. Geldmacher H, Biller H, Herbst A, et al. Die Prävalenz der chronisch obstruktiven Lungenerkrankung (COPD) in Deutschland. Ergebnisse der BOLD-Studie. Dtsch Med Wochenschr. 2008;133:2609–2614. [PubMed] [Google Scholar]

e6. Gingter C, Wilm S, Abholz H-H. Is COPD a rare disease? Prevalence and identification rates in smokers aged 40 years and over within general practice in Germany. Fam Pract. 2009;26:3–9. [PubMed] [Google Scholar]

e7. Gläser S, Schäper C, Obst A, et al. Impact of different definitions of airflow limitation on the prevalence of chronic obstructive pulmonary disease in the general population. Respiration. 2010;80:292–300. [PubMed] [Google Scholar]

e8. Lampert T, Lippe E von der, Müters S. Verbreitung des Rauchens in der Erwachsenenbevölkerung in Deutschland. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. 2013;5:802–808. [PubMed] [Google Scholar]

e9. Løkke A, Lange P, Scharling H, Fabricius P, Vestbo J. Developing COPD: a 25 year follow up study of the general population. Thorax. 2006;61:935–939. [PMC free article] [PubMed] [Google Scholar]

e10. Behrendt CE. Mild and moderate-to-severe COPD in nonsmokers: distinct demographic profiles. Chest. 2005;128:1239–1244. [PubMed] [Google Scholar]

e11. Schikowski T, Mills IC, Anderson HR, et al. Ambient air pollution: a cause of COPD? Eur Respir J. 2014;43:250–263. [PubMed] [Google Scholar]

e12. Mapel DW, Dalal AA, Blanchette CM, Petersen H, Ferguson GT. Severity of COPD at initial spirometry-confirmed diagnosis: data from medical charts and administrative claims. Int J Chron Obstruct Pulmon Dis. 2011;6:573–581. [PMC free article] [PubMed] [Google Scholar]

e13. Oshaug K, Halvorsen PA, Melbye H. Should chest examination be reinstated in the early diagnosis of chronic obstructive pulmonary disease? Int J Chron Obstruct Pulmon Dis. 2013;8:369–377. [PMC free article] [PubMed] [Google Scholar]

e14. Simel D, DL Simel D, Rennie SA, Keitz . The rational clinical examination: evidence-based clinical diagnosis. New York: McGraw-Hill; 2008. Update: chronic obstructive airways disease; pp. 159–162. [Google Scholar]

e15. Fabricius P, Løkke A, Marott JL, Vestbo J, Lange P. Prevalence of COPD in Copenhagen. Respir Med. 2011;105:410–417. [PubMed] [Google Scholar]

e16. Lam DCL, Hui CKM, Ip MSM. Issues in pulmonary function testing for the screening and diagnosis of chronic obstructive pulmonary disease. Curr Opin Pulm Med. 2012;18:104–111. [PubMed] [Google Scholar]

e17. Irizar-Aramburu M, Martinez-Eizaguirre J, Pacheco-Bravo P, et al. Effectiveness of spirometry as a motivational tool for smoking cessation: a clinical trial, the ESPIMOAT study. BMC Family Practice. 2013;14 [PMC free article] [PubMed] [Google Scholar]

e18. Murphy DE, Panos RJ. Diagnosis of COPD and clinical course in patients with unrecognized airflow limitation. Int J Chron Obstruct Pulmon Dis. 2013;8:199–208. [PMC free article] [PubMed] [Google Scholar]

e19. Herpel LB, Kanner RE, Lee SM, et al. Variability of spirometry in chronic obstructive pulmonary disease. Results from two clinical trials. Am J Respir Crit Care Med. 2006;173:1106–1113. [PMC free article] [PubMed] [Google Scholar]

e20. Miller MR. Getting the diagnosis of chronic obstructive pulmonary disease correct. Am J Respir Crit Care Med. 2014;189:228–229. [PubMed] [Google Scholar]

e21. Stanojevic S, Quanjer P, Miller MR, Stocks J. The Global Lung Function Initiative: dispelling some myths of lung function test interpretation. Breathe. 2013;9:462–474. [Google Scholar]

e22. Loring SH, Garcia-Jacques M, Malhotra A. Pulmonary characteristics in COPD and mechanisms of increased work of breathing. J Appl Physiol. 2009;107:309–314. [PMC free article] [PubMed] [Google Scholar]

e23. Price DB, Yawn BP, Jones RCM. Improving the differential diagnosis of chronic obstructive pulmonary disease in primary care. Mayo Clin Proc. 2010;85:1122–1129. [PMC free article] [PubMed] [Google Scholar]

e24. Miravitlles M, Andreu I, Romero Y, Sitjar S, Altés A, Anton E. Difficulties in differential diagnosis of COPD and asthma in primary care. Br J Gen Pract. 2012;62:e68–e75. [PMC free article] [PubMed] [Google Scholar]

e25. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. www.ginasthma.org/documents/4. 2014. (last accessed on 7 August 2014) [Google Scholar]

e26. Tuder RM, Petrache I. Pathogenesis of chronic obstructive pulmonary disease. J Clin Invest. 2012;122:2749–2755. [PMC free article] [PubMed] [Google Scholar]

e27. Köhler D, Schönhofer B, Voshaar T. Stuttgart: Thieme; 2010. Pneumologie: Ein Leitfaden für rationales Handeln in Klinik und Praxis. [Google Scholar]

e28. European Respiratory Society. European lung white book. www.erswhitebook.org/ 2013. (last accessed on 7 August 2014)

e29. Coates A, Graham B, McFadden R, et al. Spirometry in primary care. Can Respir J. 2013;20:13–21. [PMC free article] [PubMed] [Google Scholar]

e30. Townsend MC, Hankinson JL, Lindesmith LA, Slivka WA, Stiver G, Ayres GT. Is my lung function really that good? Flow-type spirometer problems that elevate test results. Chest. 2004;125:1902–1909. [PubMed] [Google Scholar]

e31. Enright PL. Should we keep pushing for a spirometer in every doctor’s office? Respir Care. 2012;57:146–153. [PubMed] [Google Scholar]

e32. Quanjer PH, Pretto JJ, Brazzale DJ, Boros PW. Grading the severity of airways obstruction: new wine in new bottles. Eur Respir J. 2014;43:505–512. [PubMed] [Google Scholar]

e33. Quanjer PH, Weiner DJ, Pretto JJ, Brazzale DJ, Boros PW. Measurement of FEF25-75% and FEF75% does not contribute to clinical decision making. Eur Respir J. 2014;43:1051–1058. [PubMed] [Google Scholar]


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The severity of airway obstruction in COPD

GOLDCondition: testing after bronchodilation and FEV1/FVC < 0.7
1mildFEV1 ≥ 80% predicted
2moderate50% ≤ FEV1 <80% predicted
3severe30% ≤ FEV1 <50% predicted
4very severeFEV1 <30% predicted (until 2011. also fev1 <50% and chronic hypoxemia with pao2 < 60 mm hg)
ATS/ERSCondition: Tiffeneau Index below 5th percentile for normalized distribution (LLN)
1mildFEV1 ≥ 70% predicted
2moderateFEV1 60–69% predicted
3moderate to severeFEV1 50–59% predicted
4severeFEV1 35–49% predicted
5very severeFEV1 < 35% predicted