Chronic obstructive pulmonary disease diagnosis

Adapted from GOLD Science Committee. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Updated 2005. Available at www.goldcopd.com. Used with permission. 

DIAGNOSIS OF ACUTE RESPIRATORY FAILURE IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE ... 

American Thoracic Society (1995). Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 152, S77-S120. 

Buist S for the Executive Committee, Global Initiative for Chronic Obstructive Lung Disease Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease Medical Communications Resources, Inc. 2007. http //www.goldcopd.com... 

A 68-year-old man with chronic obstructive pulmonary disease underwent CT examination of the abdomen with intravenous infusion of iomeprol for suspected hepatocellular carcinoma and 2 hours later developed severe dyspnea. A chest X-ray showed bilateral diffuse shadowing of the lungs and the heart shadow was not enlarged. A diagnosis of non-cardiogenic pulmonary edema was made and he improved with glucocorticoids. 

The development of a bedside assay for plasma BNP has focused considerable attention on the use of BNP as an aid in the diagnosis of suspected heart failure. Plasma BNP concentration is positively correlated with the degree of left ventricular dysfunction and heart failure, and this assay is now used frequently in acute care settings to assist in the differential diagnosis of dyspnea [heart failure versus asthma, chronic obstructive pulmonary disease (COPD), or infection]. Recent studies found that an elevated BNP concentration is an independent predictor of heart failure as the cause of dyspnea and that in patients with decompensated heart failure, an elevated pre-hospital discharge BNP concentration is associated with an increased risk of death or readmission. Additional research is ongoing to better characterize the role of BNP measurement in the diagnosis and treatment of heart failure. 

Schapira RM, Reinke LF. The outpatient diagnosis and management of chronic obstructive pulmonary disease Pharmacotherapy, administration of supplemental oxygen, and smoking cessation techniques. J Gen Intern Med 1995 10 40-55. 

Patients with lung cancer frequently have numerous concurrent medical problems. Such problems may be related to invasion of the primary tumor and its metastases, paraneoplastic syndromes (see clinical presentation, above), chemotherapy and radiotherapy toxicity, or concomitant disease states (e.g., cardiac disease, renal dysfunction, chronic obstructive pulmonary disease, asthma, or diabetes). Depression is also common and sometimes persistent in patients with SCLC and NSCLC and should be treated. Identification, diagnosis, and treatment of the patient as a whole may improve the patient s overall quality of life and tolerance to cancer treatments. 

Occupationally related airway diseases, including asthma and chronic obstructive pulmonary disease (COPD), have emerged as having substantial public he th importance. Nearly 30% of COPD and adult asthma may be attributable to occupational exposure. Occupational asthma is now the most frequent occupational respiratory disease diagnosis. More than 20 million U.S. workers are exposed to substances that can cause airway diseases. 

Clinical Management of Chronic Obstructive Pulmonary Disease, edited by T. Similowski, W. A. Whitelaw, and J.-P. Derenne Sleep Apnea Pathogenesis, Diagnosis, and Treatment, edited by A. I. Pack... 

Heussel CP, Hafner B, Lill J, Schreiber W, Thelen M, Kauczor HU (2001) Paired inspiratory/expiratory spiral CT and continuous respiration cine CT in the diagnosis of tracheal instability. Eur Radiol 11 982-989 Hogg JC (2006) State of the art. Bronchiolitis in chronic obstructive pulmonary disease. Proc Am Thorac Soc 3 489 93... 

Pryor JA, Webber BA, Hodson BA, et al. Evaluation of the forced expiration technique as an adjunet to postural drainage in treatment of cystic fibrosis. BMJ 1979 2(6187) 417-418. American ThOTacic Society. Standards for the Diagnosis and Care of Patients with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 1995 152(5 pt 2) S77-S121. Clarke SW, Pavia D. Lung mucus jnoduction and mucociliary clearance methods of assessment. Br J Clin Pharmacol 1980 9(6) 537-546. 

Because of the bronchial muscle relaxant effect, caffeine is used in chronic obstructive pulmonary disease and for the treatment of asthma. The use of caffeine in the treatment of children with minimal brain dysfunction, to increase the duration of electroconvulsive therapy-induced seizure, for allergic rhinitis, as well as for atopic dermatitis has also been described. Recently, caffeine has been used as a diagnostic test for malignant hyperthermia and in the diagnosis of neuroleptic malignant syndrome, a complication of neuroleptic therapy. 

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