Fam Pract. 2009 PMID: 19423699I do not find this review helpful. This review cautiously concludes "There is insufficient evidence to assess the value of history taking and physical examination for diagnosing COPD". This contrasts with the careful Rational Clinical Examination Project that provides a bottom line with 5 bulleted points from their interpretation of the literature. Juxtaposing these two studies demonstrates how arbitrary evidence-based medicine can be in its acceptance of evidence (Goodman, PMID: 12204023).
Part of the problem is that the authors deleted two of the studies that I thought were best - Holleman (PMID 8441077) and my own (PMID 8430714).
I believe this review particularly underplays the role of auscultating diminished breath sounds. Diminished breath sounds were the most sensitive finding in our study and in Holleman's study. While breath sounds were not statistically significant in Holleman's study, they were only auscultated in the last third of the study and so they had less observations to generate statistical power. Diminished breath sounds have been significant findings in other studies (van Schayck et al, PMID 1792447; Hepper et al, PMID 5351681; Schneider, PMID 14263096; Bohadana, PMID 684671; Melbye, PMID 9656782; Pardee, PMID 7357938).
I encourage you to read the Rational Clinical Examination for this topic instead.
Citation:
Broekhuizen BD, Sachs AP, Oostvogels R, Hoes AW, Verheij TJ, Moons KG. (2009). The diagnostic value of history and physical examination for COPD in suspected or known cases: a systematic review. Family Practice
