III. Diagnosis: Obstructive Lung Disease

  1. Criteria
    1. FEV1 to FVC Ratio <0.7 (or <LLN or for children<85% of predicted) AND
    2. Normal FVC or FVC response to Bronchodilator
  2. Approach
    1. Assess Severity
      1. See FEV1 interpretation above
    2. Assess Bronchodilator response
      1. Bronchodilator response with FEV1 or FVC increased >12% at any age (or >200 ml in adults)
        1. Consistent with reversible Obstructive Lung Disease (Asthma)
      2. Inadequate Bronchodilator response
        1. Consistent with irreversible Obstructive Lung Disease (COPD)

IV. Diagnosis: Asthma

  1. Spirometry
    1. Lung function tests may be normal without exacerbation (Intermittent Asthma, Exercise induced Asthma)
    2. FEV1 and FEV1/FVC ratio reduced
    3. FEV1 improves >12% or 200 ml after Bronchodilator
    4. Partially reversible airflow obstruction
    5. Peak Expiratory Flow >20% variation over 2 weeks
  2. Risk Factors
    1. Prematurity
    2. Tobacco Exposure
    3. Obesity
    4. Atopy (Asthma with Allergic Rhinitis and Eczema)
    5. Asthma Family History
  3. Symptoms
    1. Shortness of Breath
    2. Chest tightness
    3. Wheezing
    4. Variable cough

V. Diagnosis: Chronic Obstructive Pulmonary Disease (COPD)

  1. Spirometry
    1. Post-Bronchodilator FEV1 to FVC Ratio: 0.7
    2. Minimal reversibility with Bronchodilator (contrast with Asthma)
    3. DLCO diminished in Emphysema
    4. Increased Total Lung Capacity
    5. Increased Residual Volume
    6. Peak Flow <350 L/min
  2. Risk Factors
    1. Tobacco Abuse
    2. Alpha-1-Antitrypsin Deficiency
    3. Air pollutants (outdoor, indoor or Occupational Asthma)
  3. Symptoms
    1. Dyspnea
    2. Chronic Cough
    3. Recurrent lower respiratory tract infections

VI. Diagnosis: Asthma-COPD Overlap

  1. Background
    1. Not considered a distinct condition, but rather a patient with features shared between the 2 diagnoses
    2. Primarily managed as Asthma, with additional therapies considered from the COPD arsenal
    3. Those with persistent Asthma are much higher risk for developing COPD with aging (RR 12.5)
      1. Approximately 25% of COPD patients have a history of comorbid Asthma
      2. Silva (2004) Chest 126(1): 59-65 [PubMed]
      3. de Marco (2013) PloS One 8(5): e62985 [PubMed]
  2. Spirometry
    1. FEV1 and FEV1/FVC ratio persistently reduced despite Bronchodilator (as seen in COPD)
    2. FEV1 improves >12% or 200 ml after Bronchodilator (as seen in Asthma)

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Related Studies

Ontology: Lung function significantly obstructed (C0429674)

Concepts Finding (T033)
SnomedCT 142194008, 165021009
English Lung funct signific obstructed, Lung function significantly obstructed (situation), Lung function significantly obstructed, Lung function significantly obstructed (finding)
Spanish función pulmonar significativamente obstruida (hallazgo), función pulmonar significativamente obstruida

Ontology: Lung Diseases, Obstructive (C0600260)

Definition (MSH) Any disorder marked by obstruction of conducting airways of the lung. AIRWAY OBSTRUCTION may be acute, chronic, intermittent, or persistent.
Definition (MSHCZE) Jakákoli porucha vzniklá obstrukcí vzdušných plicních cest. Obstrukce dýchacích cest (DÝCHACÍ CESTY – OBSTRUKCE) může být akutní, chronická, přerušovaná nebo přetrvávající.
Concepts Disease or Syndrome (T047)
MSH D008173
English Lung Disease, Obstructive, Lung Diseases, Obstructive, Obstructive Lung Disease, LUNG DIS OBSTRUCTIVE, obstructive airway disease, respiratory airway obstruction, obstructive lung disease (generalized), Obstructive Pulmonary Diseases, Obstructive Pulmonary Disease, Pulmonary Disease, Obstructive, Pulmonary Diseases, Obstructive, Obstructive Lung Diseases, Obstructive airways disorder NOS, Obstruction lung disease, Disease obstructive lung, Lung disease obstructive, Lung Diseases, Obstructive [Disease/Finding], airway obstructive disease, obstructive airways disorder, airways disease obstructive, disease lung obstruction, obstruction lung disease, airway disorder obstructive, disease lung obstructive, diseases lung obstruction, obstructive lung disease, obstructive lung diseases, Obstructive airway disease, Lungs--Diseases, Obstructive, Obstructive airways disorder
Italian Patologia ostruttiva delle vie aeree, Patologia ostruttiva delle vie aeree NAS, Malattia ostruttiva polmonare, Malattia polmonare ostruttiva, Pneumopatia ostruttiva, Malattie ostruttive polmonari, Malattie ostruttive del polmone
Dutch obstructieve longziekte, obstructieve luchtwegaandoening NAO, longziekte obstructief, obstructieve luchtwegaandoening, Longziekte, obstructieve, Longziekten, obstructieve, Obstructieve longziekte, Obstructieve longziekten, Ziekte, obstructieve long-, Ziekten, long-, obstructieve
French Syndrome pulmonaire obstructif, Syndrome d'obstruction pulmonaire chronique, Trouble obstructif des voies aériennes SAI, Syndrome obstructif chronique des poumons, Trouble obstructif des voies aériennes, Bronchopneumopathies obstructives
German obstruktive Lungenerkrankung, obstruktive Atemwegserkrankung NNB, Erkrankung, obstruktiv, der Lunge, Lungenerkrankung obstruktiv, obstruktive Atemwegserkrankung, Lungenkrankheiten, obstruktive
Portuguese Doença pulmonar obstrutiva, Doença respiratória obstrutiva NE, Obstrução por doença pulmonar, Doença respiratória obstrutiva, Pneumopatias Obstrutivas
Spanish Trastorno obstructivo de las vías respiratorias NEOM, Enfermedad pulmonar obstructiva, Enfermedad obstructiva del pulmón, Enfermedades Pulmonares Obstructivas, Neumopatías Obstructivas, Trastorno obstructivo de las vías respiratorias
Japanese 閉塞性気道障害, ヘイソクセイキドウショウガイ, ヘイソクセイキドウショウガイNOS, ヘイソクセイハイシッカン, 閉塞性気道障害NOS, 肺疾患-閉塞性, 閉塞性肺疾患
Swedish Lungsjukdomar, obstruktiva
Czech bronchopulmonální obstrukční nemoci, Obstrukční onemocnění dýchacích cest, Obstrukční onemocnění plic, Plicní obstrukční onemocnění, Obstrukční porucha dýchacích cest NOS, Obstrukční plicní onemocnění, obstrukční plicní nemoci, plíce - nemoci obstrukční
Finnish Obstruktiiviset keuhkosairaudet
Russian LEGKIKH BOLEZNI OBSTRUKTIVNYE, KHRONICHESKIE NESPETSIFICHESKIE BOLEZNI LEGKIKH, KHNLZ, ЛЕГКИХ БОЛЕЗНИ ОБСТРУКТИВНЫЕ, ХНЛЗ, ХРОНИЧЕСКИЕ НЕСПЕЦИФИЧЕСКИЕ БОЛЕЗНИ ЛЕГКИХ
Croatian PLUĆNE BOLESTI, OPSTRUKTIVNE
Polish Choroby płuc obturacyjne
Hungarian Obstructív tüdőbetegség, Obstructiv tüdőbetegség, Obstructiv légúti betegség, Obstructív tüdő megbetegedés, Obstructiv légúti betegség k.m.n.
Norwegian Obstruktive lungesykdommer, Lungesykdommer, obstruktive, Obstruktive pulmonale sykdommer