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Office assessment of pulmonary function

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Abstract

Much can be done in the physician’s office to assess pulmonary function from history, physical examination, and spirometry. We will focus attention on spirometry, office spirometry being only an extension of the history and physical examination. Experiences and results obtained with a new device available for office spirometry will be reported.

History

The history relating to the pulmonary system must be thorough, detailed, and specific. The complaints of the patient should be listed in the patient’s own words, for example, “I have no wind,” with an estimation of the duration, progress, and aggravating factors. The symptom of shortness of breath is most important. It is necessary to relate it to activity and exercise tolerance with an attempt at grading the severity of dyspnea.1 The patient should be observed while he or she is dressing, walking, or moving about in the examination facility to provide a useful estimate of severity of the dyspnea. Other pulmonary symptoms such as coughing, sputum production, and wheezing are indicative of the presence of disease and probably impairment of pulmonary function, but they do not of themselves characterize the type of impairment or its severity. Only with spirometry can this be accomplished.

Physical examination

Abnormal physical findings frequently indicate advanced pulmonary impairment, as manifested by cyanosis, clubbed digits, peripheral edema, and plethora. On examination of the chest, attention should be focused on the character and rate of breathing, the use of accessory muscles of breathing, pursed lip breathing, coughing, audible wheezing, and the configuration of the . . .


 

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