Bronchial airflow limitation and chest findings in adults with respiratory infection.

OBJECTIVE

To study the predictive value of clinical chest findings for bronchial airflow limitation in patients with respiratory tract infection.

DESIGN

Associations were analysed between FEV1 (forced expiratory volume in one second) in % of predicted and physical chest findings.

SETTING

The Municipal Emergency Clinic in Tromsø, Norway.

PARTICIPANTS

398 adult patients with respiratory tract infection and 40 general practitioners.

OUTCOME MEASURES

Mean FEV1% predicted and frequency of FEV1 < 80% predicted according to chest findings. Regression coefficients of the findings with FEV % predicted as outcome variable.

RESULTS

Mean FEV1% predicted was 87 (range 25-129). Pathological chest findings were recorded in 127 patients (32%) and in 22 of the 24 patients (92%) with FEV1% predicted less than 60. The 78 patients with wheezes had a mean FEV1% predicted of 74 (range 29-120), significantly lower than those without wheezes (p < 0.0001), and 63% had FEV1% predicted less than 80. Prolonged expiration or strenuous respiration was recorded in 49 patients. The 29 patients with wheezes in this subgroup had a significantly lower mean FEV1% predicted, 65, than the 20 patients without wheezes (p < 0.005). By multiple regression wheezes and strenuous respiration were the most significant predictors of FEV1% predicted, together with patients' statement of very annoying dyspnoea.

CONCLUSION

When predicting the degree of bronchial obstruction in a patient with respiratory infection, the doctor may take into account wheezes heard by auscultation, an impression of strenuous respiration, and the patient's statement about severe dyspnoea.