COPD, CHF

Today(Jul 6) we discussed a 69M with a history of COPD and CHF, coming in with SOBOE that was ultimately felt to be secondary to his CHF. We discussed several different issues, including the clinical examination for COPD & ascites, analysis of thoracentesis, and the differential diagnosis for someone presenting with shortness of breath.

With respect to a few specific issues:

1. Here's a summary of a recent Cochrane review on LABA/steroid vs tiotropium. Essentially, it's a mixed bag, with significant flaws in study design indicating that further study is needed.

2. Here's a link to a recent systematic review on PE in COPDE, that sites the Annals of Internal Medicine article from 2006 that I mentioned today in morning report (Ann Intern Med. 2006 Mar 21;144(6):390-6). Overall, the prevalence of PE was 19.9% but almost 25% in patients who ultimately required admission. Presentations were very similar between patients who did and did not have PE. Thus, it is important for us to calculate probability of PE in our patients when they present with COPDE.

3. The JAMA "Does the clinical examination predict airflow limitation" is from 1995 and I am unable to pull it up. However, there is a succinct ppt presentation online that summarizes it well:

I should also correct myself - the barrel chest was more sensitive than I had realized.