Lung Sounds Should Be An Index To Judge The Severity Of Initial Diagnosis COPD

BackgroundChronic obstructive pulmonary disease(COPD)seriously endangers human health because of its high prevalence and related disability and mortality.The China Pulmonary Health(CPH)study showed that the disease burden could be as high as 99.9 million,which has constituted a major disease burden in China.Diagnosis and evaluation of COPD mainly depends on symptoms and spirometry,but spirometry requires professional instruments and strict quality control requirements.Lung sounds are obtained by a trained specialist using a stethoscope to auscultate the lungs.Although proven to be associated with bronchial obstruction,weakened lung sounds and wheezing are not listed that can be used to screen,diagnose and evaluate diseases earlier in GOLD guidelines.At present,there is no report about whether the strength of lung sound and wheezing by stethoscope are related to the phenotype and condition of COPD.This study aimed to explore whether the intensity of lung sounds and wheezing in the patients with newly diagnosed COPD can reflect the severity and phenotype of the disease through a retrospective study,and further explored an indicator use in early diagnosis of COPD.ObjectiveTo explore the value of pulmonary auscultation in judging the severity of chronic obstructive pulmonary disease(COPD)at initial diagnosis.MethodsThe patients with newly diagnosed COPD in our hospital between May,2016 and May,2019 were retrospectively enrolled in this study.Auscultation is mainly performed by a senior physician,according to the findings of pulmonary auscultation,the lung sounds were classified into 5 groups:normal breathing sounds,weakened breathing sounds,weakened breathing sounds with wheezing,obviously weakened breathing sounds,and obviously weakened breathing sounds with wheezing.The pulmonary function of the patients was graded according to GOLD guidelines,and the differential diagnosis of COPD from asthmatic asthma COPD overlap(ACO)was made based on the GOLD guidelines and the European Respiratory Criteria.The ANOVA analysis was used to compare the differences of lung function among different lung sound groups.Spearman correlation analysis was used to compare the relationship between lung sound and disease severity,and multiple linear regression analysis was used to test the influencing factors of disease severity.ResultsA total of 1046 newly diagnosed COPD patients were enrolled,including 949 male and 97 female patients with a mean age of 62.6±8.7.According to the GOLD criteria,88.1%of the patients were identified to have moderate or above COPD,50.0%to have severe or above COPD;a further diagnosis of ACO was made in 347(33.2%)of the patients.ANOVA analysis showed significant differences in disease course,FEV1,FEV1%,FEV1/FVC,FVC,FVC%and mMRC among the 5 auscultation groups(P<0.001),but FENO did not differ significantly among them(P=0.097).The percentage of patients with wheezing in auscultation was significantly greater in ACO group than in COPD group(P<0.001).Spearman correlation analysis showed that lung sounds was significantly correlated with disease severity,FEV1,FEV1%,FVC and FVC%of the patients(P<0.001);Multiple linear regression analysis showed that a longer disease course,a history of smoking and lung sounds were all associated with poorer lung functions and a greater disease severity.ConclusionLung sounds can be used as an indicator for assessing the severity of COPD at the initial diagnosis.