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Are further tests going to be useful to help guide diagnosis?

Looking at what further tests can help guide a diagnosis.

Let’s now have a look at some of the further tests that could guide the diagnosis.

Physical examination

  • Listening to breathing – Lung auscultation
  • Respiratory rate
  • Is there evidence of clubbing? – clubbing is characterised by changes to fingers and toes, such as bulbous enlargement of the finger tips or toes; changes in the angle between the skin and nails; or excessive sponginess of the nail base. Clubbing can develop quickly and can be indicative of various disease processes.

If coughing:

  • Chronic cough – The Chronic Cough in Adults: Make the Diagnosis and Make a Difference paper is suggested for the diagnosis of a chronic cough
  • Peak expiratory flow (if asthma is suspected, or COPD if spirometry is unavailable).
  • Blood test for pneumonia
  • Imaging scans including chest X-ray (to detect a number of conditions such as lung cancer, TB, interstitial lung disease) or more detailed tests such as high resolution CT scans.
  • Spirometry if available
  • Test for pertussis (whooping cough)
  • Test for TB – using acid-fast bacillus (AFB) stain or a tuberculosis (TB) smear. This is a test to determine if a person has TB or another type of mycobacterial infection.
  • COVID – depends on availability

If breathless:

When selecting tests, choose the investigations that might give the most information about the diagnosis with the least risk to the person.

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Chronic Respiratory Diseases (CRD) in Primary Care Settings

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