To the Editors:
The paper by Aliverti et al. 1, which appeared in a recent issue of the European Respiratory Journal, suggests that the presence of paradoxical movement of the lower ribcage at rest in chronic obstructive pulmonary disease (COPD) patients is associated with early onset hyperinflation of the chest wall and predominant dyspnoea at end exercise. Aliverti et al. 1 stated that this paradoxical movement has not been related to other forms of respiratory behaviour or symptoms.
However, this is not exact since my group has evaluated the frequency and clinical characteristics of the paradoxical movement of the lower ribcage (classically, Hoover's sign) in patients with COPD. Hoover's sign is easy to recognise and has a good interobserver agreement 2; it is a frequent finding in patients with moderate to severe COPD (36% of moderate to 76% of very severe patients) 3. In my group’s own studies, we found that the presence of the paradoxical movement of the lower ribcage was independently associated with a higher degree of dyspnoea (both at rest and after exercise) and higher use of health resources, including hospitalisations 4. For this reason, we proposed the inclusion of this sign among the data useful for predicting outcomes in COPD 5.
The paper by Aliverti et al. 1 adds interesting information and reinforces the usefulness of including this frequently forgotten sign in the physical examination of COPD patients.
Statement of interest
None declared.
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