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Four examiners performed standardized physical examinations on patients who had recently had tests of pulmonary function. Four physical signs were studied: intensity of breath sounds during brisk deep inspiration, palpable tensing of scalene muscles during tidal ventilation, expiratory wheeze, and occurrence of a moist, crackling sound in the expiratory air-flow phase of voluntary cough. A numerical rating system was used to express breath sound loudness. Examiners recorded each of the other three signs as present or absent AD four observations were significantly related to abnormality of the FEV 1 . The eleven possible combinations of two or more signs were evaluated for their ability to estimate the FEV 1 . Two procedures for weighting the data were also tested. The best system used all four observations and both weighting procedures. With this combination, separation of normal and abnormal subjects was 77 percent accurate. Patients classified as normal had an FEV 1 less than 80 percent of predicted one-third of the time, but less than 5 percent of this group had less than 45 percent of predicted FEV 1 . Seventy-six percent of patients classified as mildly abnormal on the basis of the clinical signs had airway obstruction; 20 percent of this group was severely compromised. When the physical examination predicted moderate or severe abnormality, the FEV 1 was below normal 96 percent of the time. Two-thirds of such patients had advanced obstructive disease.

Each of four examiners performed standardized physical examinations on a group of patients who had just undergone tests of ventilatory function. The intensity of breath sounds heard with deep inspiration was graded on a rating scale of 0 to 4; the grades in six areas of the chest were added to give a total score, with possible values ranging from 0 to 24. Correlation of breath-sound scores with percentage of predicted forced expiratory volume in one second (FEV1) was significant at the 1 percent level for all of the examiners. Differences between the examiners in their assessment of breath sounds were not statistically significant. Grading the loudness of breath sounds was a poor screening test for mild ventilatory abnormality, but normal breath sounds nearly excluded the possibility of severe reduction in the FEV1. Definitely reduced breath-sound intensity was strong evidence for the presence of obstructive pulmonary disease.