Anthonisen triad as a marker of chronic obstructive pulmonary disease exacerbation: correlation between clinical and endoscopic findings

The study aims at evaluating the accuracy of the Anthonisen triad as a criterion for severity of chronic obstructive pulmonary disease during exacerbation. Clinical and endoscopic comparisons were made in 1969 patients (100%) with chronic obstructive pulmonary disease of III-IV degree of severity according to GOLD (2019), group D, severe exacerbation. Shortness of breath was observed in all 1969 patients (100%); and 8 patients with increasing dyspnea as the sole symptom were not enrolled in the study since they had other causes of dyspnea. 75,87% of patients demonstrated reduced amount of produced sputum, and in 26.6% of patients the sputum was non-purulent. However, bronchoscopy revealed increased amount of bronchial secretions containing purulent material in all patients. Adherence to formal criteria of the Anthonisen triad for clinical diagnosis of exacerbation of severe chronic obstructive pulmonary disease may contribute to the occurrence of diagnostic errors.