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Christopher R. Brigham
,
Stephen L. Demeter
, and
E. Ranolph Soo Hoo

, resulting in significant morbidity and mortality. It is the leading risk factor for several respiratory diseases, including chronic obstructive pulmonary disease (COPD) and lung cancer. 2 COPD encompasses emphysema and chronic bronchitis, characterized by persistent respiratory symptoms and airflow limitation owing to airway and/or alveolar abnormalities. The primary cause of COPD is exposure to tobacco smoke (either active smoking or second-hand smoke), contributing to 85% to 90% of all cases. 3 In these conditions, tobacco smoke leads to chronic inflammation of the

in AMA Guides® Newsletter
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Stephen L. Demeter

example, if a person with CAD has symptoms justifying inclusion in NYHA class IV but also has severe shortness of breath caused by chronic obstructive pulmonary disease (COPD), it would be duplicative to use this historical parameter to modify both the CAD and COPD ratings. The impairment with the higher rating should be modified and this parameter ignored in rating the lesser impairment. Because of methodological changes, ratings using the Sixth Edition are less susceptible to double-dipping than those from earlier editions, especially musculoskeletal ratings

in AMA Guides® Newsletter
Stephen L. Demeter

PFTs are “static” tests of lung function. They provide significant information regarding a person's ability to breathe. PFTs are used to make clinical diagnoses such as chronic obstructive pulmonary disease (COPD), and asthma, and can stratify the severity of those disease processes. However, they are necessarily incomplete. They do not measure the ability of the lungs (or heart) to provide adequate oxygenation to metabolizing tissues during activity, such as during exercise. It is very possible for a person to have normal or near normal lung function when measured

in AMA Guides® Newsletter
Marcos Iglesias

as physical or mental health conditions that last 1 year or more and limit activities or require ongoing medical treatment. 2 They include illnesses, such as obesity, cardiovascular disease (coronary artery disease, congestive heart failure, hypertension, peripheral arterial disease), diabetes, respiratory disease (chronic obstructive pulmonary disease [COPD], obstructive sleep apnea), dementia, substance abuse, and mental illness. Chronic diseases are common, deadly, disabling, costly, and frequently preventable. Almost 60% of the adult population of the United

in AMA Guides® Newsletter
Stephen L. Demeter
and
E. Randolph Soo Hoo

using the Sixth Edition, irrespective of the rating for the first injury and irrespective of the edition that was used. Subtract the rating of the first injury, rated using the same edition as the rating for the second injury, from the rating for the second injury. This gives the apportionment of the rating for the first and second injuries. The last example involves the case presented at the beginning of this article. There are 2 factors that contribute to the examinee's pulmonary impairment: HP and chronic obstructive pulmonary disease (COPD). When approaching

in AMA Guides® Newsletter
James B. Talmage
,
Mark H. Hyman
,
Christopher R. Brigham
,
Sarah H. Gulick
, and
Leslie Burton

direct referral to a pulmonary rehabilitation program. Depending on the degree of desaturation, it may be necessary to prescribe oxygen. Permanent pulmonary disease has been documented in COVID-19 patients. 21 Many medical offices perform simple spirometry testing. However, as opposed to impairment evaluation for asthma or chronic obstructive pulmonary disease (COPD), impairment evaluation for post-COVID-19 patients generally requires the performance of the DLco or DCO. A full pulmonary function test, with and without bronchodilators, is recommended. Obtaining a

in AMA Guides® Newsletter