Asthma versus chronic obstructive pulmonary disease — exploring why ‘reversibility versus irreversibility’ is no longer an appropriate approach

L, Dow

doi:10.1046/j.1365-2222.1999.00589.x

Cited by 16 publications

(10 citation statements)

References 31 publications

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“…Records were excluded for individuals aged less than 40 years because COPD is rare below this age. As it is difficult to separate asthma from COPD in some cases, data for a primary diagnosis of asthma (ICD‐9 code 493) were also extracted for the same age range and over the same period to examine potential diagnostic transfer between asthma and COPD 13 …”

Section: Methodsmentioning

confidence: 99%

“…As it is difficult to separate asthma from COPD in some cases, data for a primary diagnosis of asthma (ICD-9 code 493) were also extracted for the same age range and over the same period to examine potential diagnostic transfer between asthma and COPD. 13 The data were deidentified to maintain individual confidentiality, although each patient was represented by a unique identifier supplied by the Data Linkage Unit to allow linkage with death data and the analysis of patientrelated outcomes. Mortality data include all deaths registered in Western Australia.…”

Section: Methodsmentioning

confidence: 99%

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Readmission and survival following hospitalization for chronic obstructive pulmonary disease: long‐term trends

Geelhoed

Brameld

Holman

et al. 2007

Internal Medicine Journal

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Readmission and survival following hospitalization for chronic obstructive pulmonary disease: long‐term trends

Geelhoed

Brameld

Holman

et al. 2007

Internal Medicine Journal

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“…Further confounding factors are the speed of inspiration preceding the test (40), the variability of the bronchodilator response over time, and differences in how the response is calculated and expressed. The variability in bronchodilator response over time (33,41) suggests that reversibility testing should not be a one‐off measure but rather should be regularly recorded to give a real indication of degree of reversibility and effect of drugs (42). However, conducting multiple tests is impracticable and unlikely to be undertaken in the primary care setting.…”

Section: Clinical Implications and Discussionmentioning

confidence: 99%

FEV1 reversibility does not adequately predict effect of formoterol via Aerolizer® in chronic obstructive pulmonary disease

Muir

Benhamou

Cuvelier

et al. 2004

International Journal of Clinical Practice

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Evaluation of patients with chronic obstructive pulmonary disease (COPD) often includes the use of post-bronchodilator reversibility testing to guide treatment decisions. Recommendations for reversibility testing differ and there is no universally accepted method or outcome criterion. A survey of recent clinical trials with beta2-agonists in COPD illustrates the diversity of methods used to assess reversibility and highlights the difficulty of comparing data from such trials. Two recent studies demonstrated the benefits of treatment with the long-acting beta2-agonist bronchodilator formoterol (Foradil Aerolizer) in patients with COPD. When patients were classified according to their degree of reversibility as partially or poorly reversible, improvements were observed in both groups irrespective of the definition applied. These results suggest that bronchodilator reversibility testing should not be used as a rigid basis for treatment decisions with beta2-agonists in COPD patients. There is a pressing need for the role of reversibility testing to be clearly defined.

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“…The degree of reversibility following bronchodilator administration has played a pivotal role in the evaluation of obstructive lung disease, thereby infl uencing drug choice and patterns of care (Dow 1999). In addition to the clinical importance, bronchodilator testing can have regulatory importance as European regulators now require that COPD patients included in clinical trials meet the ERS defi nition of irreversible disease .…”

Section: Introductionmentioning

confidence: 99%

Diagnostic value of post-bronchodilator pulmonary function testing to distinguish between stable, moderate to severe COPD and asthma

Irusen¹

2008

COPD

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Objective: The GOLD guidelines suggest that the presence of a post-bronchodilator forced expiratory volume in one second (FEV 1 ) Ͻ 80% of the predicted value in combination with a FEV 1 /forced vital capacity (FVC) Ͻ 70% confi rms the diagnosis of COPD. Limited data exist regarding the accuracy of these criteria to distinguish between COPD and asthma. The aim of this study therefore was to investigate the diagnostic value of post-bronchodilator lung function parameters in obstructive lung disease. Methods:The pulmonary function tests of 43 (22 = COPD, 21 = asthma) patients with similar baseline characteristics were evaluated (baseline FEV 1 were 55.7% + 7.6%, and 59.3% + 8.4% predicted for COPD and asthma, respectively). Bronchodilator responsiveness (BDR) was calculated according to three recognized pulmonary function test criteria. Results: The first criteria, post-bronchodilator FEV 1 Ͻ 80% of the predicted value in combination with a post-bronchodilator FEV 1 /FVC ratio of Ͻ70%, had an accuracy of 70% to diagnose COPD. This combination was very sensitive (100%) in diagnosing COPD, but it was not specifi c (38%). The second BDR criteria, defi ned as an increase of Ͻ12% and 200 mL of initial FEV 1 and criterion number 3, an increase of Ͻ9% of predicted FEV 1 , were less sensitive (55% and 59%, respectively), but more specifi c (81% and 76% respectively) to diagnose COPD. Our fi ndings suggest that the current recommended spirometric indices are not optimal in differentiating between COPD and asthma.

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Asthma versus chronic obstructive pulmonary disease — exploring why ‘reversibility versus irreversibility’ is no longer an appropriate approach

Cited by 16 publications

References 31 publications

Readmission and survival following hospitalization for chronic obstructive pulmonary disease: long‐term trends

Readmission and survival following hospitalization for chronic obstructive pulmonary disease: long‐term trends

FEV1 reversibility does not adequately predict effect of formoterol via Aerolizer® in chronic obstructive pulmonary disease

Diagnostic value of post-bronchodilator pulmonary function testing to distinguish between stable, moderate to severe COPD and asthma

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