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

Abstract

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.

Pre- and post-bronchodilator airway obstruction are associated with similar clinical characteristics but different prognosis – report from a population-based study

“… 7 – 10 In addition to this diagnostic dilemma, there is lack of knowledge about the importance of pre-respectively post-bronchodilation airflow limitation in relation to the clinical picture and prognosis of obstructive airway diseases. 11 Also, the presence of comorbid conditions is important when evaluating clinical characteristics in relation to prognosis. 12 – 15 Comorbidities are common in COPD, and it has been estimated that 68% of subjects with COPD have cardiovascular disease, diabetes, or depression.…”

Pharmacotherapy of chronic obstructive pulmonary disease: Therapeutic considerations with a focus on inhaled corticosteroids

“…Despite these constraints, up to 60% of COPD subjects may show spirometric reversibility as defined by the American Thoracic Society. 4,5 The Global Initiative for Obstructive Lung Disease (GOLD) and South African guidelines consider the definition for COPD exemplified by the post-bronchodilator forced expiratory volume in one second (FEV 1 )/forced vital capacity (FVC) of < 0.70 as being diagnostic. 1,2 Another limitation, however, is that the criterion is neither sensitive nor definitive for the detection of COPD.…”

“…1,2 Another limitation, however, is that the criterion is neither sensitive nor definitive for the detection of COPD. 4 The SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study) research group reported on an observational study involving 2736 current or former smokers. 6 Respiratory symptoms were present in 50% of subjects with spirometry in the normal range (who would not have met the COPD definition).…”

Bronchodilator reversibility testing in morbidly obese non-smokers: fluticasone/salmeterol efficacy versus salbutamol bronchodilator

“…Asthma and chronic obstructive pulmonary disease (COPD) are complex chronic diseases with a high prevalence across the globe. Asthma is an inflammatory disease characterised by airway hyperresponsiveness that is mostly reversible, while COPD is an irreversible, progressive airway obstruction [ 1 ]. A diagnosis of obstructive pulmonary disease usually depends on symptomatic features.…”