Drop in lung function during asthma and COPD exacerbations – can it be assessed without spirometry?

Abstract

BackgroundWhen assessing patients with exacerbation of asthma or COPD, it may be useful to know the drop in forced expiratory volume in 1 second (FEV1) compared with stable state, in particular when considering treatment with oral corticosteroids. The objective of the study was to identify indicators of drop in FEV1 during exacerbations.MethodsIn this prospective multicenter study from primary care, patients diagnosed with asthma or COPD were examined at stable state and during exacerbations the following year. Symptoms, chest findings, and pulse oximetry were recorded, and spirometry was performed. A fixed drop in FEV1 (10% and ≥200 mL) and percentage change in FEV1 were outcomes when possible indicators were evaluated.ResultsThree hundred and eighty patients attended baseline examination, and 88 with a subsequent exacerbation were included in the analysis. Thirty (34%) had a significant drop in FEV1 (10% and 200 mL). Increased wheezing was the only symptom associated with this drop with a likelihood ratio of 6.4 (95% confidence interval, 1.9–21.7). Crackles and any new auscultation finding were also associated with a significant drop in FEV1, as was a ≥2% drop in oxygen saturation (SpO2) to ≤92% in the subgroup diagnosed with COPD. Very bothersome wheezing and severe decrease in SpO2 were also very strong predictors of change in FEV1 in linear regression adjusted for age, gender, and baseline FEV1% predicted.ConclusionIncreased wheezing, as experienced by the patient, and a decreased SpO2 value strongly indicated a drop in lung function during asthma and COPD exacerbations and should probably be taken into account when treatment with oral corticosteroids is considered.

Inspiratory crackles—early and late—revisited: identifying COPD by crackle characteristics

“…However, when they occur early during inspiration, the clinician has reason to suspect COPD, and even more so when heard bilaterally, although such crackles may also indicate bronchiectasis 23 and asthma. 17 The PPVs found in our study are similar to those found for high COPD questionnaire scores 24 25 But, identification of crackles cannot match the questionnaires in terms of sensitivity.…”

“…We examined a sample of the general population who were mainly in a stable clinical state, and only a few of those with COPD were examined during an exacerbation. In patients with COPD, the prevalence of crackles tend to increase during exacerbations, 17 and a stronger association between crackles and COPD would probably be found if patients with COPD with exacerbations had been a particular focus of this study. Visualising spectrograms during the classification might have been of additional help in assessing the timing and type of crackles.…”

Associations with antibiotic prescribing for acute exacerbation of COPD in primary care: secondary analysis of a randomised controlled trial

“… 26 However, crackles are commonly heard in COPD, 27 and especially during exacerbations, related to worsened bronchial obstruction. 28 In the present study, while the link between crackles and antibiotic prescribing was independent of CRP result, a greater number of participants in the high CRP group (59.2%) experienced crackles than did those in the low CRP group (44.0%), indicative of a relationship between crackles and more seriously unwell participants. Further investigation is required to determine the diagnostic and prognostic value of crackles and other chest sounds, and whether further safe reductions in antibiotic prescribing for AECOPD are possible.…”

The effect of exacerbations on lung density in α1-antitrypsin deficiency

“…Although the impact of acute exacerbations on pulmonary function measurements has been well described [11][12][13], their impact on CT lung density has not been extensively studied.…”