Detection of COPD in a high-risk population: should the diagnostic work-up include bronchodilator reversibility testing?

TY - JOUR

T1 - Detection of COPD in a high-risk population

T2 - should the diagnostic work-up include bronchodilator reversibility testing?

AU - Kjeldgaard, Peter

AU - Dahl, Ronald

AU - Løkke, Anders

AU - Ulrik, Charlotte Suppli

PY - 2015/2/23

Y1 - 2015/2/23

N2 - Background: Underdiagnosis of chronic obstructive pulmonary disease (COPD) is widespread. Early detection of COPD may improve the outcome by timely smoking cessation, a change in lifestyle, and treatment with an inhaled bronchodilator (BD). The objective of this study was to evaluate the diagnostic role of BD reversibility testing in early COPD case finding. Methods: General practitioners (n=241) consecutively recruited subjects aged ³ 35 years with relevant exposure (history of smoking, and/or occupational exposure) and at least one respiratory symptom. Information on age, smoking status, body mass index, dyspnea score (Medical Research Council scale), and spirometry was obtained. Individuals with airway obstruction (forced expiratory volume in one second [FEV1]/forced vital capacity [FVC] <0.70) underwent a BD test with an inhaled β2 agonist, which was considered positive if ΔFEV1 was >0.20 L and >12%. Asthma and COPD were, respectively, defined as an FEV1 increase>0.50 L and a post-BD FEV1/FVC <0.70. Results: In total, 4,049 subjects (51% male) were included (mean age 58 years, body mass index 27, 32 pack-years of smoking). A significant BD response was found in 143 (15%) of the 937 subjects (23%) with airway obstruction at screening spirometry. In 59% of these subjects, the post-BD FEV1/FVC remained <0.70. In 24% of the subjects with pre-BD airway obstruction, the post-BD FEV1/FVC ratio was within the reference range. In subjects with confirmed COPD, the mean increase in FEV1 following BD was 0.11 L±0.10 L. The subjects with COPD and a significant BD response were characterized by a higher prevalence of dyspnea (72% versus 57%, P=0.02) but less cough (55% versus 75%, P=0.001) when compared with COPD subjects without BD reversibility. Conclusion: Administration of a BD in COPD case finding is important in order to determine the post-BD FEV1/FVC ratio. Exclusion of subjects with a significant BD response may result in underdiagnosis of COPD, and we question the need for the BD reversibility test in the diagnostic screening algorithm in early COPD case finding.

AB - Background: Underdiagnosis of chronic obstructive pulmonary disease (COPD) is widespread. Early detection of COPD may improve the outcome by timely smoking cessation, a change in lifestyle, and treatment with an inhaled bronchodilator (BD). The objective of this study was to evaluate the diagnostic role of BD reversibility testing in early COPD case finding. Methods: General practitioners (n=241) consecutively recruited subjects aged ³ 35 years with relevant exposure (history of smoking, and/or occupational exposure) and at least one respiratory symptom. Information on age, smoking status, body mass index, dyspnea score (Medical Research Council scale), and spirometry was obtained. Individuals with airway obstruction (forced expiratory volume in one second [FEV1]/forced vital capacity [FVC] <0.70) underwent a BD test with an inhaled β2 agonist, which was considered positive if ΔFEV1 was >0.20 L and >12%. Asthma and COPD were, respectively, defined as an FEV1 increase>0.50 L and a post-BD FEV1/FVC <0.70. Results: In total, 4,049 subjects (51% male) were included (mean age 58 years, body mass index 27, 32 pack-years of smoking). A significant BD response was found in 143 (15%) of the 937 subjects (23%) with airway obstruction at screening spirometry. In 59% of these subjects, the post-BD FEV1/FVC remained <0.70. In 24% of the subjects with pre-BD airway obstruction, the post-BD FEV1/FVC ratio was within the reference range. In subjects with confirmed COPD, the mean increase in FEV1 following BD was 0.11 L±0.10 L. The subjects with COPD and a significant BD response were characterized by a higher prevalence of dyspnea (72% versus 57%, P=0.02) but less cough (55% versus 75%, P=0.001) when compared with COPD subjects without BD reversibility. Conclusion: Administration of a BD in COPD case finding is important in order to determine the post-BD FEV1/FVC ratio. Exclusion of subjects with a significant BD response may result in underdiagnosis of COPD, and we question the need for the BD reversibility test in the diagnostic screening algorithm in early COPD case finding.

KW - Administration, Inhalation

KW - Adrenergic beta-2 Receptor Agonists

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Algorithms

KW - Critical Pathways

KW - Denmark

KW - Female

KW - Forced Expiratory Volume

KW - General Practice

KW - Humans

KW - Lung

KW - Male

KW - Middle Aged

KW - Predictive Value of Tests

KW - Prevalence

KW - Pulmonary Disease, Chronic Obstructive

KW - Risk Factors

KW - Spirometry

KW - Vital Capacity

U2 - 10.2147/copd.s76047

DO - 10.2147/copd.s76047

M3 - Journal article

C2 - 25759573

SN - 1176-9106

VL - 10

SP - 407

EP - 414

JO - International Journal of COPD

JF - International Journal of COPD

IS - 1

ER -