Detection of COPD in a high-risk population: should the diagnostic work-up include bronchodilator reversibility testing?
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Detection of COPD in a high-risk population : should the diagnostic work-up include bronchodilator reversibility testing? / Kjeldgaard, Peter; Dahl, Ronald; Løkke, Anders; Ulrik, Charlotte Suppli.
I: International Journal of Chronic Obstructive Pulmonary Disease, Bind 10, Nr. 1, 2015, s. 407-14.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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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
Y1 - 2015
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 ≥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 ≥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
VL - 10
SP - 407
EP - 414
JO - International Journal of COPD
JF - International Journal of COPD
SN - 1176-9106
IS - 1
ER -
ID: 162683692