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Bronchodilator reversibility testing in chronic obstructive pulmonary disease.

Calverley, Peter MA and Burge, P Sherwood and Spencer, Sally and Anderson, Julie A and Jones, Paul W (2003) Bronchodilator reversibility testing in chronic obstructive pulmonary disease. Thorax, 58 (8). pp. 659-664. ISSN 0040-6376

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Abstract

A limited or absent bronchodilator response is used to classify chronic obstructive pulmonary disease (COPD) and can determine the treatment offered. The reliability of the recommended response criteria and their relationship to disease progression has not been established. METHODS: 660 patients meeting European Respiratory Society (ERS) diagnostic criteria for irreversible COPD were studied. Spirometric parameters were measured on three occasions before and after salbutamol and ipratropium bromide sequentially or in combination over 2 months. Responses were classified using the American Thoracic Society/GOLD (ATS) and ERS criteria. Patients were followed for 3 years with post-bronchodilator FEV(1) and exacerbation history recorded 3 monthly and health status 6 monthly. RESULTS: FEV(1) increased significantly with each bronchodilator, a response that was normally distributed. Mean post-bronchodilator FEV(1) was reproducible between visits (intraclass correlation 0.93). The absolute change in FEV(1) was independent of the pre-bronchodilator value but the percentage change correlated with pre-bronchodilator FEV(1) (r=-0.44; p<0.0001). Using ATS criteria, 52.1% of patients changed responder status between visits compared with 38.2% using ERS criteria. Smoking status, atopy, and withdrawing inhaled corticosteroids were unrelated to bronchodilator response, as was the rate of decline in FEV(1), decline in health status, and exacerbation rate. CONCLUSION: In moderate to severe COPD bronchodilator responsiveness is a continuous variable. Classifying patients as "responders" and "non-responders" can be misleading and does not predict disease progression.

Item Type: Article
Journal or Publication Title: Thorax
Subjects: R Medicine > R Medicine (General)
Departments: Faculty of Health and Medicine
ID Code: 55050
Deposited By: ep_importer_pure
Deposited On: 13 Jun 2012 14:09
Refereed?: Yes
Published?: Published
Last Modified: 09 Apr 2014 23:38
Identification Number:
URI: http://eprints.lancs.ac.uk/id/eprint/55050

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