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Bronchial obstruction reversibility test in the assessment of severity in COPD - controversies
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Abstract
Aim: to assess the changes in the degree of severity of COPD in the classification based upon the pre- and post- bronchodilator FEV1 and to compare the interpretation of the reversibility test as suggested by GOLD and ATS/ ERS and the PRS.
Methods: 145 COPD patients (67F, 78M, mean age 67.5 ± 8.9 yrs) with a negative bronchial obstruction reversibility test (salbutamol 400 μg) were enrolled to the study. For each patient the degree of COPD severity using the pre- and postbronchodilator FEV1 was established. The pre- and post-bronchodilator classifications were compared. Differences in the interpretation of the reversibility test according to the GOLD and ATS/ ERS and the Polish guidelines were analyzed.
Results: In 22 subjects (15.2%) the degree of disease severity changed after salbutamol. The changes were most frequent in the group of severe and very severe COPD (77.3% of changes). In 1 patient (0.7%) post-bronchodilator severity was greater than before salbutamol intake. In 7 patients (4.8%) the post-bronchodilator FEV1/FVC exceeded 70%, thus excluding the diagnosis of COPD. Of all the 145 negative (according to the ATS/ ERS and GOLD criteria) reversibility tests in 24 cases (16.6%) the test was positive when the criteria recommended by PRS were applied.
Conclusions: the bronchial obstruction reversibility test is essential in the diagnosis and assessment of severity of COPD. Despite poor obstruction reversibility in this disease the use of pre-bronchodilator FEV1 in the assessment of COPD severity may be misleading and is an obstacle in the comparative analysis of studies in the domain of this disease. Differences in the guidelines for the management of COPD may also hinder comparative studies and influence epidemiologic data.
Abstract
Aim: to assess the changes in the degree of severity of COPD in the classification based upon the pre- and post- bronchodilator FEV1 and to compare the interpretation of the reversibility test as suggested by GOLD and ATS/ ERS and the PRS.
Methods: 145 COPD patients (67F, 78M, mean age 67.5 ± 8.9 yrs) with a negative bronchial obstruction reversibility test (salbutamol 400 μg) were enrolled to the study. For each patient the degree of COPD severity using the pre- and postbronchodilator FEV1 was established. The pre- and post-bronchodilator classifications were compared. Differences in the interpretation of the reversibility test according to the GOLD and ATS/ ERS and the Polish guidelines were analyzed.
Results: In 22 subjects (15.2%) the degree of disease severity changed after salbutamol. The changes were most frequent in the group of severe and very severe COPD (77.3% of changes). In 1 patient (0.7%) post-bronchodilator severity was greater than before salbutamol intake. In 7 patients (4.8%) the post-bronchodilator FEV1/FVC exceeded 70%, thus excluding the diagnosis of COPD. Of all the 145 negative (according to the ATS/ ERS and GOLD criteria) reversibility tests in 24 cases (16.6%) the test was positive when the criteria recommended by PRS were applied.
Conclusions: the bronchial obstruction reversibility test is essential in the diagnosis and assessment of severity of COPD. Despite poor obstruction reversibility in this disease the use of pre-bronchodilator FEV1 in the assessment of COPD severity may be misleading and is an obstacle in the comparative analysis of studies in the domain of this disease. Differences in the guidelines for the management of COPD may also hinder comparative studies and influence epidemiologic data.
Keywords
COPD; reversibility test; GOLD; Polish guidelines


Title
Bronchial obstruction reversibility test in the assessment of severity in COPD - controversies
Journal
Advances in Respiratory Medicine
Issue
Article type
Research paper
Pages
68-71
Published online
2008-02-18
Bibliographic record
Pneumonol Alergol Pol 2006;74(1):68-71.
Keywords
COPD
reversibility test
GOLD
Polish guidelines
Authors
Marta Maskey-Warzęchowska
Monika Pankowska
Ryszarda Chazan