Severity Staging of Chronic Obstructive Pulmonary Disease: Differences in Pre- and Post-Bronchodilator Spirometry.
10.3349/ymj.2009.50.5.672
- Author:
Sheng Hsiang LIN
1
;
Ping Hung KUO
;
Sow Hsong KUO
;
Pan Chyr YANG
Author Information
1. Department of Internal Medicine, Taipei County Hospital, Taipei County, Taiwan.
- Publication Type:Original Article ; Comparative Study
- Keywords:
Bronchodilator test;
chronic obstructive pulmonary disease;
severity staging
- MeSH:
Bronchodilator Agents/*diagnostic use;
Fenoterol/diagnostic use;
Forced Expiratory Volume/drug effects;
Humans;
Practice Guidelines as Topic;
Prognosis;
Pulmonary Disease, Chronic Obstructive/*diagnosis;
Spirometry/methods
- From:Yonsei Medical Journal
2009;50(5):672-676
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines for chronic obstructive pulmonary disease (COPD) uses the post-bronchodilator spirometry for diagnosis and severity staging. We evaluated differences in the severity classification of COPD, based on pre- and post-bronchodilator spirometry. MATERIALS AND METHODS: From 2000 to 2004, 207 COPD patients who underwent spirometry before and after inhalation of 400 microg of fenoterol were analyzed. A responder to the bronchodilator test (BDT) was defined by the American Thoracic Society (ATS) as an increase in forced expiratory volume in one second (FEV1) or forced vital capacity > or = 12% and > or = 200 mL, and by the European Respiratory Society (ERS) as an increase in FEV1 > or = 10% of the predicted value. COPD severity was classified according to the 2008 GOLD guidelines. RESULTS: For the entire study population, the FEV1 increased by 11.8 +/- 12.5% of baseline after BDT and 41.1% and 27.1% of subjects were classified as responders using the ATS and ERS criteria, respectively. Based on pre-BDT spirometry, 55, 85, 58, and 9 patients were classified as Stage I-IV COPD, respectively. Sixty-seven (32.4%) patients changed severity staging after BDT, including 20.0%, 28.2%, 44.8%, and 66.7% of pre-BDT patients Stages I through IV, respectively. More ATS or ERS BDT-responders had a change in severity staging than non-responders (52.9% vs. 18.9% and 62.5% vs. 21.2%, both p < 0.001). CONCLUSION: Our data suggest that the severity staging of COPD using pre-BDT spirometry might lead to significant differences as compared to staging, based on post-BDT spirometry, as recommended by the current GOLD guidelines.
