Yonsei Med J.  2009 Oct;50(5):672-676. 10.3349/ymj.2009.50.5.672.

Severity Staging of Chronic Obstructive Pulmonary Disease: Differences in Pre- and Post-Bronchodilator Spirometry

• Lin SH
• Kuo PH
• Kuo SH
• Yang PC

• KMID: 1103821
• DOI: http://doi.org/10.3349/ymj.2009.50.5.672

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.

Keyword

Bronchodilator test; chronic obstructive pulmonary disease; severity staging

MeSH Terms

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

Figure

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  Fig. 1 Percentage of patients changed in severity class after BDT. The relation between percentage and pre-BDT stage was statistically significant (p= 0.004). BDT, bronchodilator test.

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