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Bronchodilator reversibility testing in chronic obstructive pulmonary disease
P M A Calverley1, P S Burge, S Spencer
1Department of Medicine, The University of Liverpool, Liverpool, UK. pmacal@liverpool.ac.uk
Thorax
|July 30, 2003
Summary
Bronchodilator response in COPD is a continuous variable, not a simple responder/non-responder classification. This variability does not predict disease progression in patients with moderate to severe chronic obstructive pulmonary disease.
Area of Science:
- Pulmonology
- Respiratory Medicine
- Clinical Trials
Background:
- Bronchodilator response is key for classifying chronic obstructive pulmonary disease (COPD) and guiding treatment.
- The reliability of current COPD response criteria and their link to disease progression remain unclear.
Purpose of the Study:
- To evaluate the reliability of bronchodilator response criteria in COPD.
- To determine if bronchodilator response predicts disease progression in COPD patients.
Main Methods:
- Studied 660 patients with irreversible COPD using spirometry before and after bronchodilators over 2 months.
- Assessed response using American Thoracic Society/GOLD (ATS) and European Respiratory Society (ERS) criteria.
- Followed patients for 3 years, monitoring FEV(1), exacerbations, and health status.
Main Results:
- Bronchodilator response (FEV(1) increase) was a continuous, normally distributed variable.
- Responder status varied significantly between visits using ATS (52.1%) and ERS (38.2%) criteria.
- Bronchodilator response did not correlate with smoking, atopy, inhaled corticosteroid withdrawal, FEV(1) decline, or exacerbation rates.
Conclusions:
- Bronchodilator responsiveness in moderate to severe COPD is a continuous spectrum.
- Classifying COPD patients as responders or non-responders is misleading and does not predict disease progression.
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