Beta2 agonist reversibility testing in COPD diagnosis

The place of testingthe reversibility of airway obstruction with an inhaled short-acting beta2 agonist in the diagnosis of chronic obstructive pulmonary disease (COPD) has caused some confusion in primary care. When reviewing the management of patients with stable COPD, in 2001, we stated that "to help rule out asthma, reversibility testing should be undertaken by measuring FEV1 [forced expiratory volume in 1 second] before and after the patient inhales a short-acting beta2 agonist". In keeping with this idea, the current general medical services (GMS) contract for GPs in the U.K. requires confirmation of the diagnosis of COPD with both spirometric evidence of airflow obstruction and reversibility testing of such obstruction. Other national and international guidelines have also recommended this approach. However, the National Institutefor Health and Clinical Excellence (NICE) guideline on COPD statesthat, in most patients, routine spirometric reversibility testing is not necessary in the diagnostic process, and that it should only be used when there is diagnostic uncertainty or if the patient is thought to have both COPD and asthma. Here we reconsider the role of reversibility testing with a short-acting beta2 agonist in the diagnosis of COPD.