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Drop in lung function during asthma and COPD exacerbations - can it be assessed without spirometry?

Hasse Melbye¹, Salwan Al-Ani¹, Mark Spigt²

¹General Practice Research Unit, Department of Community Medicine, UIT The Arctic University of Norway, Tromsø, Norway.

International Journal of Chronic Obstructive Pulmonary Disease

|December 21, 2016

Summary

Wheezing and decreased oxygen saturation (SpO₂) indicate significant lung function decline during asthma and COPD exacerbations. These indicators can help guide oral corticosteroid treatment decisions.

Keywords:

bronchial obstruction diagnostic tests primary care systemic corticosteroids

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Area of Science:

Pulmonology
Respiratory Medicine
Clinical Medicine

Background:

Assessing lung function decline during asthma and COPD exacerbations is crucial for treatment decisions, particularly regarding oral corticosteroids.
Understanding indicators of forced expiratory volume in 1 second (FEV₁) drop is important for managing these respiratory conditions.

Purpose of the Study:

To identify clinical indicators that predict a significant drop in forced expiratory volume in 1 second (FEV₁) during exacerbations of asthma and COPD.

Main Methods:

A prospective, multicenter study involving patients with asthma or COPD was conducted.
Patients were assessed during stable states and subsequent exacerbations, recording symptoms, chest findings, and pulse oximetry.
Spirometry was performed to measure forced expiratory volume in 1 second (FEV₁) drop, with a 10% and ≥200 mL change defined as significant.

Main Results:

Of 88 patients analyzed, 34% experienced a significant drop in FEV₁.
Increased wheezing was the sole symptom significantly associated with FEV₁ drop (LR 6.4).
Crackles, new auscultation findings, and a ≥2% drop in oxygen saturation (SpO₂) to ≤92% (in COPD subgroup) also correlated with FEV₁ decline.

Conclusions:

Increased wheezing and decreased SpO₂ are strong indicators of reduced lung function during asthma and COPD exacerbations.
These findings suggest that wheezing and SpO₂ levels should be considered when deciding on oral corticosteroid treatment for exacerbations.