Physician estimation of FEV1 in acute exacerbation of COPD

There have been recent recommendations to include objective measurements of airway obstruction in the treatment of patients with acute asthma. These recommendations are based in part on the inaccuracy of physicians in estimating airways obstruction in asthmatic patients. The purpose of this study was to evaluate the ability of physicians to estimate the degree of airways obstruction in patients with acute exacerbation of COPD. We studied 90 patients. The physicians were able to estimate the percent of predicted normal FEV1 to within 10 points only 38 percent of the time prior to treatment and 46 percent of the time posttreatment. Forty-nine percent of the patients whom the physicians believed had an improvement in pulmonary function with treatment actually did not improve, while 31 percent of the patients who the physicians believed did not improve their pulmonary function with treatment actually did improve. We conclude that physicians' estimates of the degree of airway obstruction in acute exacerbation of COPD are inaccurate. Assessment of patients in the emergency department presenting with COPD should be based on objective measurements of pulmonary function.