Spirometry is not enough to diagnose COPD in epidemiological studies: a follow-up study. (December 2017)

• Record Type: Journal Article
• Authors: Andreeva, Elena; Pokhaznikova, Marina; Lebedev, Anatoly; Moiseeva, Irina; Kuznetsova, Olga; Degryse, Jean-Marie
• Is Part Of: NPJ primary care respiratory medicine. Volume 27(2017)
• Page Start: 1
• Page End: 9
• Publication Date: 2017-12
• Subjects: Respiratory organs -- Diseases -- Periodicals; Primary care (Medicine) -- Periodicals; Respiratory Therapy; Asthma; Primary Health Care; Primary care (Medicine); Respiratory organs -- Diseases; Periodicals; Periodicals; Fulltext; Internet Resources; Periodicals; 616.2
• DOI: 10.1038/s41533-017-0062-6
• Languages: English
• ISSNs: 2055-1010

Abstract

Abstract A hallmark of the diagnosis of chronic obstructive pulmonary disease (COPD) is the measurement of post-bronchodilator (post-BD) airflow obstruction (AO) by spirometry, but spirometry is not enough for the provision of a clinical diagnosis. In the majority of previous epidemiological studies, COPD diagnosis has been based on spirometry and a few clinical characteristics. The aim of our study was to identify outcomes in patients newly diagnosed with airflow obstruction (AO) based on a diagnostic work-up conducted as part of a population-based cross-sectional study in North-Western Russia. Spirometry was performed before (pre-BD) and after BD administration, and AO was defined using the FEV1/FVC <0.70 and FEV1/FVC <lower limit of normal cut-off values. Relevant symptoms were recorded. Participants with AO identified at baseline were then examined by a pulmonologist, including a clinical examination and second spirometry with BD test. Of the 102 participants with post-BD AO in the initial assessment, only 60.8% still had AO identified at the second examination; among these patients, the following final diagnoses were reported: COPD (n = 41), asthma (n = 5), asthma–COPD overlap syndrome (ACOS) (n = 4) and likely ACOS (n = 5). Of the 65 participants with pre-BD AO, 23.1% had post-BD AO at the second assessment, and these patients had been diagnosed with COPD (n = 12), asthma (n = 1), ACOS (n = 1), likely ACOS (n = 1). Serial spirometric assessments complemented by a comprehensive clinical evaluation are recommended in new epidemiological studies. COPD: Single lung function test not enough for diagnosis A single lung function test is insufficient to accurately diagnose chronic obstructive pulmonary disease (COPD). A team led by Jean-Marie Degryse from the Université Catholique de Louvain, Belgium, studied patients in Northwestern Russia who showed signs of airflow obstruction, as measured by a spirometer, a medical device that records the amount of air inhaled and exhaled and the speed of breath. Among those who initially showed signs of limited lung function, even after treatment with a bronchodilator, a large proportion did not exhibit airflow obstruction on a second spirometry test months later. Moreover, not everyone who had confirmed airflow obstruction were diagnosed with COPD when examined by a pulmonologist. Some had asthma or asthma-COPD overlap syndrome. The findings point to the need for clinical assessments and follow-up spirometry tests to accurately diagnose and manage COPD.