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Free Content Clinical data discriminating between adults with positive and negative results on bronchodilator testing

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Abstract:

OBJECTIVE: To evaluate how spirometry, symptoms and smoking discriminate between subjects who are responsive to bronchodilator testing and those who are non-responsive, and to examine how cut-off points of positive tests are related to symptoms of chronic obstructive pulmonary disease (COPD) and asthma.

METHODS: Subjects aged 47–48 and 71–73 years living in Bergen, Norway, were recruited. The 3506 participants (69%) filled in questionnaires and performed a bronchodilator test using salbutamol.

RESULTS: Tests were positive (forced expiratory volume in 1 s [ΔFEV1] ≥200 ml and ≥12%) in 107 subjects (3%). In logistic regression, spirometry (FEV1 < 80%, OR 6.0, 95%CI 3.6–10.2, and FEV1/FVC < 0.70, OR 3.1, 95%CI 1.9–5.2) and pack-years ≥ 20 (OR 0.3, 95%CI 0.2–0.7), but not symptoms, predicted the test outcome. FEV1% and FEV1/forced volume capacity (FVC) discriminated equally well between positive and negative tests (area under the receiver operating characteristic [ROC] curve 0.81, 95%CI 0.77–0.85 vs. 0.77, 95%CI 0.72–0.82). The largest likelihood ratio for positive tests was 5.4 (95%CI 3.8–7.8) using FEV1 < 80% and FEV1/FVC < 0.70.

CONCLUSIONS: Spirometry and to a lesser extent smoking, but not symptoms, are useful in discriminating between middle-aged and elderly patients with positive and negative bronchodilator tests. Acute responses to salbutamol, expressed by commonly used ΔFEV1 cut-off points, are poorly related to COPD- and asthma-like symptoms.

Keywords: albuterol-salbutamol; bronchial reactivity; pulmonary epidemiology; pulmonary function test

Document Type: Regular Paper

Affiliations: 1: Section for Thoracic Medicine, Institute of Medicine, University of Bergen, Bergen, Norway; Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway 2: Section for Thoracic Medicine, Institute of Medicine, University of Bergen, Bergen, Norway; and Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway 3: Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway; Section for Epidemiology and Medical Statistics, Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway

Publication date: February 1, 2008

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

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