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