Detection of COPD in a high-risk population: should the diagnostic work-up include bronchodilator reversibility testing?

Figures & data

Figure 1 Flowchart describing the diagnostic algorithm used for participants with a screening spirometry revealing airflow obstruction (FEV₁/FVC <0.70).

Abbreviations: COPD, chronic obstructive pulmonary disease; FEV₁, forced expiratory volume in one second; FVC, forced vital capacity.

Table 1 Characteristics of enrolled subjects with a confirmed diagnosis of COPD (ie, post-bronchodilator FEV₁/FVC <0.70) versus subjects not having COPD

	COPD (n=687)	No COPDa (n=3,362)	P-value
Sex, male	369 (54%)	1,688 (50%)	0.094
Age	63 (10.5)	56 (11.8)	<0.001
BMI	26 (5.1)	27 (5.1)	<0.001
Pack-years	40 (23.2)	30 (21.9)	<0.001
Symptoms
Cough	501 (73%)	2,389 (71%)	0.324
Dyspnea	398 (58%)	1,554 (46%)	<0.001
Wheezing	183 (27%)	559 (17%)	<0.001
Sputum	281 (41%)	963 (29%)	<0.001
Recurrent RTI	88 (13%)	28 (10%)	0.016
MRC	2 (0.8)	1.7 (0.7)	<0.001
Spirometry
FEV1 screeningb	1.9 (0.69)	2.8 (0.83)	<0.001
FEV1 % predictedc	68 (19.4)	92 (18.2)	<0.001

Notes: Data are given as the mean ± standard deviation or number of subjects (%).

a Subjects with FEV₁/FVC ≥0.70 or post-bronchodilator ΔFEV₁ <0.500 L

b FEV₁ at initial screening spirometry

c FEV₁ % predicted.

Abbreviations: BMI, body mass index; COPD, chronic obstructive pulmonary disease; FEV₁, forced expiratory volume in one second; FVC, forced vital capacity; MRC, Medical Research Council dyspnea scale; RTI, respiratory tract infection.

Figure 2 Prevalence of respiratory symptoms in individuals diagnosed with COPD compared with individuals not fulfilling the spirometric criteria for a diagnosis of COPD.

Note: All enrolled subjects had more than one respiratory symptom.
Abbreviation: COPD, chronic obstructive pulmonary disease.

Figure 3 Graphic representation of all subjects with airway obstruction^a at screening spirometry (n=937) according to the presence of post-bronchodilator airway obstruction and/or BD reversibility.^b

Notes: (A) Subjects with post-BD airway obstruction, (B) subjects with a significant BD response, and (C) subjects with normal post-BD FEV₁/FVC. ^aFEV₁/FVC ratio <0.70; ^bchange in FEV₁ >0.200 L and >12%.
Abbreviations: BD, bronchodilator; FEV₁, forced expiratory volume in one second; FVC, forced vital capacity.

Table 2 Comparison of characteristics for subjects with a confirmed diagnosis of COPD (ie, post-bronchodilator FEV₁/FVC <0.70) with and without bronchodilator reversibility

	Reversibility (n=60)	No reversibility (n=627)	P-value
Sex, male	35 (58%)	334 (52%)	0.452
Age	63 (10.0)	63 (10.5)	0.407
BMI	26 (5.7)	26 (5.0)	0.531
Pack-years	42 (23.5)	40 (23.2)	0.380
Symptoms
Cough	33 (55%)	468 (75%)	0.001
Dyspnea	43 (72%)	355 (57%)	0.024
Wheezing	16 (27%)	167 (27%)	0.996
Sputum	25 (42%)	256 (41%)	0.900
Recurrent RTI	10 (17%)	78 (12%)	0.349
MRC	2.2 (0.8)	2.0 (0.8)	0.152
Spirometry
FEV1 screeninga	1.7 (0.6)	1.9 (0.7)	0.014
FEV1% predictedb	58 (13.4)	68 (19.6)	<0.001

Notes: Data are given as the mean (standard deviation) or number (%) of subjects; a positive reversibility test defined as ΔFEV₁ >0.200 L and 12% of pre-bronchodilator FEV₁ level after administration of bronchodilator

a FEV₁ at initial screening spirometry

b FEV₁ % predicted.

Abbreviations: BMI, body mass index; COPD, chronic obstructive pulmonary disease; FEV₁, forced expiratory volume in one second; FVC, forced vital capacity; MRC, Medical Research Council dyspnea scale; RTI, respiratory tract infection.

Table S1 List of definitions

Definitions
Airway obstruction	FEV1/FVC ratio <0.70
BD reversibility test	ERS/ATS recommendations: ”Significant” BD response was defined as an increase in FEV1 of minimum 0.200 L and 12% of pre-BD FEV1 after administration of a short-acting β2 agonist^Citation30
Corticosteroid reversibility test	Six weeks of treatment with inhaled corticosteroid or 14 days of oral steroid followed by repeat spirometry. An increase in FEV1 of >0.200 L was considered a positive test
COPD	Spirometric defined according to GOLD recommendations 2014: Post-BD FEV1/FVC ratio <0.70^Citation16
GOLD severity of airway obstruction	FEV1 % predicted:
GOLD 1: mild	≥80%
GOLD 2: moderate	50%≤ FEV1 <80%
GOLD 3: severe	30%≤ FEV1 <50%
GOLD 4: very severe	<30%
Asthma	Increase in FEV1 >0.500 L at the BD reversibility test or >0.200–0.500 L with additional 0.200 L increase on the corticosteroid reversibility test

Abbreviations: ATS, American Thoracic Society; BD, bronchodilator; COPD, chronic obstructive pulmonary disease; ERS, European Respiratory Society; FEV₁, forced expiratory volume in one second; FVC, forced vital capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease.

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