Article Text
Abstract
Introduction We compared the predictive value of prebronchodilator and postbronchodilator spirometry for chronic obstructive pulmonary disease (COPD) features and outcomes.
Methods We analysed COPDGene data of 10 192 subjects with smoking history. We created regressions models with the following dependent variables: clinical, functional and radiographic features, and the following independent variables: prebronchodilator airflow obstruction (PREO) and postbronchodilator airflow obstruction (POSTO), prebronchodilator and postbronchodilator FEV1% predicted. We compared the model performance using the Akaike information criterion (AIC).
Results The COPD prevalence was higher using PREO. About 8.5% had PREO but no airflow obstruction in postbronchodilator spirometry (POSTN) (PREO-POSTN) and 3% of all subjects had no aiflow obstruction in prebronchodilator spirometry (PREN) but POSTO (PREN-POSTO). We found no difference in COPD features and outcomes between PREO-POSTN and PREN-POSTO subjects. Although, both prebronchodilator and postbronchodilator spirometries are both associated with chronic bronchitis, dyspnoea, exercise capacity and COPD radiographic findings, models that included postbronchodilator spirometric measures performed better than models with prebronchodilator measures to predict these COPD features. The predictive value of prebronchodilator and postbronchodilator spirometries for respiratory exacerbations, change in forced expiratory volume in 1 s, dyspnoea and exercise capacity during a 5-year period is relatively similar, but postbronchodilator spirometric measures are better predictors of mortality based on AIC.
Conclusions Postbronchodilator spirometry may be a more accurate predictor of COPD features and outcomes.
- Respiratory Measurement
- Clinical Epidemiology
- Copd Exacerbations
- Emphysema
- Imaging/ct Mri Etc
- COPD epidemiology
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Footnotes
Contributors All authors made substantial contributions to the study. SF participated in study conception and design, data analysis and interpretation and drafting of the manuscript. ME participated in study design, data interpretation and drafting of the manuscript. DG participated in data interpretation. AC participated in study conception and design, data interpretation and drafting of the manuscript.
Funding The project described was supported by Award Number R01 HL089897 and Award Number R01 HL089856 from the National Heart, Lung, and Blood Institute. The COPDGene project is also supported by the COPD Foundation through contributions made to an Industry Advisory Board comprised of AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, Pfizer, Siemens and Sunovion.
Competing interests None declared.
Ethics approval The institutional review boards at each participating center outlined below approved the study protocol. Details of the study protocol have been published previously.12
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Please contact COPD gene investigators for additional data request.
Collaborators COPDgene investigators