Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Apr 24:12:1269-1277.
doi: 10.2147/COPD.S127923. eCollection 2017.

Pre- and post-bronchodilator airway obstruction are associated with similar clinical characteristics but different prognosis - report from a population-based study

Sami Sawalha  1 , Linnea Hedman  2 , Eva Rönmark  2 , Bo Lundbäck  3 , Anne Lindberg  1
Affiliations

Pre- and post-bronchodilator airway obstruction are associated with similar clinical characteristics but different prognosis - report from a population-based study

Sami Sawalha et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Introduction: According to guidelines, the diagnosis of COPD should be confirmed by post-bronchodilator (post-BD) airway obstruction on spirometry; however, in clinical practice, this is not always performed. The aim of this population-based study was to compare clinical characteristics and prognosis, assessed as mortality, between subjects with airway obstruction divided into pre- but not post-BD obstruction, post-BD airway obstruction (COPD), and subjects without airway obstruction.

Materials and methods: In 2002-2004, four adult population-based cohorts were reexamined with spirometry and structured interview. Subjects with airway obstruction, with a ratio of forced expiratory volume in 1 s to (forced) vital capacity <0.70 (n=993), were identified together with sex- and age-matched referents (n=993). These subjects were further divided into subjects with pre- but not post-BD airway obstruction (pre- not post-BD obstruction) and subjects with post-BD airway obstruction (COPD). Mortality data were collected until December 31, 2014.

Results: Out of 993 subjects with airway obstruction, 736 (74%) had COPD and 257 (26%) pre- not post-BD obstruction. Any respiratory symptoms, allergic rhinitis, asthma, exacerbations, and comorbidities were equally common among subjects with COPD and pre- not post-BD obstruction, but less common among nonobstructive subjects. Mortality was highest among subjects with COPD and higher in men than in women. In both sexes, COPD, but not pre- not post-BD obstruction, was associated with an increased risk for death compared to those without airway obstruction. When COPD was divided into Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages, GOLD 2 and 3-4 had an increased risk for death when compared to the nonobstructive group, also when adjusted for common confounders and comorbidities such as heart disease, diabetes, and anxiety/depression.

Conclusion: Even though subjects with COPD and pre- not post-BD obstruction had fairly similar presentation of clinical characteristics, only those with COPD, specifically GOLD stage ≥2, had increased risk for death when compared with nonobstructive subjects.

Keywords: chronic airflow obstructions; epidemiology; mortality; spirometry.

PubMed Disclaimer

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work. The authors alone are responsible for the content and writing of the paper.

Figures

Figure 1
Figure 1
Study population by spirometric classification. Note: aPost-BD obstructive; fullfilling the spirometric criteria for COPD according to GOLD. Abbreviations: BD, bronchodilator; FEV1, forced expiratory volume in 1 s; GOLD, Global Initiative for Chronic Obstruc tive Lung Disease; VC, vital capacity.
Figure 2
Figure 2
Survival among nonobstructive, pre-BD obstructive, and COPD (A) illustrated by Kaplan–Meier curves, (B) divided into GOLD 1, GOLD 2, and GOLD 3–4 illustrated by Kaplan–Meier curves. Abbreviations: BD, bronchodilator; GOLD, Global Initiative for Chronic Obstructive Lung Disease.
See this image and copyright information in PMC

References

    1. Fabbri LM, Rabe KF. From COPD to chronic systemic inflammatory syndrome? Lancet. 2007;370(9589):797–799. - PubMed
    1. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 2016. [Accessed November 1, 2016]. Available from: http://goldcopd.org/global-strategy-diagnosis-management-prevention-copd...
    1. Bakke PS, Rönmark E, Eagan T, et al. Recommendations for epidemiological studies on COPD. Eur Respir J. 2011;38(6):1261. - PubMed
    1. Lindberg A, Bjerg A, Ronmark E, Larsson LG, Lundback B. Prevalence and underdiagnosis of COPD by disease severity and the attributable fraction of smoking. Report from the Obstructive Lung Disease in Northern Sweden Studies. Respir Med. 2006;100(2):264–272. - PubMed
    1. Sobradillo V, Miravitlles M, Jimenez CA, et al. Epidemiological study of chronic obstructive pulmonary disease in Spain (IBERPOC): prevalence of chronic respiratory symptoms and airflow limitation. Arch Bronconeumol. 1999;35(4):159–166. - PubMed

Substances