Can a Single Spirometry Measure Accurately Diagnose Chronic Obstructive Pulmonary Disease?

Summary and Comment |
August 17, 2017

Can a Single Spirometry Measure Accurately Diagnose Chronic Obstructive Pulmonary Disease?

  1. David J. Amrol, MD

Maybe not in patients with mild obstruction

  1. David J. Amrol, MD

In patients with typical respiratory symptoms and histories of exposure to inhaled toxins, chronic pulmonary obstructive disease (COPD) is diagnosed by confirming fixed airflow obstruction on spirometry (i.e., post-bronchodilator forced expiratory volume in 1 second [FEV1] to forced vital capacity [FVC] ratio of <0.70). After a patient is labeled as having COPD, this diagnosis often is not revisited. In this study, researchers used data from serial spirometry in more than 7000 patients with mild-to-moderate COPD in two prospective cohort studies to evaluate changes in airflow obstruction over time.

During 5 years, 13% and 27% of patients in the two studies no longer met criteria for fixed obstruction and thus no longer had COPD (diagnostic reversal), and 20% and 6% of patients had spirometry that varied year to year from normal to obstructed (diagnostic instability). Those patients who quit smoking had the greatest chance of diagnostic reversal, and those with the mildest baseline obstruction had the most diagnostic instability.

Comment

I'm frequently surprised to find normal spirometry in patients previously labeled as having COPD. Although more than 95% of patients with FEV1:FVC ratios of <0.65 still retain COPD diagnoses 5 years later, COPD should not be diagnosed in patients with GOLD stage 1 disease based on a single spirometric measure. We should be especially wary of diagnosing COPD during acute viral respiratory infections. Spirometry should be repeated annually in patients with borderline obstruction, and they should feel encouraged that as many as 25% of them can reverse their diagnoses with smoking cessation.

Editor Disclosures at Time of Publication

  • Disclosures for David J. Amrol, MD at time of publication Consultant / Advisory board CSL Behring; Horizon Pharmaceuticals

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