Diagnostic value of post-bronchodilator pulmonary function testing to distinguish between stable, moderate to severe COPD and asthma.
Diagnostic value of post-bronchodilator pulmonary function testing to distinguish between stable, moderate to severe COPD and asthma.
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DOI：
10.2147/copd.s948
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发表时间：
2008
影响因子：
2.8
通讯作者：
Irusen EM
中科院分区：
文献类型：
--
作者：
Richter DC;Joubert JR;Nell H;Schuurmans MM;Irusen EM
GOLD指南建议，支气管扩张剂后1秒用力呼气量(FEV1)和预测值的80%，以及FEV1/用力肺活量(FVC)和70%的组合可确认COPD的诊断。关于区分COPD和哮喘的这些标准的准确性，目前存在有限的数据。因此，本研究的目的是探讨支气管扩张剂后肺功能参数在阻塞性肺疾病中的诊断价值。对基线特征相似的43例患者(COPD组22例，哮喘组21例)进行肺功能检测(基线FEV1分别为55.7%±7.6%和59.3%±8.4%)。根据三种公认的肺功能试验标准计算支气管扩张剂反应性(BDR)。第一个标准，支气管扩张剂治疗后FEV1和FVC的预测值的80%，结合治疗后FEV1/FVC的70%，诊断COPD的准确率为70%。联合检测对诊断COPD非常敏感(100%)，但不具特异性(38%)。第二个BDR标准定义为初始FEV1增加12%和200毫升，标准3增加预测FEV1的9%，诊断COPD的敏感性较低(分别为55%和59%)，但更具特异性(分别为81%和76%)。我们的发现表明，目前推荐的肺活量指数在区分COPD和哮喘方面并不是最理想的。
The GOLD guidelines suggest that the presence of a post-bronchodilator forced expiratory volume in one second (FEV1) < 80% of the predicted value in combination with a FEV1/forced vital capacity (FVC) < 70% confirms the diagnosis of COPD. Limited data exist regarding the accuracy of these criteria to distinguish between COPD and asthma. The aim of this study therefore was to investigate the diagnostic value of post-bronchodilator lung function parameters in obstructive lung disease. The pulmonary function tests of 43 (22 = COPD, 21 = asthma) patients with similar baseline characteristics were evaluated (baseline FEV1 were 55.7% ± 7.6%, and 59.3% ± 8.4% predicted for COPD and asthma, respectively). Bronchodilator responsiveness (BDR) was calculated according to three recognized pulmonary function test criteria. The first criteria, post-bronchodilator FEV1 < 80% of the predicted value in combination with a post-bronchodilator FEV1/FVC ratio of <70%, had an accuracy of 70% to diagnose COPD. This combination was very sensitive (100%) in diagnosing COPD, but it was not specific (38%). The second BDR criteria, defined as an increase of <12% and 200 mL of initial FEV1 and criterion number 3, an increase of < 9% of predicted FEV1, were less sensitive (55% and 59%, respectively), but more specific (81% and 76% respectively) to diagnose COPD. Our findings suggest that the current recommended spirometric indices are not optimal in differentiating between COPD and asthma.