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Comparative Study
, 8 (1), 89

COPD Diagnosis Related to Different Guidelines and Spirometry Techniques

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Comparative Study

COPD Diagnosis Related to Different Guidelines and Spirometry Techniques

Lennart Nathell et al. Respir Res.

Abstract

The aim was to compare the diagnosis of COPD among smokers according to different international guidelines and to compare the outcome when using slow (SVC) and forced vital capacity (FVC). In order to find current smokers a questionnaire was sent to persons who had been on sick leave for more than two weeks. Those who smoked more than 8 cigarettes per day were invited to perform a spirometry. Totally 3,887 spirometries were performed. In this sample 10.2% fulfilled the NICE COPD-criteria, 14.0% the GOLD COPD-criteria and 21.7% the ERS COPD criteria. The diagnosis according to NICE and GOLD guidelines is based on FVC and in the ERS guidelines the best value of either SVC or FVC is used. Thus, substantially more subjects with COPD were found when the best of either SVC or FVC was used. Forced VC tended to be higher than SVC when lung function was normal and in those with mild obstruction prior to bronchodilatation whereas SVC exceeded FVC after bronchodilatation in those who had severe bronchial obstruction.The diagnosis of COPD is highly depending on which guidelines are used for defining the disease. If FVC and not the best of SVC and FVC is used when defining COPD the diagnosis will be missed in a substantial number of patients.

Figures

Figure 1
Figure 1
Number of participants in each step of the study.
Figure 2
Figure 2
A. Slow (SVC) and forced vital capacity (FVC) before bronchodilatation in 3887 smokers and pre- and post-bronchodilatation in 1577 smokers with a pre-bronchodilator FEV1/VC-ratio below 0.75. B. The difference between SVC and FVC corrected for VC-level in the same smokers as in panel A.
Figure 3
Figure 3
Relationship between pre- and post-bronchodilator slow (SVC) and forced (FVC) vital capacity corrected for VC-level in 1577 smokers with a pre-bronchodilator FEV1/VC -ratio below 0.75.
Figure 4
Figure 4
A. Difference between pre-bronchodilator slow (SVC) and forced (FVC) vital capacity related to FEV1 as percent of predicted value prior to bronchodilatation in 3881 smokers. Due to difficulties in taking instructions or technical errors data from 6 spirometries were not included in the analyses which thus are based on 3881 and not 3887 smokers. B. Difference between post-bronchodilator slow (SVC) and forced (FVC) vital capacity related to FEV1 as percent of predicted value after bronchodilatation in 1574 smokers with a pre-bronchodilator FEV1/VC -ratio below 0.75. Due to unacceptable measurements or technical errors data from 3 spirometries were not included in the analyses which thus is based on 1574 and not 1577 smokers.

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