The forgotten message from gold: FVC is a primary clinical outcome measure of bronchodilator reversibility in COPD

Pulm Pharmacol Ther. 2008 Oct;21(5):767-73. doi: 10.1016/j.pupt.2008.04.005. Epub 2008 May 6.


Background: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends the use of forced expiratory volume in 1s (FEV(1)) to assess airways reversibility. The American Thoracic Society (ATS) and the European Respiratory Society (ERS) recommend FEV(1) and/or forced vital capacity (FVC). This study assessed whether FVC detects reversibility in more chronic obstructive pulmonary disease (COPD) patients than FEV(1) after acute short-acting bronchodilator inhalation.

Methods: Plethysmographic data of 168 consecutive stable male COPD patients who underwent reversibility testing were analyzed.

Results: Seventy-seven patients showed a clinically significant increase in FVC, whereas only 49 patients showed a clinically significant increase in FEV(1). Thus, FVC detected reversibility in 57% more patients than FEV(1). Of the 90 patients showing clinically significant reversibility, FEV(1) did not detect 41 patients that FVC detected, indicating a 45% difference.

Conclusion: FEV(1) underestimates acute bronchodilation effects. FVC should thus be a primary clinical outcome measure of bronchodilator reversibility in COPD, as it detects reversibility in more patients. This message, forgotten by GOLD, should be promoted in future consensus statements.

MeSH terms

  • Administration, Inhalation
  • Adrenergic beta-2 Receptor Agonists
  • Aged
  • Albuterol / administration & dosage
  • Albuterol / therapeutic use
  • Bronchodilator Agents / administration & dosage
  • Bronchodilator Agents / therapeutic use*
  • Forced Expiratory Volume / drug effects
  • Forced Expiratory Volume / physiology
  • Humans
  • Lung Volume Measurements / methods
  • Male
  • Middle Aged
  • Plethysmography / methods
  • Practice Guidelines as Topic
  • Pulmonary Disease, Chronic Obstructive / diagnosis
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Pulmonary Disease, Chronic Obstructive / physiopathology*
  • Pulmonary Ventilation / drug effects
  • Pulmonary Ventilation / physiology
  • Spirometry / methods
  • Time Factors
  • Treatment Outcome
  • Vital Capacity / drug effects*
  • Vital Capacity / physiology


  • Adrenergic beta-2 Receptor Agonists
  • Bronchodilator Agents
  • Albuterol