CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Bronchodilator reversibility testing in chronic obstructive pulmonary disease

P M A Calverley¹, P S Burge², S Spencer³, J A Anderson⁴, P W Jones³ for the ISOLDE Study Investigators

¹ Department of Medicine, The University of Liverpool, Liverpool, UK
² Birmingham Heartlands Hospital, Birmingham, UK
³ St George’s Hospital Medical School, London, UK
⁴ Department of Medical Statistics, GlaxoSmithKline R&D, UK

Correspondence to:
Correspondence to:
Professor P M A Calverley, Clinical Science Centre, University Hospital Aintree, Liverpool L9 7AL, UK;
pmacal{at}liverpool.ac.uk

Background: A limited or absent bronchodilator response is used to classify chronic obstructive pulmonary disease (COPD) and can determine the treatment offered. The reliability of the recommended response criteria and their relationship to disease progression has not been established.

Methods: 660 patients meeting European Respiratory Society (ERS) diagnostic criteria for irreversible COPD were studied. Spirometric parameters were measured on three occasions before and after salbutamol and ipratropium bromide sequentially or in combination over 2 months. Responses were classified using the American Thoracic Society/GOLD (ATS) and ERS criteria. Patients were followed for 3 years with post-bronchodilator FEV₁ and exacerbation history recorded 3 monthly and health status 6 monthly.

Results: FEV₁ increased significantly with each bronchodilator, a response that was normally distributed. Mean post-bronchodilator FEV₁ was reproducible between visits (intraclass correlation 0.93). The absolute change in FEV₁ was independent of the pre-bronchodilator value but the percentage change correlated with pre-bronchodilator FEV₁ (r=-0.44; p<0.0001). Using ATS criteria, 52.1% of patients changed responder status between visits compared with 38.2% using ERS criteria. Smoking status, atopy, and withdrawing inhaled corticosteroids were unrelated to bronchodilator response, as was the rate of decline in FEV₁, decline in health status, and exacerbation rate.

Conclusion: In moderate to severe COPD bronchodilator responsiveness is a continuous variable. Classifying patients as "responders" and "non-responders" can be misleading and does not predict disease progression.

Keywords: chronic obstructive pulmonary disease; bronchodilator reversibility

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