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Pre- and post-bronchodilator airway obstruction are associated with similar clinical characteristics but different prognosis - report from a population-based study

Artikel i vetenskaplig tidskrift
Författare S. Sawalha
L. Hedman
E. Ronmark
Bo Lundbäck
A. Lindberg
Publicerad i International Journal of Chronic Obstructive Pulmonary Disease
Volym 12
Sidor 1269-1277
ISSN 1178-2005
Publiceringsår 2017
Publicerad vid Krefting Research Centre
Institutionen för medicin
Sidor 1269-1277
Språk en
Länkar https://doi.org/10.2147/COPD.S12792...
Ämnesord epidemiology, spirometry, chronic airflow obstructions, mortality, pulmonary-disease, northern-sweden, lung-disease, respiratory symptoms, gender-differences, follow-up, copd, mortality, prevalence, health, Respiratory System
Ämneskategorier Epidemiologi, Lungmedicin och allergi

Sammanfattning

Introduction: According to guidelines, the diagnosis of COPD should be confirmed by post-bronchodilator (post-BD) airway obstruction on spirometry; however, in clinical practice, this is not always performed. The aim of this population-based study was to compare clinical characteristics and prognosis, assessed as mortality, between subjects with airway obstruction divided into pre-but not post-BD obstruction, post-BD airway obstruction (COPD), and subjects without airway obstruction. Materials and methods: In 2002-2004, four adult population-based cohorts were reexamined with spirometry and structured interview. Subjects with airway obstruction, with a ratio of forced expiratory volume in 1 s to (forced) vital capacity,0.70 (n=993), were identified together with sex-and age-matched referents (n=993). These subjects were further divided into subjects with pre-but not post-BD airway obstruction (pre-not post-BD obstruction) and subjects with post-BD airway obstruction (COPD). Mortality data were collected until December 31, 2014. Results: Out of 993 subjects with airway obstruction, 736 (74%) had COPD and 257 (26%) pre-not post-BD obstruction. Any respiratory symptoms, allergic rhinitis, asthma, exacerbations, and comorbidities were equally common among subjects with COPD and pre-not post-BD obstruction, but less common among nonobstructive subjects. Mortality was highest among subjects with COPD and higher in men than in women. In both sexes, COPD, but not pre-not post-BD obstruction, was associated with an increased risk for death compared to those without airway obstruction. When COPD was divided into Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages, GOLD 2 and 3-4 had an increased risk for death when compared to the nonobstructive group, also when adjusted for common confounders and comorbidities such as heart disease, diabetes, and anxiety/depression. Conclusion: Even though subjects with COPD and pre-not post-BD obstruction had fairly similar presentation of clinical characteristics, only those with COPD, specifically GOLD stage >= 2, had increased risk for death when compared with nonobstructive subjects.

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