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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
- Sawalha, Sami (author)
- Hedman, Linnea (author)
- Rönmark, Eva (author)
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- Lundbäck, Bo (author)
- Lindberg, Anne (author)
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- 2017
- 2017
- English.
- In: The International Journal of Chronic Obstructive Pulmonary Disease. - 1176-9106. ; 12, 1269-1277
- swepub:Mat__t
Abstract
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- 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.
Subject headings
- Medical and Health Sciences (hsv)
- Health Sciences (hsv)
- Environmental Health and Occupational Health (hsv)
- Medicin och hälsovetenskap (hsv)
- Hälsovetenskaper (hsv)
- Miljömedicin och yrkesmedicin (hsv)
Keyword
- chronic airflow obstructions
- epidemiology
- mortality
- spirometry
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- Hedman, Linnea
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