Bronchodilator reversibility in Australian adults with chronic obstructive pulmonary disease.
OBJECTIVE
Bronchodilator reversibility (BDR) and inhaled corticosteroid (ICS) use were assessed for volunteers who responded to an advertisement requesting current or ex-smokers who were experiencing breathlessness to attend for lung function testing.


METHODS
One hundred and fifty-four volunteers responded. Forced expiratory volume (FEV1) was measured before and after 400 microg of salbutamol. Significant BDR was assessed according to guidelines of: (i) the American Thoracic Society (> or =12% plus 200 mL of baseline FEV1 or forced vital capacity), (ii) the British-Thoracic Society (BTS) (> or =15% plus 200 mL of baseline FEV1), (iii) the European Thoracic Society (> or =10% predicted FEV1), and (iv) the most commonly used criteria in Australia and New Zealand (> or =15% of baseline FEV1).


RESULTS
One hundred and twenty-three subjects (33 female; 40 current smokers; median pack years 48 (range 5-144)) were suitable for analysis (i.e. had no history of asthma, demonstrable airflow limitation and a forced expiratory ratio (FER) of <70%). Twenty (16%) patients had an FEV1 within the normal range but FER of <70%, 24 (20%) patients had mild disease (FEV1 60-80% predicted), 31 (24%) patients had moderate disease (FEV1 40-59% predicted), and 48 (39%) patients had severe disease (FEV1 <40% predicted), according to BTS criteria. Significant BDR was evident in: (i) 58 (47%) subjects by American criteria, (ii) 26 (21%) subjects by British criteria, (iii) 19 (15%) subjects by European criteria and (iv) 36 (29%) subjects by Australasian criteria. ICS use was reported by 71 (58%) subjects overall and was weakly, but significantly, related to poorer FEV1 (r = -0.2; P < 0.01), and greater BDR (r = 0.3; P < 0.005).


CONCLUSIONS
Chronic obstructive pulmonary disease in Australian volunteers with no history of asthma encompasses many individuals with significant BDR. Interestingly, most volunteers reported ICS use and this was related to poorer spirometry and greater BDR. However, until the underlying immuno-pathology has been determined they cannot be assumed to have "asthma" or even an "asthmatic element".
Reid
D W
DW
Department of Respiratory Medicine and Monash Medical School, Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia.
Soltani
A
A
Johns
D P
DP
Bish
R
R
Williams
T J
TJ
Burns
G P
GP
Walters
E H
EH
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy; D001993:Bronchodilator Agents; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents