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


CONCLUSIONS
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.
Service de Physiologie et d'Exploration Fonctionnelle, EPS Farhat Hached, Sousse 4000, Tunisia.
Helmi
H
Ben Saad
Christian
C
Préfaut
Zouhair
Z
Tabka
Abdelkrim
A
Zbidi
Maurice
M
Hayot
D000280:Administration, Inhalation; D058666:Adrenergic beta-2 Receptor Agonists; D000368:Aged; D000420:Albuterol / Q000008:administration & dosage / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005541:Forced Expiratory Volume / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008176:Lung Volume Measurements / Q000379:methods; D008297:Male; D008875:Middle Aged; D010991:Plethysmography / Q000379:methods; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology*; D012123:Pulmonary Ventilation / Q000187:drug effects / Q000502:physiology; D013147:Spirometry / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D014797:Vital Capacity / Q000187:drug effects* / Q000502:physiology
D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents; D000420:Albuterol