title: Airway obstruction and bronchodilator responsiveness in adults with acute cough.
abstract: OBJECTIVE
  We sought to determine the prevalence of airway obstruction and bronchodilator responsiveness in adults consulting for acute cough in primary care.
  
  
  METHODS
  Family physicians recruited 3,105 adult patients with acute cough (28 days or shorter) attending primary care practices in 12 European countries. After exclusion of patients with preexisting physician-diagnosed asthma or chronic obstructive pulmonary disease (COPD), we undertook complete case analysis of spirometry results (n = 1,947) 28 to 35 days after inclusion. Bronchodilator responsiveness was diagnosed if there were recurrent complaints of wheezing, cough, or dyspnea and an increase of the forced expiratory volume in 1 second (FEV(1)) of 12% or more after bronchodilation. Airway obstruction was diagnosed according to 2 thresholds for the (postbronchodilator) ratio of FEV(1) to forced vital capacity (FEV(1):FVC): less than 0.7 and less than the lower limit of normal.
  
  
  RESULTS
  There were 240 participants who showed bronchodilator responsiveness (12%), 193 (10%) had a FEV(1)/FVC ratio of less than 0.7, and 126 (6%) had a ratio of less than the lower limit of normal. Spearman's correlation between the 2 definitions of obstruction was 0.71 (P <.001), with discordance most pronounced among those younger than 30 years and in older participants.
  
  
  CONCLUSIONS
  Both bronchodilator responsiveness and persistent airway obstruction are common in adults without established asthma or COPD who consult for acute cough in primary care, which suggests a high risk of undiagnosed asthma and COPD. Different accepted methods to define airway obstruction detected different numbers of patients, especially at the extremes of age. As both conditions benefit from appropriate and timely interventions, clinicians should be aware and responsive to potential underdiagnosis.
authors.affiliation: University Medical Center Utrecht, Julius Center for Health, Sciences and Primary Care, Utrecht, the Netherlands.
authors.forename: Saskia van
authors.initials: Sv
authors.lastname: Vugt
authors.forename: Lidewij
authors.initials: L
authors.lastname: Broekhuizen
authors.forename: Nicolaas
authors.initials: N
authors.lastname: Zuithoff
authors.forename: Christopher
authors.initials: C
authors.lastname: Butler
authors.forename: Kerenza
authors.initials: K
authors.lastname: Hood
authors.forename: Samuel
authors.initials: S
authors.lastname: Coenen
authors.forename: Herman
authors.initials: H
authors.lastname: Goossens
authors.forename: Paul
authors.initials: P
authors.lastname: Little
authors.forename: Jordi
authors.initials: J
authors.lastname: Almirall
authors.forename: Francesco
authors.initials: F
authors.lastname: Blasi
authors.forename: Slawomir
authors.initials: S
authors.lastname: Chlabicz
authors.forename: Mel
authors.initials: M
authors.lastname: Davies
authors.forename: Maciek
authors.initials: M
authors.lastname: Godycki-Cwirko
authors.forename: Helena
authors.initials: H
authors.lastname: Hupkova
authors.forename: Janko
authors.initials: J
authors.lastname: Kersnik
authors.forename: Michael
authors.initials: M
authors.lastname: Moore
authors.forename: Tom
authors.initials: T
authors.lastname: Schaberg
authors.forename: An
authors.initials: A
authors.lastname: De Sutter
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
authors.forename: Theo
authors.initials: T
authors.lastname: Verheij
mesh_terms: D000208:Acute Disease; D000328:Adult; D000402:Airway Obstruction / Q000453:epidemiology*; D001249:Asthma / Q000175:diagnosis*; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D003371:Cough / Q000188:drug therapy* / Q000209:etiology; D003430:Cross-Sectional Studies; D005060:Europe / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis*; D013147:Spirometry / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents