Role of Bronchodilator Reversibility Testing in Differentiating Asthma From COPD

만성폐쇄성폐질환과 천식을 감별 진단하는데 기관지확장제 가역성 검사의 역할

  • Oh, Yeon-Mok (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lim, Chae Man (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Shim, Tae Sun (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Koh, Younsuck (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Woo Sung (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Dong-Soon (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Won Dong (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Se Kyu (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Yoo, Jee Hong (Department of Internal Medicine, School of Medicine, Kyung Hee University) ;
  • Lee, Sang Do (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • 오연목 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 임채만 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 심태선 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 고윤석 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 김우성 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 김동순 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 김원동 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 김세규 (연세대학교 의과대학 내과학교실) ;
  • 유지홍 (경희대학교 의과대학 내과학교실) ;
  • 이상도 (울산대학교 의과대학 서울아산병원 호흡기내과)
  • Received : 2004.08.18
  • Accepted : 2004.09.20
  • Published : 2004.11.30

Abstract

Background : Although bronchodilator reversibility testing is widely performed to diagnose asthma or COPD, there is debate upon its usefulness and methods to differentiate asthma from COPD. The purpose of this study is to elucidate the role of bronchodilator reversibility testing in differentiating asthma from COPD and to confirm which method is better at evaluating bronchodilator reversibility. Methods : 26 asthma patients and 31 COPD patients were reviewed retrospectively. Spirometry was performed before and after bronchodilator inhalation to get $FEV_1$, FVC. To evaluate bronchodilator reversibility, the increase in $FEV_1$ or FVC was expressed as three methods, 'percentage of the baseline value', 'percentage of the predicted value', or 'absolute value'. Area under the ROC curve was measured to compare the three methods. In addition, the criteria of American Thoracic Society (ATS) for bronchodilator reversibility were compared to those of European Respiratory Society (ERS). Results : 1. In differentiating asthma from COPD, 'percentage of the predicted value', or 'absolute value' method was useful but 'percentage of the baseline value' was not. However, the ability to differentiate was weak because areas under the ROC curves by all methods were less than 0.75. 2. The criteria of ERS were superior to those of ATS for bronchodilator reversibility to differentiate asthma from COPD because likelihood ratio (LR) of a positive test by ERS criteria was greater than ATS criteria and because LR of a negative test by ERS criteria was less than ATS criteria. Conclusion : In differentiating asthma from COPD, bronchodilator reversibility testing has a weak role and should be considered as an adjunctive test.

References

  1. National Heart, Lune, and Blood Institute/ World Health Organization workshop report: Global Strategy for Asthma Management and Prevention [Internet]. National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA [revised 2002; cited Aueust 2003]. Available from: URL: http://www.ginasthma.com
  2. National Heart, Lung, and Blood Institute and World Health Organization. Global initiative for chronic obstructive lung disease-Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease [Internet]. National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA [revised 2003; cited August 2004]. Available from: URL: http://www.goldcopd.com
  3. Crapo RO. Pulmonary function testing, In: Baum GL, Crapo JD, Celli BR, Karlinsky BJ, editors. Textbook of pulmonary diseases. 6th ed. Philadelphia: Lippin cott-Raven; 1998. p. 199-218
  4. Gold WM. Pulmonary function testing, In: Murray JF, Nadel JA, editors. Textbook of Respiratory Medicine. 3rd ed. Philadelphia: W.B. Saunders Company; 2000. p. 781-881
  5. Calverley PM, Burge PS, Spencer S, Anderson JA, Jones PW. Bronchodilator reversibility testing in chronic obstructive pulmonary disease. Thorax 2003;58:659-64
  6. Rebuck AS, Read J. Assessment and management of severe asthma. Am J Med 1971;51:788-98
  7. National Collaborating Centre for Chronic Conditions. Chronic obstructive pulmonary disease National clinical guideline on management of chronic obstructive pulmonary disease in adults in primary and secondary care. Thorax 2004;59(Suppl I):1-232
  8. American Thoracic Society. Lung function testing: selection of reference values and interpretative strategies. Am J Respir Crit Care Med 1991:144:1202-18
  9. Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Fabbri LM, et al. Lung volumes and forced ventilatory flows. Report Working Party Standar-dization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J 1993:16;5-40
  10. Morris JF. Spirometry in the evaluation of pulmonary function. West J Med 1976;125:110-8
  11. Eliasson O, Degraff AC Jr. The use of criteria for reversibility and obstruction to define patient groups for bronchodilator trials. Influence of clinical diagnosis, spirometric, and anthropometric variables. Am Rev Respir Dis 1985;132:858-64
  12. Quadrelli SA, Roncoroni AJ, Montiel GC. Evaluation of bronchodilator response in patients with airway obstruction. Respir Med. 1999;93:630-6
  13. American Thoracic Society and European Respiratory Society. Standards for the diagnosis and treatment of patients with chronic obstructive pulmonary disease [Internet]. American Thoracic Society. New York, NY, USA [revised 2004; cited 8 August 2004]. Available from URL: http://www.thoracic.org/COPD