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Correspondence |

Does Spirometry Still Measure Up in the Diagnosis of COPD?Spirometry in the Diagnosis of COPD FREE TO VIEW

Wouter D. van Dijk, MD
Author and Funding Information

From the Department of Primary and Community Care, Radboud University Nijmegen Medical Centre.

Correspondence to: Wouter D. van Dijk, MD, Radboud University Nijmegen Medical Centre, Department of Primary and Community Care (117-ELG), Geert Grooteplein noord 21, 6525 EZ, Nijmegen, The Netherlands; e-mail: w.vandijk@aios.umcn.nl


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(1):276-277. doi:10.1378/chest.12-2083
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Published online
To the Editor:

An adequate and early diagnosis of COPD is essential for an appropriate and efficient treatment of this debilitating disease. Currently, spirometry is required to establish a diagnosis of COPD in patients with chronic respiratory symptoms or in those at risk.1 According to the results reported in CHEST (December 2012) by Mohamed Hoesein et al,2 this approach would misdiagnose an important group of patients who do not (yet) fulfill the spirometry diagnostic criteria; that is, among male heavy smokers, those with higher FEV1/FVC ratios may be the ones with the fastest FEV1 decline, a hallmark of COPD. However, from their regression model that exposed potential confounders, it appears that a higher level of FEV1 actually preserved airflow.2 Adjustments for this confounder would have subsequently disfavored individuals with higher FEV1/FVC ratios. I wonder how the different groups would compare without these adjustments. Moreover, a recent article by Akkermans et al3 revealed a faster FEV1 decline for patients with lower FEV1/FVC ratios in both smokers and nonsmokers. Although the ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints), UPLIFT (Understanding Potential Long-term Impacts on Function With Tiotropium), and TORCH (Towards a Revolution in COPD Health) trials indeed found FEV1 decline to be inversely related to GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage, as recognized by Mohamed Hoesein et al,3 this effect may as well be explained by the inverse relation across all studies between GOLD stage and the prevalence of current smoking, the most important factor for FEV1 decline.4-7

Whether a horse-racing effect should be acknowledged in the progression of COPD remains undecided. As yet, the current spirometry diagnostic criteria appear to remain crucial in the diagnosis of COPD. In the end, one of the striking results from this cohort appears to be the relatively high FEV1 decline in heavy smokers. Apart from an adequate diagnosis of COPD, smoking may still be the most important and practical tool to predict future disease and may as well be the most important feature at which to direct intervention.

References

Global Initiative for Chronic Obstructive Lung Disease. Global strategy for diagnosis, management, and prevention of COPD. Global Initiative for Chronic Obstructive Lung Disease website.http://www.goldcopd.org. Updated December 2011. Accessed July 1, 2012.
 
Mohamed Hoesein FAA, Zanen P, Boezen HM, et al. Lung function decline in male heavy smokers relates to baseline airflow obstruction severity. Chest. 2012;142(6):1530-1538. [CrossRef]
 
Akkermans RP, Berrevoets MA, Smeele IJ, et al. Lung function decline in relation to diagnostic criteria for airflow obstruction in respiratory symptomatic subjects. BMC Pulm Med. 2012;12(1):12. [CrossRef] [PubMed]
 
Agusti A, Calverley PM, Celli B, et al;. Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) Investigators Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) Investigators. Characterisation of COPD heterogeneity in the ECLIPSE cohort. Respir Res. 2010;11:122. [PubMed]
 
Kesten S, Celli B, Decramer M, Liu D, Tashkin D. Adverse health consequences in COPD patients with rapid decline in FEV1—evidence from the UPLIFT trial. Respir Res. 2011;12:129. [CrossRef] [PubMed]
 
Jenkins CR, Jones PW, Calverley PM, et al. Efficacy of salmeterol/fluticasone propionate by GOLD stage of chronic obstructive pulmonary disease: analysis from the randomised, placebo-controlled TORCH study. Respir Res. 2009;10:59. [CrossRef] [PubMed]
 
Vestbo J, Edwards LD, Scanlon PD, et al;. ECLIPSE Investigators ECLIPSE Investigators. Changes in forced expiratory volume in 1 second over time in COPD. N Engl J Med. 2011;365(13):1184-1192. [CrossRef] [PubMed]
 

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References

Global Initiative for Chronic Obstructive Lung Disease. Global strategy for diagnosis, management, and prevention of COPD. Global Initiative for Chronic Obstructive Lung Disease website.http://www.goldcopd.org. Updated December 2011. Accessed July 1, 2012.
 
Mohamed Hoesein FAA, Zanen P, Boezen HM, et al. Lung function decline in male heavy smokers relates to baseline airflow obstruction severity. Chest. 2012;142(6):1530-1538. [CrossRef]
 
Akkermans RP, Berrevoets MA, Smeele IJ, et al. Lung function decline in relation to diagnostic criteria for airflow obstruction in respiratory symptomatic subjects. BMC Pulm Med. 2012;12(1):12. [CrossRef] [PubMed]
 
Agusti A, Calverley PM, Celli B, et al;. Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) Investigators Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) Investigators. Characterisation of COPD heterogeneity in the ECLIPSE cohort. Respir Res. 2010;11:122. [PubMed]
 
Kesten S, Celli B, Decramer M, Liu D, Tashkin D. Adverse health consequences in COPD patients with rapid decline in FEV1—evidence from the UPLIFT trial. Respir Res. 2011;12:129. [CrossRef] [PubMed]
 
Jenkins CR, Jones PW, Calverley PM, et al. Efficacy of salmeterol/fluticasone propionate by GOLD stage of chronic obstructive pulmonary disease: analysis from the randomised, placebo-controlled TORCH study. Respir Res. 2009;10:59. [CrossRef] [PubMed]
 
Vestbo J, Edwards LD, Scanlon PD, et al;. ECLIPSE Investigators ECLIPSE Investigators. Changes in forced expiratory volume in 1 second over time in COPD. N Engl J Med. 2011;365(13):1184-1192. [CrossRef] [PubMed]
 
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