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Airway obstruction and bronchodilator responsiveness in adults with acute cough

Airway obstruction and bronchodilator responsiveness in adults with acute cough
Airway obstruction and bronchodilator responsiveness in adults with acute cough
PURPOSE: 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.
acute cough, asthmachronic obstructive pulmonary disease, primary health care, spirometry
1544-1709
523-529
Vugt, S.V.
dfa0bc32-ac59-4848-a626-0a4c09ee3ef3
Broekhuizen, L.
87f94aef-2d83-45e9-ab72-74888ec324a3
Zuithoff, N.
fa5af62a-8684-410d-8768-d1e28b0bb003
Butler, C.
7fb510dd-3e7b-4a9a-809c-5c1549b1e7f1
Hood, K.
12e14eb3-2c75-409f-a69d-add733644d89
Coenen, S.
9afe2a52-9f4f-45bb-b8e5-c6ee3eeb3498
Goossens, H.
533640f7-b568-4d95-a7c1-28158d154ba8
Little, P.
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Almirall, J.
252a968f-8b7b-47cd-ad7b-8c3f4f5cda4d
Blasi, F.
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Chlabicz, S.
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Davies, M.
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Godycki-Cwirko, M.
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Hupkova, H.
2af8dd03-035b-46ae-b338-acf19058e8c1
Kersnik, J.
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Moore, M.
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Schaberg, T.
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De Sutter, A.
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Torres, A.
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Verheij, T.
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GRACE Project Group
Vugt, S.V.
dfa0bc32-ac59-4848-a626-0a4c09ee3ef3
Broekhuizen, L.
87f94aef-2d83-45e9-ab72-74888ec324a3
Zuithoff, N.
fa5af62a-8684-410d-8768-d1e28b0bb003
Butler, C.
7fb510dd-3e7b-4a9a-809c-5c1549b1e7f1
Hood, K.
12e14eb3-2c75-409f-a69d-add733644d89
Coenen, S.
9afe2a52-9f4f-45bb-b8e5-c6ee3eeb3498
Goossens, H.
533640f7-b568-4d95-a7c1-28158d154ba8
Little, P.
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Almirall, J.
252a968f-8b7b-47cd-ad7b-8c3f4f5cda4d
Blasi, F.
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Chlabicz, S.
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Davies, M.
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Godycki-Cwirko, M.
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Hupkova, H.
2af8dd03-035b-46ae-b338-acf19058e8c1
Kersnik, J.
54a3eea5-f4fb-4fe7-9809-7d167353b19d
Moore, M.
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Schaberg, T.
b226b96b-c4b0-4d97-8b4d-e5ffe5b6bd76
De Sutter, A.
9114cd76-97bf-43c0-9dad-928318cea259
Torres, A.
6f6cb97f-8162-440c-a426-b96f19ebd4a1
Verheij, T.
cc355b92-ba85-4102-98a0-cee55f0504f6

Vugt, S.V., Broekhuizen, L., Zuithoff, N., Butler, C., Hood, K., Coenen, S., Goossens, H., Little, P., Almirall, J., Blasi, F., Chlabicz, S., Davies, M., Godycki-Cwirko, M., Hupkova, H., Kersnik, J., Moore, M., Schaberg, T., De Sutter, A., Torres, A. and Verheij, T. , GRACE Project Group (2012) Airway obstruction and bronchodilator responsiveness in adults with acute cough. Annals of Family Medicine, 10 (6), 523-529. (doi:10.1370/afm.1416). (PMID:23149529)

Record type: Article

Abstract

PURPOSE: 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.

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More information

Published date: November 2012
Keywords: acute cough, asthmachronic obstructive pulmonary disease, primary health care, spirometry
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 347573
URI: http://eprints.soton.ac.uk/id/eprint/347573
ISSN: 1544-1709
PURE UUID: 39e740bd-cb09-4947-9f47-6631e638eb24
ORCID for M. Moore: ORCID iD orcid.org/0000-0002-5127-4509

Catalogue record

Date deposited: 25 Jan 2013 15:13
Last modified: 09 Nov 2021 03:11

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Contributors

Author: S.V. Vugt
Author: L. Broekhuizen
Author: N. Zuithoff
Author: C. Butler
Author: K. Hood
Author: S. Coenen
Author: H. Goossens
Author: P. Little
Author: J. Almirall
Author: F. Blasi
Author: S. Chlabicz
Author: M. Davies
Author: M. Godycki-Cwirko
Author: H. Hupkova
Author: J. Kersnik
Author: M. Moore ORCID iD
Author: T. Schaberg
Author: A. De Sutter
Author: A. Torres
Author: T. Verheij
Corporate Author: GRACE Project Group

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