Abstract
PURPOSE We wanted to determine the diagnostic value of an oral prednisolone test for chronic obstructive pulmonary disorders.
METHODS Two hundred thirty-three patients with cough for longer than 14 days, without known chronic obstructive pulmonary disease (COPD) or asthma, participated in a diagnostic study in Dutch primary care between 2006 and 2009. These patients used a 14-day prednisolone test of 30 mg/d and recorded before-after bronchodilator measurements of forced expiratory volume in 1 second (FEV1). An expert panel determined the presence or absence of COPD and asthma based on an extensive diagnostic workup. The proportion of responders to the prednisolone test (increased FEV1 exceeding 200 mL or 12% of baseline) per diagnosis group was compared, and the diagnostic value of the test was quantified by logistic regression and analysis of the area under the receiver operating characteristic curve (ROC area).
RESULTS In patients with COPD, 23% (14 of 61) responded to the test; in patients with asthma 4% (1 of 25) responded; in patients with asthma and COPD, 7% (1 of 14) responded; and in those without asthma or COPD, 11% (14 of 133) responded. Being a responder was, unexpectedly, associated with COPD (OR = 2.4; 95% confidence interval [CI], 1.1–5.2). After multivariate analysis, adjusting for age, sex, and smoking, the OR = 2.0 (95% CI, 0.8–5.0) and the ROC area did not increase (0.78; 95% CI, 0.72–0.85 vs 0.79; 95% CI, 0.72–0.85).
CONCLUSION A response to a prednisolone test was suggestive of COPD, but added no diagnostic value to more easily obtainable characteristics.
Footnotes
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Conflicts of interest: Dr Sachs has been a speaker at congresses sponsored by GlaxoSmithKline, Boehringer-Ingelheim, Pfizer or AstraZeneca. Dr Verheij participates in studies that received grants from GlaxoSmithKline and Wyeth.
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Financial support: This work was funded by the Netherlands Organisation for Health Research and Development (ZonMw), grant No. 945-04-015; and research grants from GlaxoSmithKline, Boehringer-Ingelheim, and Pfizer.
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Disclaimer: The study sponsors had no involvement in the study design, the collection, analysis, and interpretation of the data, the writing of the report, or in the decision to submit the paper for publication.
- Received for publication May 25, 2010.
- Revision received October 25, 2010.
- Accepted for publication November 5, 2010.
- © Annals of Family Medicine, Inc.