Article Figures & Data
Figures
- Figure 1
Flowchart of the study and the participants.
COPD = chronic obstructive pulmonary disease.
a Spirometry after the prednisolone test took place maximally 5 days after the 14th day of prednisolone treatment.
Tables
- Table 1
Characteristics of Included and Excluded Participants Measured Before Prednisolone Test Treatment
Characteristics Included N=233 Excluded N=167 P Value History Age, mean (SD), y 63 (9) 63 (9) .7a Male, % 49 40 .1b Duration of cough, mean [median] (SD)d 110 [42] (197) 89 [35] (171) .30c Current smoker, % 27 24 .4b Pack years of smoking mean [median] (SD) 19 [10] (24) 12 [4] (20) .01c Allergy for pollen or dust mite, % 14 13 .8b Current use inhaled steroids, % 13 10 .3b Spirometryd FEV1, mean (SD), L 2.6 (0.8) 2.7 (0.7)e .7a FEV1, predicted mean (SD), % 93 (20) 96 (19)e .3a FVC, predicted mean (SD), % 103 (19) 102 (19)e .4a FEV1/FVC, mean (SD), % 73 (10) 76 (12)e .004a - Table 2
Response to the Test Treatment With Prednisolone in 233 Patients With Persistent Cough
Postbronchodilator Total N=233 COPD n=61 Asthma n=25 COPD and Asthma n=14 No COPD or Asthma n=133 P Value Increased FEV1, median (SD), %a 0 (9) 1 (10) 1 (4) −5 (6) 0 (9) .01b Increased FEV1, median (SD), mLc 0 (190) 20 (230) 30 (130) −100 (150) 0 (170) .01b Responder: >12% or 200 mL, n (%) 30 (13)d 14 (23)e 1 (4) 1 (7) 14 (11) .03f -
COPD = chronic obstructive pulmonary disease; FEV1 = forced expiratory volume in 1 second.
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↵a [(FEV1 posttest–FEV1 pretest)/FEV1 pretest]x100%.
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↵b Kruskal Wallis test.
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↵c FEV1 posttest–FEV1 pretest.
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↵d In all 30 responders, FEV1 was >200 mL, and in 18 cases FEV1 was also >12% of baseline.
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↵e Of these 14, 11 had mild and 3 had moderate to severe COPD.
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↵f χ2 Test.
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- Table 3
Results of Univariate Characteristics of the Prednisolone Test for COPD and Multivariate Analysis of Responder Characteristics
Diagnostic Variables OR (95% CI) PPV % (95% CI) NPV % (95% CI) LR+ (95% CI) LR− (95% CI) Univariate analysis Responder 2.4 (1.1–5.2) 50 (33–67) 70 (64–76) 2.1 (1.1–4.1) 0.9 (0.8–1.0) Multivariate analysis Responder 2.0 (0.8–5.0) – – – – Age (per 5 y) 1.4 (1.1–1.7) – – – – Male 2.3 (1.2–4.3) – – – – Current smoking 8.3 (4.0–17.2) – – – – -
CI=confidence interval; COPD = chronic obstructive pulmonary disease; LR+ = positive likelihood ratio; LR− = negative likelihood ratio; NPV = negative predictive value; OR = odds ratio; PPV = positive predictive value.
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Note: The 14 patients with both asthma and COPD were included as patients with COPD in this analysis.
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The Article in Brief
Diagnostic Value of Oral Prednisolone Test for Chronic Obstructive Pulmonary Disorders
Berna D. L Broekhuizen , and colleagues
Background A patient�s response to oral prednisolone, a corticosteroid drug, is sometimes used to help diagnose chronic obstructive pulmonary disorders. This study examined the added value of using oral prednisolone for this diagnostic purpose.
What This Study Found A response to oral prednisolone is suggestive of chronic obstructive pulmonary disease (COPD), but, when added to other diagnostic information, does not have relevant value for diagnosing or excluding COPD. Of 233 patients complaining of cough who were given a 14-day test treatment with oral prednisolone, researchers found those who responded to the treatment were more likely to have COPD than asthma. After adjusting for age, sex and smoking status, however, the association between prednisolone and COPD was no longer statistically significant.
Implications
- In light of the unwillingness of many patients to undergo the prednisolone test, the authors recommend against using it in the diagnostic workup when COPD is suspected.
