RT Journal Article
SR Electronic
T1 Airway Obstruction and Bronchodilator Responsiveness in Adults With Acute Cough
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 523
OP 529
DO 10.1370/afm.1416
VO 10
IS 6
A1 Vugt, Saskia van
A1 Broekhuizen, Lidewij
A1 Zuithoff, Nicolaas
A1 Butler, Christopher
A1 Hood, Kerenza
A1 Coenen, Samuel
A1 Goossens, Herman
A1 Little, Paul
A1 Almirall, Jordi
A1 Blasi, Francesco
A1 Chlabicz, Slawomir
A1 Davies, Mel
A1 Godycki-Cwirko, Maciek
A1 Hupkova, Helena
A1 Kersnik, Janko
A1 Moore, Michael
A1 Schaberg, Tom
A1 De Sutter, An
A1 Torres, Antoni
A1 Verheij, Theo
A1 ,
YR 2012
UL http://www.annfammed.org/content/10/6/523.abstract
AB 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 (FEV1) of 12% or more after bronchodilation. Airway obstruction was diagnosed according to 2 thresholds for the (postbronchodilator) ratio of FEV1 to forced vital capacity (FEV1: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 FEV1/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.