Airway Obstruction and Bronchodilator Responsiveness in Adults With Acute Cough

1. Saskia van Vugt, MD, MSc, 
2. Lidewij Broekhuizen, MD, PhD,
3. Nicolaas Zuithoff, MSc, PhD, 
4. Christopher Butler, MD, PhD,
5. Kerenza Hood, PhD, 
6. Samuel Coenen, MD, PhD, 
7. Herman Goossens, MD, PhD, 
8. Paul Little, MD, PhD, 
9. Jordi Almirall, MD, PhD,
10. Francesco Blasi, MD, PhD, 
11. Slawomir Chlabicz, MD, PhD, 
12. Mel Davies, RN, PhD, 
13. Maciek Godycki-Cwirko, MD, PhD, 
14. Helena Hupkova, MD, PhD, 
15. Janko Kersnik, MD, PhD, 
16. Michael Moore, MD, PhD,
17. Tom Schaberg, MD, PhD, 
18. An De Sutter, MD, PhD, 
19. Antoni Torres, MD, PhD, 
20. Theo Verheij, MD, PhD and 
21. On behalf of the GRACE Project Group

+Author Affiliations

1. University Medical Center Utrecht, Julius Center for Health, Sciences and Primary Care, Utrecht, the Netherlands (van Vugt, Broekhuizen, Zuithoff, Verheij); Cardiff University, Institute of Primary Care and Public Health Medicine, Cardiff, Wales, United Kingdom (Butler, Hood); University of Antwerp, Vaccine & Infectious Disease Institute (VAXINFECTIO), Antwerp, Belgium (Coenen, Goossens); Primary Care Medical Group, University of Southampton Medical School, Southampton, United Kingdom (Little, Moore); Intensive Care Unit, Hospital de Mataro, Mataro, Spain (Almirall); Respiratory Medicine Section, Dipar-timento Toraco-Polmonare e Cardiocircolatorio, University of Milan, IRCCS Fondazione Cà Granda, Milan, Italy (Blasi); Department of Family Medicine and Community Nursing, Medical University of Bialystok, Bialystok, Poland (Chlabicz); Ely Bridge Surgery, Ely Bridge Surgery, Cardiff, United Kingdom (Davies); Department of Family and Community Medicine, Medical University of Lodz, Lodz, Poland (Godycki-Cwirko); Institute of Microbiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia (Hupkova); Zdravstveni dom Jesenice and University of Ljubljana Medical School, Slovenia (Kersnik); Zentrum für Pneumologie, Diakoniekrankenhaus Rotenburg, Rotenburg, Germany (Schaberg); Ghent University, University Hospital, Ghent, Belgium (De Sutter); Servei de Pneumologia, Institut Clinic del Torax, Barcelona, Spain (Torres)

1. CORRESPONDING AUTHOR: Lidewij Broekhuizen, MD, PhD, Julius Center for Health Sciences and Primary Care, Stratenum 6.131 - P.O.Box 85500, NL- 3508 GA, Utrecht, the Netherlands, b.d.l.broekhuizen@umcutrecht.nl

 

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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 (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.

Ann Fam Med November/December 2012 10:523-529;doi:10.1370/afm.1416

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