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New Gold Guidelines Recommend Using Pre-Bronchodilator Spirometry to Rule Out Copd and Post-Bronchodilator Measurements To Confirm Copd Diagnosis.
For Decades, The Global Initiative for Chronic Obstructive Lung Disease (Gold) Report has Advised Copd Assessment in Patients with Chronic Respiratory Sympton and/OR Exposure to Cigarette Smoking and Other Risk Factors. To Confirm Copd, Forced Spirometry Showing Airflow Obstruction After Bonchodilation Is Required, Using a Threshold of Post-Bronchodilator (BD) Forced Expiratory Volume In 1 Second (Feb1)/Forced Vital Capacity (FVC) Ratio of Less Than 0.7.
“The Concept That Airflow Obstruction in Copd is Persistent and Cannot Be Fully Reverse Proceded for This Recommendation, With Post-BD Feb1/FVC Less Than 0.7 Ensuring That the Diagnosis of Copd Was Confined to People with Perse persistent airflow obstruction Propitage BD Treatment, ”Wrot Corresponding Author Dave Singh, MDand colleagues in a report published in the European Respiratory Journal.
After Reevaluating Evidence for Using Pre- Post-BD Spirometry to Diagnose Copd, The Gold Science Committee NowDers Using Pre-BD Spirometry to Rule Out Copd and Post-BD Measurements to Confirm Copd Diagnosis.
“This Will Reduce Clinical Workload,” Dr Singh and Coauthors Advised.
Pre- and Post-BD Spirometry have benn shown to Provide Consistency in Most Patients, Although the Post-BD Values Lowers the Prevalence of Copd By More than One-Third, The Report’s Authors Explained. Issues May Occur In “Volume” Response and “Flow” Response.
“Volume Response Have Reduced Fvc Due To Gas Trapping Causing Fev1/FVC Greater Than or Equal To 0.7 Pre-BD,” The Authors Wrote, “But Volume Response Occurso Post-BD with Greater Improvement in FVC Relative To Feb1, Decreasing The Ratio To Less Than 0.7.”
In Flow Responses, Flow Responses Increase The Fev1/FVC Ratio From Less Than 0.7 Pre-BD To Greater Than or Equal To 0.7 Post-BD. Nevertheless, Patients with Flow Response Have an Increased Chance of Developing Copd and Should Be Monitored Over Time.
Per the Gold 2025 Report, Pre-BD Spirometry is Useful as an Initial Test to Identify Airflow Obstruction. IF results from not indicate obstruction, most patients will not need post-BD spirometry. Instances Where the Clinical Suspicion of Copd is High are an exception. ADDITIONALLY, LOWER PRE-BD FEV1 MASURES (<80% PREDICTED) COULD SIGNAL VOLUME RESPOND.
“Post-BD Results Close to the Threshold Should Be Repeated to Tessure a Correct Diagnosis is Made,” The Authors Wrote. “Post-BD Measurements Ensure That Volume Response Are Not Overloked and Limit Copd Overdiagnosis.”
