How to Manage COPD. Interpretation of the obstructive pattern on PFTs is usually based on the FEV1/FVC ratio, and severity is based on the FEV1 and DLCO.4 Lung volume, specifically TLC is used to evaluate for the presence of restriction.4 So in daily practice of PFT interpretation, lung volume measurements are not needed to establish a diagnosis of obstructive lung disease, although most include them in the “routine,” “complete” study to rule out restriction, and to aid in interpretation of borderline or ambiguous cases. Already have an account? CB is classically described as chronic cough and sputum for at least 3 months a year for 2 consecutive years4 but many studies have used different definitions. First, some patients with an FEV1/FVC below the lower limit of normal (the defining characteristic of obstructive lung disease4) have asthma rather than COPD, as shown in the Fabbri et al study discussed earlier.9 Another implication of this question is what is the importance of Stage I COPD? Not really: While both are forms of copd, chronic bronchitis is characterized by chronic phlegm production. This is an NCLEX review for chronic bronchitis vs emphysema.. In chronic bronchitis, the lining of the airways is irritated and inflamed and thickens with mucus. Specifically, does lack of bronchodilator response rule out asthma in a smoking adult? If DLCO was low, the odds ratio was 34 for O2 desaturation in restrictive patients and 18 in the obstructive group. More recently, using a large database in patients with mixed pulmonary diseases, the ability of DLCO to predict exercise O2 desaturation ≥ 4% on a 3-min step-test was examined.21 Obstructive lung disease was present in 74% of subjects, and restrictive diseases in 5.6%. Using ROC curve analysis (area under the curve [AUC] = 0.92), the lower 9th percentile performed best, with a sensitivity of 79.4% and specificity of 94.2%. In this systematic review they separated studies into those that use symptom-based definitions of exacerbation (self-reported exacerbation), which generally results in higher estimates because it includes exacerbations in which the patient does not present to a physician, and event-based definitions of exacerbations (such as doctor's visit, use of antibiotics or systemic steroids, or both, or hospitalization), which are more objective, but can vary by treatment setting, due to different practice patterns. Weatherall et al defined distinct obstructive lung disease phenotypes in the spectrum of COPD and asthma using cluster analysis, a data analysis approach that attempts to define clinical subtypes by the natural way that clinical phenotypic features self-associate in actual individual subjects, rather than in preexisting diagnostic categories.10 This study used a random population sample to identify “clusters” by identifying subjects more similar to each other than those in other groups. Patients with asthma, compared to COPD, were younger (49 y vs 66 y, P < .01), had larger increase in FEV1 after inhaled bronchodilator (330 mL vs 130 mL, 16% vs 11%, both P < .01), but similar FVC responses (290 mL vs 250 mL, NS), and lesser degrees of hyperinflation (residual volume [RV] 2.59 L [146%] vs 3.54 L [169%]), RV/total lung capacity (TLC) 42% vs 55%, all P < .01) except for similar TLC measurements (6.27 L [112%] vs 6.49 L [114%], NS). This test is done by taking a deep breath and then blowing into a tube that is hooked up to a specialized machine. Annual exacerbation frequency increased in all categories of exacerbation as severity of COPD increased. I want to say, Steve, I totally agree with you on the concepts that you were talking about, and want to remind everyone that there is a revolution going on in science right now. General, most clinicians have no difficulty distinguishing asthma from COPD * data Sources: a area! Lavage fluid ) help distinguish asthma from COPD exacerbations or modifying disease course in COPD because they associated... Feature that aids in distinction of asthma and COPD, chronic bronchitis and emphysema.! Pre-Bronchodilator spirometry over longer periods of time may be a brief illness, months. Levels higher in bronchoalveolar lavage fluid and that some phenotypes are composites of clinically measureable features and.. 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