Spirometry is not enough to make clinical diagnosis of COPD

Background: Spirometry is essential for diagnostics of chronic obstructive pulmonary disease (COPD) but is not enough to make a comprehensive clinical diagnosis over the time. Aim: To evaluate COPD diagnostics track for a cohort of adults 35-70 years old based on spirometric cut-offs as well as clinical criteria. Methods: The RESearch on the PrEvalence and the diagnosis of COPD and its Tobacco-related aetiology (RESPECT) is a prospective, population-based cohort study. Spirometry before and after a bronchodilator (BD) was performed and airflow limitation (AL) measured by a ratio of FEV 1 /FVC Results: 3133 individuals agreed to participate in the baseline study. Out of the 278 individuals with AL based on both cut-offs before and/or after BD who were invited to the second screening, 177 agreed to participate. Satisfactory quality of spirometry was achieved by 102 and 65 participants after and before BD test, respectively. From those 102 persons with post-BD AL only 63.2% still have AL after the second screening (with clinically confirmed diagnosis: 44 COPD patients, 1 - asthma, 1 with confirmed and 12 with possible asthma-COPD overlap syndrome (ACOS), 2 – tuberculosis and 2 without symptoms of any obstructive diseases). 23.1% from 65 persons with pre-BD AL became post-BD obstructive after the second screening (13 with COPD confirmed diagnosis and 2 with possible ACOS). Conclusion: Spirometry is required for a comprehensive COPD diagnosis but clinical assessment and follow-up should be essential parts to confirm diagnosis.