Clinical And Functional Patterns In Chronic Airway Obstruction In Bombay : Their Correlation With Bronchoreversibility And Annual Changes In Spirometric Functions

Over 15 years, symptomatic clinic patients with chronic obstructive airway disorders were evaluated in six planned series with clinical assessment, spirometric functions, blood gases and chest radiography. Asthmatic subjects were younger with more females and 20% began in childhood against 7% in other categories (p<0.05). While there were symptom differences in nasal (‘N’) asthmatic (‘A’) bronchitic (‘B’) and emphysematous (‘E’) clinical presentations, 22 t o 25% had seasonal variations and 44% had frequent (8+/yr) colds (similar in four categories). There was in four categories, an increasing prevalence of chest deformity, finger clubbing, with overinflation in radiographs, and an increasing disability of spirometric functions (except bronchoreversibility); (p<0.05). With longer history PEFR declined more consistently. The annual FEV1 declines (21 to 43 ml) were similar in three categories but these were larger in those with cough and dyspnoea and a shorter history. The declines were larger with a higher initial FEVl particularly at ages above 45 years. In 258 (B+E) COPD group (series D), followed for 10 years, 31.8% developed congestive cardiac failure (CCF.) oftener with longer history: (P<0.05) Bronchoreversibility with a higher initial FEVl was lower in males. Abnormalities in PO2, particularly on exercise were seen below 1250 ml FEVl and PCO2 also, below 750 ml FEV1 (p<0.01): Of 85 COPD (Series E) reassessed after five to 12 years. 10% had died; 34% were working in dusty jobs. Those treated regularly showed smaller declines. Only in 60% the decline was steady while others showed larger fluctuations. The results are discussed.