Comparison of spirometric markers of severity and reversibility in patients with asthma and/or COPD in NOVELTY
2020
Background: NOVELTY (NCT02760329) is a global, prospective, observational study of patients with a physician-assigned diagnosis of asthma and/or COPD. Pre- and post-bronchodilator (BD) spirometry was performed at baseline. Objective: To compare spirometric markers of airflow obstruction and reversibility across the spectrum of obstructive lung disease. Methods: Pre- and post-BD FEV1, FVC, FEV1/FVC, FEF25-75%, PEFR and BD reversibility (FEV1 increase ≥200 mL and ≥12%) were compared across physician-assigned diagnosis and severity groups. Results: In the 9,180 patients assessed, mean pre-BD FEV1, FEF25-75% and PEFR, and post-BD FEV1/FVC decreased with increasing severity (Table). Across all severities, spirometric markers were lower in patients with COPD vs asthma; asthma+COPD lay in between. Reversibility was similar across all diagnoses and severities, with a greater FEV1 reversibility with more severe disease. BD reversibility was comparable across all groups, but was lower for those with severe COPD vs severe asthma and asthma+COPD for FEF25-75% and PEFR. Conclusions: Increasing physician-assigned severity was associated with greater airflow limitation across all spirometric measures, particularly in patients with COPD. However, reversibility did not differentiate asthma from COPD. The use of reversibility criteria to distinguish diagnoses for entry into clinical trials must be questioned.
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