Moffett Alexander T, Halpern Scott D, Weissman Gary E
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, PA, USA.
Respir Res. 2025 Apr 1;26(1):122. doi: 10.1186/s12931-025-03198-6.
Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend the diagnosis of chronic obstructive pulmonary disease (COPD) only in patients with a post-bronchodilator forced expiratory volume in 1 s to forced vital capacity ratio (FEV/FVC) less than 0.7. However the impact of this recommendation on clinical practice is unknown.
To estimate the effect of a documented post-bronchodilator FEV/FVC < 0.7 on the diagnosis and treatment of COPD.
We used a regression discontinuity design to measure the effect of a post-bronchodilator FEV/FVC < 0.7 on COPD diagnosis and treatment.
Patients included in a national electronic health record database who were 18 years of age and older and had a clinical encounter between 2007 and 2022 in which a post-bronchodilator FEV/FVC value was documented.
An encounter was associated with a COPD diagnosis if an international classification of disease code for COPD was assigned, and was associated with COPD treatment if a prescription for a medication commonly used to treat COPD was filled within 90 days.
Among 27,817 clinical encounters, involving 18,991 patients, a post-bronchodilator FEV/FVC < 0.7 was present in 14,876 (53.4%). The presence of a documented post-bronchodilator FEV/FVC < 0.7 increased the probability of a COPD diagnosis by 6.0% (95% confidence interval [CI] 1.1-10.9%) from 38.0% just above the 0.7 cutoff to 44.0% just below this cutoff. The presence of a documented post-bronchodilator FEV/FVC < 0.7 had no effect on the probability of COPD treatment (-2.1%, 95% CI -7.2 to 3.0%).
The presence of a documented post-bronchodilator FEV/FVC < 0.7 had only a small effect on the diagnosis of COPD and no effect on corresponding treatment decisions.
慢性阻塞性肺疾病全球倡议（GOLD）指南建议仅在支气管扩张剂后1秒用力呼气容积与用力肺活量比值（FEV₁/FVC）低于0.7的患者中诊断慢性阻塞性肺疾病（COPD）。然而，这一建议对临床实践的影响尚不清楚。
评估有记录的支气管扩张剂后FEV₁/FVC＜0.7对COPD诊断和治疗的影响。
我们采用回归断点设计来衡量支气管扩张剂后FEV₁/FVC＜0.7对COPD诊断和治疗的影响。
纳入国家电子健康记录数据库中年龄在18岁及以上且在2007年至2022年期间有临床就诊记录且记录了支气管扩张剂后FEV₁/FVC值的患者。
如果分配了COPD的国际疾病分类代码，则该次就诊与COPD诊断相关；如果在90天内开具了常用的COPD治疗药物处方，则该次就诊与COPD治疗相关。
在涉及18991名患者的27817次临床就诊中，14876次（53.4%）存在有记录的支气管扩张剂后FEV₁/FVC＜0.7。有记录的支气管扩张剂后FEV₁/FVC＜0.7使COPD诊断的概率从略高于0.7临界值时的38.0%增加到略低于该临界值时的44.0%，增加了6.0%（95%置信区间[CI]1.1 - 10.9%）。有记录的支气管扩张剂后FEV₁/FVC＜0.7对COPD治疗概率没有影响（-2.1%，95%CI -7.2至3.0%）。
有记录的支气管扩张剂后FEV₁/FVC＜0.7对COPD诊断仅有微小影响，对相应的治疗决策没有影响。
