FEV1 is poor indicator of COPD exacerbation

GPs should not be using lung-function as a measure for the management of COPD patients with recurrent exacerbations, according to UK research.

NICE guidelines state that patients should be considered for preventative therapy for exacerbations using inhaled steroids if they experience at least one exacerbation requiring oral corticosteroids or antibiotics within the previous 12 months and have an FEV1 less than 50 per cent.

Patients who experience one or more exacerbations but have FEV1 greater than 50 per cent predicted would not qualify for interventional therapy.

However, researchers found that 77 per cent of patients in the study with a FEV1 greater than 50 per cent reported one or more exacerbations. Furthermore, it was found that a third of patients with a FEV1 greater than 50 per cent suffered three or more exacerbations.

However, Somerset GP Dr Steve Holmes, chairman of the General Practice Airways Group (GPIAG), refused to rule out lung function tests.

‘Lung function is a good indicator of whether an individual has COPD but is not a good indicator of exacerbations because FEV1 figures do not change dramatically during exacerbations,’ he said.

Day-to-day clinical patterns such as the ability to self-care, quality-of-life levels and the symptoms of exacerbations are all used to assign management of COPD patients, he said.

‘More research is required to see if a combination of treatments would be effective in patients with less severe COPD.’

Under the quality framework FEV1 should be assessed annually for people with mild/moderate COPD and at least twice a year for people with severe COPD. It is worth seven points.

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