Document Type


Peer Reviewed


Publication Date


NLM Title Abbreviation

BMJ Open Respir Res

Journal/Book/Conference Title

BMJ Open Respiratory Research

DOI of Published Version

10.1136/ bmjresp-2017-000213

Start Page


End Page


Total Pages



Introduction We compared the predictive value of prebronchodilator and postbronchodilator spirometry for chronic obstructive pulmonary disease (COPD) features and outcomes.

Methods We analysed COPDGene data of 10 192 subjects with smoking history. We created regressions models with the following dependent variables: clinical, functional and radiographic features, and the following independent variables: prebronchodilator airflow obstruction (PREO) and postbronchodilator airflow obstruction (POSTO), prebronchodilator and postbronchodilator FEV₁% predicted. We compared the model performance using the Akaike information criterion (AIC).

Results The COPD prevalence was higher using PREO. About 8.5% had PREO but no airflow obstruction in postbronchodilator spirometry (POSTN) (PREO-POSTN) and 3% of all subjects had no aiflow obstruction in prebronchodilator spirometry (PREN) but POSTO (PREN-POSTO). We found no difference in COPD features and outcomes between PREO-POSTN and PREN-POSTO subjects. Although, both prebronchodilator and postbronchodilator spirometries are both associated with chronic bronchitis, dyspnoea, exercise capacity and COPD radiographic findings, models that included postbronchodilator spirometric measures performed better than models with prebronchodilator measures to predict these COPD features. The predictive value of prebronchodilator and postbronchodilator spirometries for respiratory exacerbations, change in forced expiratory volume in 1 s, dyspnoea and exercise capacity during a 5-year period is relatively similar, but postbronchodilator spirometric measures are better predictors of mortality based on AIC.

Conclusions Postbronchodilator spirometry may be a more accurate predictor of COPD features and outcomes.


OAfund, COPD, Prebronchodilator spirometry, Postbronchodilator spirometry

Granting or Sponsoring Agency

National Heart, Lung and Blood Institute, COPD Foundation contributions

Grant Number

R01 HL089897, R01 HL089856

Journal Article Version

Version of Record

Published Article/Book Citation

BMJ Open Respiratory Research 2017;4:e000213.


Copyright © 2017 The Authors

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License