Prevalence of Bronchial Hyperreactivity in Stable COPD Patients Treated at Persahabatan Hospital Jakarta, Indonesia (as per GOLD 2017 guidelines)

Abstract

Background: The Global Initiative of Chronic Lung Disease (GOLD) 2017 has separated spirometric grades (GOLD “1234”) from the symptom groups (“ABCD”) to improve diagnosis, outcome and therapy for chronic obstructive pulmonary disease (COPD) patients. Bronchial hyperreactivity (BHR) is thought to be a hallmark of asthma, yet it has been observed to occur in COPD. This study aimed to identify BHR in stable COPD patients according to GOLD 2017 grouping.

Methods: This cross-sectional study observed 80 stable COPD patients treated at asthma-COPD clinics in Persahabatan Hospital Jakarta, Indonesia, between May 2018 and March 2019. Diagnosis of COPD was done by spirometry (post-bronchodilator test FEV1/FVC <0.7). Bronchial hyperreactivity was confirmed by PC20 (Provocative Concentration 20), a bronchial challenge test using methacoline <4 mg/mL (FEV1 drop ≥20%). These were performed in all subjects within the inclusion criteria.

Results: Prevalence of BHR in COPD was 73.7% (59/80), wherein 69.7% (46/66) males and 92.9% (13/14) females had BHR in COPD. Bronchial hyperreactivity was found mostly in Group B and Group D (27.1% and 33.9, respectively). Mild BHR was found mostly in Group A and Group D (11.25% and 17.5%, respectively), while moderate-to severe BHR was observed in Group B (11.25%). Airflow limitation was identified mostly in GOLD 2 and 3 (40.7% and 44.1%, respectively). Mild BHR was mostly found in GOLD 2 (20.0%), while moderate-to severe BHR was equally observed in GOLD 2 and 3 (16.25%, both).

Conclusion: Prevalence of BHR in stable COPD patients was 73.7%, and mild BHR was common in stable COPD.