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Airway inflammation in COPD: physiological outcome measures and induced sputum

¹ Pulmonary Division, LDS Hospital and University of Utah, Salt Lake City, UT, USA. ² Firestone Institute for Respiratory Health and McMaster University, Hamilton, ON, Canada

CORRESPONDENCE: R.O. Crapo, Pulmonary Division, LDS Hospital, 8th Avenue and C Street, Salt Lake City, UT 84143, USA. Fax: 1 8014081671. E-mail: Ldrcrapo@ihc.com

Keywords: airflow, chronic obstructive pulmonary disease, markers of airway inflammation, pulmonary function, sputum induction

Received: August 21, 2002
Accepted February 20, 2003

Chronic obstructive pulmonary disease (COPD) is a result of airway inflammation, and the best predictor of COPD is the early detection of airflow limitation by spirometry. The Global Initiative for Obstructive Lung Disease Workshop Report defines airflow limitation using simple spirometric indices. Available guidelines categorise the severity of COPD using forced expiratory volume in one second (FEV₁) and forced vital capacity (FVC), with symptoms playing a minor role in the assessment.

Current standards define COPD by progressive loss of FEV₁, and thus longitudinal decline in FEV₁ will be the primary outcome variable for intervention studies aimed at preventing or reducing the loss of pulmonary function. There is evidence, however, that the variable FEV₁/FVC and FEV₁ are often not measured properly in all settings.

This article will discuss the roles of physiological measurements in diagnosing COPD and physiological outcome measures for COPD. It does not formally compare physiological measures with other outcome measures, such as symptoms or quality of life. Additionally, improved treatment of established disease requires a better understanding of the inflammatory process and its clinical effects and treatment.

The inflammatory process, and how drugs affect it, can be studied noninvasively or relatively noninvasively by using refined methods of examining spontaneous or induced sputum. Enhanced understanding of the use of induced sputum will assist in predicting patients' responses to short- and long-term inhaled corticosteroid treatment, and the methods of sputum examination need to be simplified so that they can be applied more easily to clinical practice.