ASTHMA AND CHRONIC-BRONCHITIS - CAN FAMILY PHYSICIANS PREDICT RATES OF PROGRESSION

OBJECTIVE To investigate whether the progression rate of asthma or chr onic bronchitis can be predicted from a cross-sectional assessment of features that can be measured by family physicians. DESIGN Secondary a nalysis of data from a 2-year randomized, controlled bronchodilator in tervention study in family practice. SETTING Twenty-nine general pract ices in the eastern part of The Netherlands. PATIENTS One hundred sixt y patients (101 with chronic bronchitis, 59 with asthma) from the 29 g eneral practices. INTERVENTIONS Predictors were related to the annual decline in lung function (the forced expiratory volume in one second) by means of multiple analysis of variance, controlling for age, sex, s moking habits, initial FEV, level, bronchial hyperresponsiveness, reve rsibility of obstruction, and medication during the study. MAIN OUTCOM E MEASURES Predictors of the annual decline in lung function (FEV(1)), which is believed to be the most important measure for progression. R ESULTS Only three variables predicted the decline in lung function: ha ving a barrel-shaped chest, experiencing wheezing, and an unusual diur nal peak-flow rate index. Wheezing was the best predictor of the annua l decline in lung function. In chronic bronchitis, the decline in FEV( 1) of wheezing patients was 133 mL/y compared with 62 mL/y for non-whe ezing patients (P < 0.05). In asthma with more severe symptoms, wheezi ng patients had a tendency to decline 156 mL/y compared with 57 mL/y a mong non-wheezing patients (P = 0.08). CONCLUSIONS It is nearly imposs ible to predict the progression rate of asthma or chronic bronchitis f rom symptoms, physical signs of the chest, and the PEER. Therefore, pa tients with a rapid progression rate can probably be detected only by monitoring progression of the disease through repeated lung function t esting.