PHYSICIAN ESTIMATION OF FEV(1) IN ACUTE EXACERBATION OF COPD

There have been recent recommendations to include objective measuremen ts of airway obstruction in the treatment of patients with acute asthm a. These recommendations are based in part on the inaccuracy of physic ians in estimating airways obstruction in asthmatic patients. The purp ose of this study was to evaluate the ability of physicians to estimat e the degree of airways obstruction in patients with acute exacerbatio n of COPD. We studied 90 patients. The physicians were able to estimat e the percent of predicted normal FEV(1) to within 10 points only 38 p ercent of the time prior to treatment and 46 percent of the time postt reatment. Forty-nine percent of the patients whom the physicians belie ved had an improvement in pulmonary function with treatment actually d id not improve, while 31 percent of the patients who the physicians be lieved did not improve their pulmonary function with treatment actuall y did improve. We conclude that physicians' estimates of the degree of airway obstruction in acute exacerbation of COPD are inaccurate. Asse ssment of patients in the emergency department presenting with COPD sh ould be based on objective measurements of pulmonary function.