Key messages
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Small changes in FEV1 after a bronchodilator in individuals with mild chronic obstructive pulmonary disease (COPD) can challenge the diagnosis of COPD
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The absolute change in FEV1 post-bronchodilator varies with the day of testing, the number of bronchodilator drugs used to test, and drug dose
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The absolute increase in FEV1 post-bronchodilator is similar in individuals with moderate COPD and healthy smokers
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The absolute increase in FEV1 post-bronchodilator decreases as baseline FEV1 decreases and so does the chance of being classified as reversible
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Although the average number of reversible patients in a COPD population is stable over time, individuals change their reversibility status on repeat testing
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Reversibility status does not identify patients with a different clinical course or response to treatment nor does it add to the baseline FEV1 in the prediction of patients with more rapid disease progression
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In patients with clinical and spirometric evidence of COPD, reversibility testing adds little to management. However, in patients who have atypical clinical features, reversibility testing is still warranted