Is the bronchodilator test an useful tool to measure asthma control?

Galván, Marta Ferrer; Álvarez-Gutiérrez, Francisco Javier; Falcön, Auxiliadora Romero; Romero, Beatriz; Saez, Anabelle Opazo; Gallardo, J.F. Medina

doi:10.1016/j.rmed.2017.03.008

Cited by 11 publications

(6 citation statements)

References 19 publications

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“…Future research is also needed to understand the impact of bronchodilator protocols (e.g., delivered dose) on results. The ability of an acute response to bronchodilators to predict future clinical status other than survival is unclear and BDR does not accurately differentiate between types of airway diseases (71)(72)(73). Further evidence is needed to support anchor-based approaches associated with outcomes other than survival.…”

Section: Future Directionsmentioning

confidence: 99%

ERS/ATS technical standard on interpretive strategies for routine lung function tests

et al. 2021

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BackgroundAppropriate interpretation of pulmonary function tests (PFTs) involves the classification of observed values as within/outside the normal range based on a reference population of healthy individuals, integrating knowledge of physiologic determinants of test results into functional classifications, and integrating patterns with other clinical data to estimate prognosis. In 2005, the American Thoracic Society and the European Respiratory Society jointly adopted technical standards for the interpretation of PFTs. We aimed to update the 2005 recommendations and incorporate evidence from recent literature to establish new standard for PFT interpretation.MethodsThis technical standards document was developed by an international joint task force, appointed by the European Respiratory Society and the American Thoracic Society with multidisciplinary expertise in conducting and interpreting pulmonary function tests, and developing international standards. A comprehensive literature review was conducted, and published evidence was reviewed.ResultsRecommendations for the choice of reference equations and limits of normal of the healthy population to identify individuals with unusually low or high results, respectively are discussed. Interpretation strategies for bronchodilator responsiveness testing, limits of natural changes over time and severity are also updated. Interpretation of measurements made by spirometry, lung volumes and gas transfer are described as they relate to underlying pathophysiology with updated classification protocols of common impairments.ConclusionsPFTs interpretation must be complemented with clinical expertise and consider the inherent biological variability of the test and the uncertainty of the test result to ensure appropriate interpretation of an individual's lung function measurements.

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Section: Future Directionsmentioning

confidence: 99%

ERS/ATS technical standard on interpretive strategies for routine lung function tests

et al. 2021

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“…19 Furthermore, whether an acute response can predict long-term outcomes other than survival remains unclear. 20,31,32 On the other side, some researchers argued that reversibility of airway obstruction in response to a bronchodilator was not a dichotomous trait but a continuous variable, so any cut-off level of a positive BDR might be arbitrary. 9 In addition to binary BDR categorization, a novel classification with five distinct categories was put forward, including negative, minimal, mild, moderate or marked, which was based on the changes in FEV 1 relative to the predicted values with the following intervals ≤0%, 0-2%, 2-4%, 4-8% and >8%.…”

mentioning

confidence: 99%

Bronchodilator Responsiveness Defined by the 2005 and 2021 ERS/ATS Criteria in Patients with Asthma as Well as Chronic Obstructive Pulmonary Disease

Li¹,

Lin²,

Wang³

et al. 2022

COPD

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Background: In the 2021 ERS/ATS interpretive strategies for routine lung function tests, a positive bronchodilator response (BDR) was updated as a change of >10% relative to the predicted value in forced expiratory volume in 1 second (FEV 1 ) or forced vital capacity (FVC). We aimed to explore the differences between the 2005 and 2021 ERS/ATS criteria applied to patients with asthma as well as chronic obstructive pulmonary disease (COPD). Methods: BDR test data about asthma patients aged 6-80 years and COPD patients aged 18-80 years were derived from the

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“…Although BDR is associated with worse control of disease and frequent use of reliever medications in asthmatic patients [5,6], it is not associated with the risk for COPD exacerbations [7,8,10,11,13]. In the ECLIPSE study, although the exacerbation rate was significantly higher in patients with less reversible than more reversible airway restriction, the results may have been affected by the lack of adjustment for baseline FEV1 [8,28].…”

Section: Plos Onementioning

confidence: 94%

“…Bronchodilator response (BDR) is an important method for diagnosing airway reversibility, which is primarily observed in asthma but may also be observed in COPD [2][3][4]. It is significant in asthma because it reflects poor control of the disease; however, its clinical significance in COPD is not clear [5,6]. Although several studies have shown that BDR is associated with a decline in lung function, exacerbation rate, and survival, few have shown a significant difference after adjustment for baseline lung function [7,8].…”

Section: Introductionmentioning

confidence: 99%

Differences in clinical significance of bronchodilator responses measured by forced expiratory volume in 1 second and forced vital capacity

et al. 2023

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Background The clinical implication of bronchodilator response (BDR) is not fully understood. However, BDR is frequently present in patients with chronic obstructive pulmonary disease (COPD). We identified the differences in clinical features regarding BDR. In addition, we divided BDR into BDR for forced expiratory volume in 1 s (FEV1) and BDR for forced vital capacity (FVC; i.e., BDR-FEV1 and BDR-FVC, respectively) and analyzed clinical significance. Methods We used data from the Korea COPD Subgroup Study, a multicenter cohort study of COPD patients recruited from 54 centers in South Korea since April 2012. We analyzed differences in baseline characteristics, 1-year exacerbation rate, and 3-year FEV1 decline between BDR negative and positive patients. Moreover, we analyzed the differences in clinical features between BDR-FEV1 positive and negative patients and between BDR-FVC positive and negative patients. Results Of the 2,181 patients enrolled in this study, 366 (16.8%) were BDR positive. BDR positive patients were more likely to be ever-smokers and to have a lower body mass index and higher symptom scores compared to BDR negative patients. Baseline FEV1 and FEV1/FVC were lower in the BDR positive compared to the BDR negative group (1.7 ± 0.6 and 1.6 ± 0.5, respectively, p < 0.01; 50.9 ± 12.1 and 46.5 ± 14.8, respectively, p < 0.01). BDR positive patients were more likely to have been diagnosed with asthma–COPD overlap and to receive inhaled corticosteroids (ICS) than BDR negative patients. BDR-FVC patients were more likely to be smokers, suffer from worse symptoms and have lower lung function than those with no BDR-FVC. BDR had no significant effect on 1-year moderate to severe or severe exacerbation rates or 3-year annual FEV1 decline. Interactive effects of ICS and BDR on the exacerbation rate were not significant in any group. Conclusions In this study, BDR positive patients were more likely to be ever-smokers and to have worse symptoms and lung function than BDR negative patients. BDR-FVC was associated with worse symptom control and lung function compared to BDR-FEV1. However, there were no significant differences in exacerbation rate or decline in lung function in any BDR group. In addition, the effects of ICS on exacerbations were not significant in any group.

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Is the bronchodilator test an useful tool to measure asthma control?

Abstract: Spirometric reversibility can be useful in assessing control in asthmatic patients and can predict future risk parameters. The cutoff point related to the non-control of asthma found in our work was ≥10%.

Cited by 11 publications

References 19 publications

ERS/ATS technical standard on interpretive strategies for routine lung function tests

ERS/ATS technical standard on interpretive strategies for routine lung function tests

Bronchodilator Responsiveness Defined by the 2005 and 2021 ERS/ATS Criteria in Patients with Asthma as Well as Chronic Obstructive Pulmonary Disease

Differences in clinical significance of bronchodilator responses measured by forced expiratory volume in 1 second and forced vital capacity

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