The ‘clinically significant’ bronchodilator responsiveness (BDR) in children: a comparative study between six definitions of scholarly societies and a mini-review

Guezguez, Fatma; Knaz, Hend; Anane, Ichraf; Bougrida, M.; Saad, Helmi Ben

doi:10.1080/17476348.2021.1906653

Cited by 7 publications

(5 citation statements)

References 42 publications

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“…Forced expiratory volume in 1 s (FEV 1 , L, %), forced vital capacity (FVC, L, %) and FEV 1 /FVC (absolute value) were determined before bronchodilator (BD) and after BD. Multiple definitions were applied to define and classify spirometric impairments 27–29 and clinically significant BD responsiveness (BDR) 13 including: Restrictive impairment: post‐BD FVC < lower limit of normal (LLN) and post‐BD FEV 1 /FVC ≥0.7 Mixed impairment: post‐BD FVC < LLN and post‐BD FEV 1 /FVC < 0.7 BDR traditional (BDR T ) (pre‐ to post‐BD change in either FEV 1 or FVC of ≥200 mL and ≥12% initial value) OR BDR updated (BDR U ) (pre‐ to post‐BD change in either FEV 1 or FVC of ≥10% predicted value) Airway obstruction (AO): pre‐ or post‐BD FEV 1 /FVC < LLN (AO preLLN , AO postLLN respectively) or 0.07 (see Table A1) Global initiative for chronic obstructive lung disease staging 29 Abnormal spirometry was defined as the presence of any spirometric impairment …”

Section: Methodsmentioning

confidence: 99%

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Correlation of spirometry indices to chest radiology in the diagnosis of chronic airway disease among regional and rural Indigenous Australians

Howarth

Gahreman

Saad

et al. 2023

Internal Medicine Journal

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BackgroundThe majority of Indigenous Australians reside in non‐urban locations, with reduced access to chest radiology such as computed tomography (CT). Spirometry and chest X‐ray (CXR) may be used in the absence of CT; however, the correlation of spirometry indices to CT‐defined chronic airway diseases (i.e. chronic obstructive pulmonary disease (COPD) and bronchiectasis) compared with CXR among Indigenous people is sparsely reported.AimTo evaluate spirometry indices against CXR and CT findings among adult Indigenous Australians.MethodsIndigenous patients who had undergone a spirometry test between 2012 and 2020 and had a CXR or chest CT scan assessed for the presence (+)/absence (−) of airway diseases were included in this study.ResultsOf 643 patients (57% female, 31% remote/very remote), 364 (57%) had CT and CXR available. Patients who were ‘CT− and CXR−’ for airway diseases (48%) recorded a mean FVC, FEV1 and FEV1/FVC of 61%, 59% and 0.76 compared to 57%, 49% and 0.66 in the ‘CT+ and CXR−’ group and 53%, 39% and 0.58 in the ‘CT+ and CXR+’ group. CXR showed sensitivity (44%) and specificity (88%), while spirometry showed 62% and 77% compared to CT. Spirometry demonstrated predominately restrictive impairment among ‘CT− and CXR−’ and mixed/obstructive impairment among ‘CT+ and CXR−’ and ‘CT+ and CXR+’ groups.ConclusionIndigenous Australians tend to demonstrate restrictive impairment in the absence of radiological evidence of airway disease. However, in the presence of airway disease, combinations of mixed and obstructive impairments were common. Obstructive impairment shows greater sensitivity for identifying COPD than that shown by CXR; however, CXR shows greater specificity. Hence, spirometry in conjunction with chest radiology should be utilised to aid in the assessment of airway diseases in this population.

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Section: Methodsmentioning

confidence: 99%

“…26 Forced expiratory volume in 1 s (FEV 1 , L, %), forced vital capacity (FVC, L, %) and FEV 1 /FVC (absolute value) were determined before bronchodilator (BD) and after BD. Multiple definitions were applied to define and classify spirometric impairments [27][28][29] and clinically significant BD responsiveness (BDR) 13 including:…”

Section: Spirometry Testsmentioning

confidence: 99%

Correlation of spirometry indices to chest radiology in the diagnosis of chronic airway disease among regional and rural Indigenous Australians

Howarth

Gahreman

Saad

et al. 2023

Internal Medicine Journal

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“…The following spirometry criteria for BDR following administration of bronchodilator and for airflow obstruction (AO) were utilised. 1 , 36 , 37 , 39 , 40 Presence of BDR was assessed by traditional criteria: Forced expiratory volume in one second (FEV 1 ) change pre- to post-BD of ≥12% and ≥0.2L and/or Forced vital capacity (FVC) change pre- to post-BD of ≥12% and ≥0.2L. 1 , 3 , 39–42 Presence of AO: post-BD FEV 1 /FVC ≤0.7.…”

Section: Methodsmentioning

confidence: 99%

The Prevalence of Bronchodilator Responsiveness “Asthma” Among Adult Indigenous Australians Referred for Lung Function Testing in the Top End Northern Territory of Australia

Heraganahally¹,

Howarth²,

Lloyd³

et al. 2022

JAA

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Background Among Indigenous Australians, studies examining the clinical significance of airway bronchodilator responsiveness (BDR) are limited. In this retrospective study, we examined the nature of underlying lung disease in adult Indigenous patients with BDR referred for lung function testing (LFT) in the Top End Health Service region of the Northern Territory of Australia. Methods Presence or absence of BDR as per usual (FVC or FEV 1 change pre to post ≥12% and ≥0.2L) and updated (2021 “>10% predicted) ATS/ERS criteria among Indigenous and non-Indigenous Australians was determined. The radiological findings in the Indigenous study participants with and without BDR were next assessed for the presence of underlying chronic airway/lung disease. Results We found that 123/742 (17%) Indigenous and 578/4579 (13%) non-Indigenous patients had a significant BDR. Indigenous patients with BDR were younger (mean difference 7 years), with a greater proportion of females (52 vs 32%), underweight (15 vs 4%) and current smokers (52 vs 25%). Indigenous patients with BDR displayed lower LFT values, and a higher proportion exhibited FVC BDR compared to non-Indigenous (34 vs 20%). Almost half (46%) of Indigenous patients with BDR had evidence of COPD and/or bronchiectasis on radiology. Adjusting for the presence of radiologic or spirometric evidence of COPD, the presence of BDR was similar between Indigenous and non-Indigenous patients (5–8 vs 7–11%), irrespective of which BDR criteria was used. Conclusion BDR was higher overall among Indigenous in comparison to non-Indigenous patients; however, a significant proportion of Indigenous patients demonstrating BDR had evidence of underlying COPD/bronchiectasis. This study highlights that although presence of BDR among Indigenous people may indicate asthma, it may also be observed among patients with COPD/bronchiectasis or could represent asthma/COPD/bronchiectasis overlap. Hence, a combination of clinical history, LFT and radiology should be considered for precise diagnosis of lung disease in this population.

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“…Fourth, Lovine et al 1 reported that BDR was considered significant when >12% (i.e., relative change related to the initial value) or >200 mL (i.e., absolute change from the initial value), without specifying which spirometric datum/data was/were used (e.g., FEV 1 and/or FVC). Currently, there is no clear “consensus” on what constitutes a clinically significant BDR 6,7 . In children, a “clinically significant” BDR is definition‐dependent, and a 2021 mini‐review 6 has largely discussed the following three questions regarding the issue of a “clinically significant” BDR: which spirometric datum/data, expression mode(s), and threshold(s) should be used?…”

Section: Figurementioning

confidence: 99%

“…Currently, there is no clear “consensus” on what constitutes a clinically significant BDR 6,7 . In children, a “clinically significant” BDR is definition‐dependent, and a 2021 mini‐review 6 has largely discussed the following three questions regarding the issue of a “clinically significant” BDR: which spirometric datum/data, expression mode(s), and threshold(s) should be used? The major limitation of the approach applied by Lovine et al 1 is that the absolute and relative changes in FEV 1 and FVC are inversely proportional to baseline spirometric data and are linked to sex and anthropometric data, such as height and age 4 .…”

Section: Figurementioning

confidence: 99%

The ‘clinically significant’ bronchodilator responsiveness (BDR) in children: a comparative study between six definitions of scholarly societies and a mini-review

Cited by 7 publications

References 42 publications

Correlation of spirometry indices to chest radiology in the diagnosis of chronic airway disease among regional and rural Indigenous Australians

Correlation of spirometry indices to chest radiology in the diagnosis of chronic airway disease among regional and rural Indigenous Australians

The Prevalence of Bronchodilator Responsiveness “Asthma” Among Adult Indigenous Australians Referred for Lung Function Testing in the Top End Northern Territory of Australia

In 2023, it is vital to standardize the interpretation of spirometry in children

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