Beasley, Richard, Hughes, Rod, Agusti, Alvar, Calverley, Peter, Chipps, Bradley, Del Olmo, Ricardo, Papi, Alberto, Price, David, Reddel, Helen, Müllerová, Hana et al (show 1 more authors)
(2024)
Prevalence, Diagnostic Utility and Associated Characteristics of Bronchodilator Responsiveness.
American journal of respiratory and critical care medicine, 209 (4).
pp. 390-401.
Abstract
<b>Rationale:</b> The prevalence and diagnostic utility of bronchodilator responsiveness (BDR) in a real-life setting is unclear. <b>Objective:</b> To explore this uncertainty in patients aged ⩾12 years with physician-assigned diagnoses of asthma, asthma and chronic obstructive pulmonary disease (COPD), or COPD in NOVELTY, a prospective cohort study in primary and secondary care in 18 countries. <b>Methods:</b> The proportion of patients with a positive BDR test in each diagnostic category was calculated using 2005 (ΔFEV<sub>1</sub> or ΔFVC ⩾12% and ⩾200 ml) and 2021 (ΔFEV<sub>1</sub> or ΔFVC >10% predicted) European Respiratory Society/American Thoracic Society criteria. <b>Measurements and Main Results:</b> We studied 3,519 patients with a physician-assigned diagnosis of asthma, 833 with a diagnosis of asthma + COPD, and 2,436 with a diagnosis of COPD. The prevalence of BDR was 19.7% (asthma), 29.6% (asthma + COPD), and 24.7% (COPD) using 2005 criteria and 18.1%, 23.3%, and 18.0%, respectively, using 2021 criteria. Using 2021 criteria in patients diagnosed with asthma, BDR was associated with higher fractional exhaled nitric oxide; lower lung function; higher symptom burden; more frequent hospital admissions; and greater use of triple therapy, oral corticosteroids, or biologics. In patients diagnosed with COPD, BDR (2021) was associated with lower lung function and higher symptom burden. <b>Conclusions:</b> BDR prevalence in patients with chronic airway diseases receiving treatment ranges from 18% to 30%, being modestly lower with the 2021 than with the 2005 European Respiratory Society/American Thoracic Society criteria, and it is associated with lower lung function and greater symptom burden. These observations question the validity of BDR as a key diagnostic tool for asthma managed in clinical practice or as a standard inclusion criterion for clinical trials of asthma and instead suggest that BDR be considered a treatable trait for chronic airway disease.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Humans, Asthma, Pulmonary Disease, Chronic Obstructive, Bronchodilator Agents, Vital Capacity, Forced Expiratory Volume, Prevalence, Prospective Studies, Aged |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 12 Mar 2024 08:46 |
| Last Modified: | 18 Mar 2024 00:32 |
| DOI: | 10.1164/rccm.202308-1436oc |
| Open Access URL: | https://doi.org/10.1164/rccm.202308-1436OC |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3179270 |
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