Abstract
Bronchodilator response (BDR) testing is used as a diagnostic method in obstructive airway diseases. The aim of this investigation was to compare different methods for measuring BDR in participants with asthma and chronic obstructive pulmonary disease (COPD) and to study to the extent to which BDR was related to symptom burden and phenotypic characteristics.
Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were measured before and 15 min after 200 μg of salbutamol in 35 628 subjects aged ≥16 years from three large international population studies. The subjects were categorised in three groups: current asthma (n=2833), COPD (n=1146) and no airway disease (n=31 649). Three definitions for flow-related reversibility (increase in FEV1) and three for volume-related reversibility (increase in FVC) were used.
The prevalence of bronchodilator reversibility expressed as increase FEV1 ≥12% and 200 mL was 17.3% and 18.4% in participants with asthma and COPD, respectively, while the corresponding prevalence was 5.1% in those with no airway disease. In asthma, bronchodilator reversibility was associated with wheeze (OR 1.36, 95% CI 1.04–1.79), atopy (OR 1.36, 95% CI 1.04–1.79) and higher exhaled nitric oxide fraction, while in COPD neither flow- nor volume-related bronchodilator reversibility was associated with symptom burden, exacerbations or health status after adjusting for pre-bronchodilator FEV1.
Bronchodilator reversibility was at least as common in participants with COPD as those with asthma. This indicates that measures of reversibility are of limited value for distinguishing asthma from COPD in population studies. However, in asthma, bronchodilator reversibility may be a phenotypic marker.
Abstract
Bronchodilator reversibility is at least as common in COPD as in asthma, indicating that measures of reversibility are of limited value for distinguishing asthma from COPD; however, bronchodilator reversibility in asthma may be a phenotypic marker. http://bit.ly/2W1oA4B
Footnotes
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Conflict of interest: C. Janson has nothing to disclose.
Conflict of interest: A. Malinovschi has nothing to disclose.
Conflict of interest: A.F.S. Amaral has nothing to disclose.
Conflict of interest: S. Accordini has nothing to disclose.
Conflict of interest: J. Bousquet reports personal fees and other funding from Chiesi, Cipla, Hikma, Menarini, Mundipharma, Mylan, Novartis, Sanofi-Aventis, Takeda, Teva and Uriach, and other funding from Kyomed, outside the submitted work.
Conflict of interest: S.A. Buist has nothing to disclose.
Conflict of interest: G.W. Canonica has nothing to disclose.
Conflict of interest: B. Dahlen has received personal fees from TEVA, Sanofi, GSK and AstraZeneca, outside the submitted work.
Conflict of interest: J. Garcia Aymerich has nothing to disclose.
Conflict of interest: L. Gnatiuc has nothing to disclose.
Conflict of interest: M.L. Kowalski has nothing to disclose.
Conflict of interest: J. Patel has nothing to disclose.
Conflict of interest: W. Tan has nothing to disclose.
Conflict of interest: K. Torén has nothing to disclose.
Conflict of interest: T. Zuberbier has received consultancy fees from Bayer Health Care, FAES, Novartis and Henkel; has received grants/has grants pensing form Novartis and Henkel, and has received lecture fees from AstraZeneca, AbbVie, ALK, Almirall, Astellas, Bayer HealthCare, Bencradm Berlin Chemie, FAES, HAL, Leti, Meda, Menarini, Merck, MSD, Novartis, Pfizer, Sanofi, Stallergenes, Takeda, TEVA, UCB, Henkel, Kryolan and L'Oreal, outside the submitted work.
Conflict of interest: P. Burney has nothing to disclose.
Conflict of interest: D. Jarvis has nothing to disclose.
Support statement: Funding was received from the European Union's Horizon 2020 research and innovation programme (no. 633212S), the Sixth European Union Framework Programme for Research (no. FOODCT_2004-506378), the Medical Research Council (grant number 92091), the Wellcome Trust (no. 085790/Z/08/Z) and the Swedish Heart and Lung Foundation (no. 20170303). For a more complete list of sponsors for the ECRHS and BOLD studies see www.ecrhs.org and www.boldstudy.org. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received March 20, 2019.
- Accepted May 28, 2019.
- Copyright ©ERS 2019
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