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Bronchodilator reversibility in asthma and COPD: Findings from three large population studies
Sabtu, 29 Jun 2019 16:05:52

Christer JansonAndrei MalinovschiAndre F.S. AmaralSimone AccordiniJean BousquetA. Sonia BuistGiorgio Walter CanonicaBarbro DahlénJudith Garcia-AymerichLouisa GnatiucMarek L KowalskiJaymini PatelWan TanKjell TorénTorsten ZuberbierPeter BurneyDeborah Jarvis

European Respiratory Journal 2019; DOI: 10.1183/13993003.00561-2019

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 COPD and to study to the extent to which BDR was related to symptom burden and phenotypic characteristics.

Forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) was measured before and 15 min after 200 μg of salbutamol in 35 628 subjects aged 16 years and older 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 (increase in FEV1) and three for volume related (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 (95% CI): 1.36 (1.04–1.79)), atopy (OR 1.36 (1.04–1.79)) and higher FeNO while in COPD neither flow nor volume related bronchodilator reversibility was associated with symptom burden, exacerbations or health status after adjusting for prebronchodilator 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. In asthma, however, bronchodilator reversibility may be a phenotypic marker.

Footnotes

This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.

Conflict of interest: Dr. Janson has nothing to disclose.

Conflict of interest: Dr. Malinovschi has nothing to disclose.

Conflict of interest: Dr. Amaral has nothing to disclose.

Conflict of interest: Prof. Accordini has nothing to disclose.

Conflict of interest: Dr. BOUSQUET reports personal fees and other from Chiesi, Cipla, Hikma, Menarini, Mundipharma, Mylan, Novartis, Sanofi-Aventis, Takeda, Teva, Uriach, other from Kyomed, from null, outside the submitted work.

Conflict of interest: Dr. Canonica has nothing to disclose.

Conflict of interest: Barbro Dahlen

Conflict of interest: Dr. Gnatiuc has nothing to disclose.

Conflict of interest: Dr. Kowalski has nothing to disclose.

Conflict of interest: Dr. Patel has nothing to disclose.

Conflict of interest: Dr. tan has nothing to disclose.

Conflict of interest: Dr. Torén has nothing to disclose.

Conflict of interest: Dr. BURNEY has nothing to disclose.

Conflict of interest: Prof. Jarvis has nothing to disclose.

Conflict of interest: Dr. Garcia Aymerich has nothing to disclose.

Conflict of interest: Dr. Buist has nothing to disclose.