Bronchodilator Response in FVC Is Larger and More Relevant Than in FEV 1 in Severe Airflow Obstruction

Quanjer, Philip H.; Ruppel, Gregg; Langhammer, Arnulf; Krishna, Amresh; Mertens, Frans W.; Johannessen, Ane; Menezes, Ana Maria Baptista; Wehrmeister, Fernando César; Pérez‐Padilla, Rogelio; Swanney, Maureen P.; Tan, Wan C.; Bourbeau, Jean

doi:10.1016/j.chest.2016.12.017

Cited by 52 publications

(64 citation statements)

References 37 publications

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“…Therefore, we believe this study's findings are helpful to characterize clinical associations of bronchodilator responsiveness rather than using them to make therapeutic decisions. We hope that our findings, in addition to recently reported studies that characterize BDR, 11,34 will spur guideline committees to revisit current BDR criteria.…”

Section: Relevance To Aco Phenotypementioning

confidence: 57%

“…BDR was evaluated as absolute change from baseline FEV1 (FEV1L) and percentage change from baseline FEV1 (FEV1%). BDR is a continuous variable with an unimodal, not bimodal, response pattern 11 . Using fixed population-based criteria for both volume and percentage change in BDR is not optimal, especially considering differences in drug, dosage and administration methods in published studies .…”

Section: Spirometry and Proposed Bdr Gradesmentioning

confidence: 99%

“…Further, BDR to a short acting bronchodilator is no longer recommended to predict long term response and is not thought helpful in making therapeutic decisions 11 . Therefore, we believe this study's findings are helpful to characterize clinical associations of bronchodilator responsiveness rather than using them to make therapeutic decisions.…”

Section: Relevance To Aco Phenotypementioning

confidence: 99%

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A New Bronchodilator Response Grading Strategy Identifies Distinct Patient Populations

Hansen¹,

Dilektaşlı

Pórszász³

et al. 2019

Annals ATS

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Background: A positive bronchodilator response (BDR) by American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines requires an increase in FEV1 or FVC 200 mL and 12% after bronchodilator inhalation. This dual criterion is insensitive in those with high or low FEV1. We aimed to establish BDR criteria with volume or percentage FEV1 change. Methods: The largest FEV1 and FVC were identified from 3 pre-and 3 post-bronchodilator maneuvers in COPDGene participants. 7,741 individuals with coefficient of variation <15% for both FEV1 and FVC formed bronchodilator categories of FEV1 response: negative (≤0.00% or ≤0.00L), minimal (>0.00% to ≤9.00% or >0.00L to ≤0.09L), mild (>9.00% to ≤16.00% or >0.09L to ≤0.16L), moderate (>16.00% to ≤26.00% or >0.16L to ≤0.26L), and marked (>26.00% or >0.26L). These response-size categories are based on empirical limits considering average FEV1 increase of ~160 ml and the clinically important difference for FEV1. To compare flow and volume response characteristics, BDR-FEV1 category assignments were applied for the BDR-FVC response. Results: 20% met mild and 31% met moderate or marked BDR-FEV1 criteria; whereas 12% met mild and 33% met moderate or marked BDR-FVC criteria. In contrast, only 20.6% met ATS/ERS positive criteria. Minimal, mild, moderate and marked BDR-FEV1 categories were associated with greater six-minute walking distance, lower St. George's Respiratory Questionnaire and mMRC dyspnea scores as compared to those in negative BDR-FEV1 category. Moderate and marked BDR-FEV1 categories were associated with fewer exacerbations and minimal BDR was associated with lower computerized tomography airway wall thickness compared to negative BDR. Compared with negative, all BDR-FVC categories were associated 7 with increasing emphysema% and gas trapping%. Moderate and marked BDR-FVC categories were associated with higher SGRQ scores but fewer exacerbations and lower dyspnea scores. Conclusions: BDR grading by FEV1 volume or percentage response identified subjects otherwise missed by ATS/ERS criteria. BDR grades were associated with functional exercise performance, quality of life, exacerbation frequency, dyspnea and radiological airway measures. BDR grades in FEV1 and FVC indicate different clinical and radiological characteristics.

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Section: Relevance To Aco Phenotypementioning

confidence: 57%

Section: Spirometry and Proposed Bdr Gradesmentioning

confidence: 99%

Section: Relevance To Aco Phenotypementioning

confidence: 99%

See 1 more Smart Citation

A New Bronchodilator Response Grading Strategy Identifies Distinct Patient Populations

Hansen¹,

Dilektaşlı

Pórszász³

et al. 2019

Annals ATS

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“…Further studies using LABA/LAMA combinations are required to address these important scientific questions. 5) Given the heterogeneity of COPD, it would have been of interest to evaluate further parameters such as additional spirometric measures (eg, forced vital capacity [FVC]49 or other markers of small airways dysfunction) or the effects of treatments on physical activity 50,51. Data on such parameters are, however, not uniformly presented in RCTs; therefore, in this meta-analysis, the most commonly used clinically relevant outcomes were prespecified as the outcomes of interest.…”

Section: Discussionmentioning

confidence: 99%

LABA/LAMA combinations versus LAMA monotherapy or LABA/ICS in COPD: a systematic review and meta-analysis

Rodrigo¹,

Price²,

Anzueto³

et al. 2017

COPD

120

114

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BackgroundRandomized controlled trials (RCTs) indicate that long-acting bronchodilator combinations, such as β2-agonist (LABA)/muscarinic antagonist (LAMA), have favorable efficacy compared with commonly used COPD treatments. The objective of this analysis was to compare the efficacy and safety of LABA/LAMA with LAMA or LABA/inhaled corticosteroid (ICS) in adults with stable moderate-to-very-severe COPD.MethodsThis systematic review and meta-analysis (PubMed/MEDLINE, Embase, Cochrane Library and clinical trial/manufacturer databases) included RCTs comparing ≥12 weeks’ LABA/LAMA treatment with LAMA and/or LABA/ICS (approved doses only). Eligible studies were independently selected by two authors using predefined data fields; the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed.ResultsEighteen studies (23 trials) were eligible (N=20,185). LABA/LAMA significantly improved trough forced expiratory volume in 1 second (FEV1) from baseline to week 12 versus both LAMA and LABA/ICS (0.07 L and 0.08 L, P<0.0001), with patients more likely to achieve clinically important improvements in FEV1 of >100 mL (risk ratio [RR]: 1.33, 95% confidence interval [CI]: [1.20, 1.46] and RR: 1.44, 95% CI: [1.33, 1.56], respectively, the number needed to treat being eight and six, respectively). LABA/LAMA improved transitional dyspnea index and St George’s Respiratory Questionnaire scores at week 12 versus LAMA (both P<0.0001), but not versus LABA/ICS, and reduced rescue medication use versus both (P<0.0001 and P=0.001, respectively). LABA/LAMA significantly reduced moderate/severe exacerbation rate compared with LABA/ICS (RR 0.82, 95% CI: [0.75, 0.91]). Adverse event (AE) incidence was no different for LABA/LAMA versus LAMA treatment, but it was lower versus LABA/ICS (RR 0.94, 95% CI: [0.89, 0.99]), including a lower pneumonia risk (RR 0.59, 95% CI: [0.43, 0.81]). LABA/LAMA presented a lower risk for withdrawals due to lack of efficacy versus LAMA (RR: 0.66, 95% CI: [0.51, 0.87]) and due to AEs versus LABA/ICS (RR: 0.83, 95% CI: [0.69, 0.99]).ConclusionThe greater efficacy and comparable safety profiles observed with LABA/LAMA combinations versus LAMA or LABA/ICS support their potential role as first-line treatment options in COPD. These findings are of direct relevance to clinical practice because we included all currently available LABA/LAMAs and comparators, only at doses approved for clinical use.

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“…A significant increase in FVC (≥200 mL and 12%) may be related to a reduction in hyperinflation (reduction in residual volume), which has clinical benefits. Significant increases in FVC following bronchodilator administration have been shown to occur more often than significant increases in FEV 1 in severe COPD . Differences between clinical practice guidelines and the ATS/ERS definitions of BD response may result in inconsistencies in clinical management.…”

Section: Discussionmentioning

confidence: 99%

Substantial variation exists in spirometry interpretation practices for airflow obstruction in accredited lung function laboratories across Australia and New Zealand

Holt

Thompson

Miller

et al. 2019

Internal Medicine Journal

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Significant heterogeneity in spirometry interpretation for airflow obstruction exists across Australian and New Zealand accredited lung function laboratories. Lack of standardisation may translate into clinically appreciable differences for the diagnosis and management of common respiratory conditions. Ongoing discussion regarding formal standardisation is required. This article is protected by copyright. All rights reserved.

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Bronchodilator Response in FVC Is Larger and More Relevant Than in FEV 1 in Severe Airflow Obstruction

Cited by 52 publications

References 37 publications

A New Bronchodilator Response Grading Strategy Identifies Distinct Patient Populations

A New Bronchodilator Response Grading Strategy Identifies Distinct Patient Populations

LABA/LAMA combinations versus LAMA monotherapy or LABA/ICS in COPD: a systematic review and meta-analysis

Substantial variation exists in spirometry interpretation practices for airflow obstruction in accredited lung function laboratories across Australia and New Zealand

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