Bronchodilator Responsiveness in Tobacco-Exposed People With or Without COPD

Fortis, Spyridon; Quibrera, P. Miguel; Dransfield, Mark; Dolezal, Brett A.; Kim, Victor; Alexis, Neil E.; Anderson, Wayne H.; Arjomandi, Mehrdad; Barr, R. Graham; Basta, Patricia V.; Bateman, Lori A.; Bhatt, Surya P.; Bleecker, Eugene R.; Boucher, Richard C.; Bowler, Russell P.; Christenson, Stephanie A.; Comellas, A.P.; Cooper, Christopher B.; Couper, David; Criner, Gerard J.; Crystal, Ronald G.; Curtis, Jeffrey L.; Doerschuk, Claire M.; Drummond, Brad; Freeman, Christine M.; Galbán, Craig J.; Han, MeiLan K.; Hansel, Nadia N.; Hastie, Annette T.; Hoffman, Eric A.; Huang, Yvonne J.; Kaner, Robert J.; Kanner, Richard E.; Kleerup, Eric C.; Krishnan, Jerry A.; LaVange, Lisa M.; Lazarus, Stephen C.; Martínez, Fernando J.; Meyers, Deborah A.; Moore, Wendy C.; Newell, John D.; Paine, Robert; Paulin, Laura M.; Peters, Stephen P.; Pirozzi, C.S.; Putcha, Nirupama; Oelsner, Elizabeth C.; O’Neal, Wanda K.; Ortega, Victor E.; Raman, Sanjeev; Rennard, Stephen I.; Tashkin, Donald P.; Wells, James M.; Wise, Robert A.; Woodruff, Prescott G.

doi:10.1016/j.chest.2022.11.009

Cited by 4 publications

(3 citation statements)

References 40 publications

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“…The patients with asthma with BDR had worse post-BD lung function, higher F e NO , and a greater burden from respiratory symptoms and more hospital admissions, despite higher levels of treatment with triple therapy, continuous oral corticosteroids, and biologics. For COPD, BDR positivity was associated with modestly worse airflow obstruction and a greater burden from respiratory symptoms, consistent with the increased rate of lung function decline in patients with COPD with BDR ( 33 , 34 ). The commonality of worse lung function and symptom burden with BDR positivity across both diagnostic groups is likely to related, to some extent, to the progressively greater magnitude of FEV 1 change with lower pre-BD FEV 1 percent predicted.…”

Section: Discussionsupporting

confidence: 56%

Prevalence, Diagnostic Utility and Associated Characteristics of Bronchodilator Responsiveness

Beasley,

Hughes,

Agusti

et al. 2024

Am J Respir Crit Care Med

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Rationale The prevalence and diagnostic utility of bronchodilator responsiveness (BDR) in a real-life setting is unclear. Objective 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. Methods The proportion of patients with a positive BDR test in each diagnostic category was calculated using 2005 (ΔFEV 1 or ΔFVC ⩾12% and ⩾200 ml) and 2021 (ΔFEV 1 or ΔFVC >10% predicted) European Respiratory Society/American Thoracic Society criteria. Measurements and Main Results 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. Conclusions 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.

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Section: Discussionsupporting

confidence: 56%

Prevalence, Diagnostic Utility and Associated Characteristics of Bronchodilator Responsiveness

Beasley,

Hughes,

Agusti

et al. 2024

Am J Respir Crit Care Med

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“…In COPD, an increase in both FEV 1 and FVC by 12% and 200 ml after bronchodilator administration was associated with a phenotype that is characterized by less emphysema but reduced mortality ( 15 ). BDR in FVC is typically associated with greater degree of emphysema ( 18 , 19 ) and functional small airway disease ( 20 ). A drawback of BDR is its instability over time ( 14 , 15 ).…”

Section: Asthma-copd Overlap and Copd With Eosinophiliamentioning

confidence: 99%

“…Nevertheless, the hallmark of asthma is lung variability, and it is not surprising that BDR is not stable over time. A recent study showed that consistent BDR in individuals with former or current smoking exposure is associated with prior asthma diagnosis, lung function decline, and functional small airway disease ( 20 ).…”

Section: Asthma-copd Overlap and Copd With Eosinophiliamentioning

confidence: 99%

Chronic obstructive pulmonary disease (COPD) and COPD-like phenotypes

Fortis,

Georgopoulos,

Tzanakis

et al. 2024

Front. Med.

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Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease. Historically, two COPD phenotypes have been described: chronic bronchitis and emphysema. Although these phenotypes may provide additional characterization of the pathophysiology of the disease, they are not extensive enough to reflect the heterogeneity of COPD and do not provide granular categorization that indicates specific treatment, perhaps with the exception of adding inhaled glucocorticoids (ICS) in patients with chronic bronchitis. In this review, we describe COPD phenotypes that provide prognostication and/or indicate specific treatment. We also describe COPD-like phenotypes that do not necessarily meet the current diagnostic criteria for COPD but provide additional prognostication and may be the targets for future clinical trials.

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Bronchodilator Responsiveness Over Time

Mulpuru

Aaron

2023

Chest

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Bronchodilator Responsiveness in Tobacco-Exposed People With or Without COPD

Cited by 4 publications

References 40 publications

Prevalence, Diagnostic Utility and Associated Characteristics of Bronchodilator Responsiveness

Prevalence, Diagnostic Utility and Associated Characteristics of Bronchodilator Responsiveness

Chronic obstructive pulmonary disease (COPD) and COPD-like phenotypes

Bronchodilator Responsiveness Over Time

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