Which bronchodilator reversibility criteria can predict severe acute exacerbation in chronic obstructive pulmonary disease patients?

Abstract

BackgroundIt is unclear whether various bronchodilator reversibility (BDR) criteria affect the prognosis of chronic obstructive pulmonary disease (COPD). The aim of this study is to evaluate the impact of positive BDR defined according to various BDR criteria on the risk of severe acute exacerbation (AE) in COPD patients.MethodsPatients from four prospective COPD cohorts in South Korea who underwent follow-up for at least 1 year were enrolled in this study. The assessed BDR criteria included the Global Initiative for Chronic Obstructive Lung Disease (GOLD), American Thoracic Society (ATS), American College of Chest Physicians, (ACCP), major criteria of the Spanish definition of asthma-COPD overlap syndrome (ACOS), criteria compatible with ACOS in the Global Initiative for Asthma (GINA), and European Respiratory Society (ERS). The rate of patients with severe AE who required hospitalization within 1 year due to BDR results according to each set of criteria was analyzed using logistic regression models.ResultsAmong a total of 854 patients, the BDR-positive cases varied according to the criteria used. There was a 3.5% positive BDR rate according to GINA and a 29.9% rate according to the ATS criteria. Positive BDR according to the GOLD criteria was significantly associated with a decreased risk of severe AE (adjusted odds ratio (aOR) = 0.38; 95% Confidence interval (CI) = 0.15–0.93). This result remained statistically significant even in a sensitivity analysis that included only participants with a smoking history of at least 10 pack-years and in the analysis for the propensity score-matched participants.ConclusionsAmong different criteria for positive BDR, the use of the GOLD ones was significantly associated with a decreased risk of severe AE in COPD patients. Increase use of ICS/LABA may have affected this relationship.Electronic supplementary materialThe online version of this article (doi:10.1186/s12931-017-0587-9) contains supplementary material, which is available to authorized users.

Effect of TRPM8 and TRPA1 Polymorphisms on COPD Predisposition and Lung Function in COPD Patients

“…In the COPD group, 58.7% of patients had positive response to salbutamol, which is considered to be associated with better prognosis in terms of reduced risk of severe acute exacerbations [ 34 ]. The TRPA1 rs959976 polymorphism significantly influenced the response both qualitatively and quantitatively.…”

Clinical characterization and outcomes of impulse oscillometry-defined bronchodilator response: an ECOPD cohort-based study

“…However, the clinical significance of spirometric BDR in patients with COPD remains controversial. Numerous studies have reported no association between spirometric BDR and exacerbations, mortality, or hospitalization rates in patients with COPD after adjusting for baseline function [ 6 , 7 , 9 ], however, a few studies have presented contrary conclusions [ 8 , 10 ].…”

The paradoxical response to short-acting bronchodilator administration in patients with chronic obstructive pulmonary disease

“…Post-bronchodilator spirometry is required for the diagnosis of chronic obstructive pulmonary disease (COPD), but the role of bronchodilator response (BDR) is unclear in COPD (1). Positive bronchodilator reversibility is no longer recommended as a treatment option for COPD, and there is no standard definition yet (2,3). In addition, positive bronchodilator reversibility does not predict the clinical outcomes of long-term use of bronchodilators and inhaled corticosteroid (ICS) (4).…”