Worldwide patterns of bronchodilator responsiveness: results from the Burden of Obstructive Lung Disease study

Abstract

RationaleCriteria for a clinically significant bronchodilator response (BDR) are mainly based on studies in patients with obstructive lung diseases. Little is known about the BDR in healthy general populations, and even less about the worldwide patterns.Methods10 360 adults aged 40 years and older from 14 countries in North America, Europe, Africa and Asia participated in the Burden of Obstructive Lung Disease study. Spirometry was used before and after an inhaled bronchodilator to determine the distribution of the BDR in population-based samples of healthy non-smokers and individuals with airflow obstruction.ResultsIn 3922 healthy never smokers, the weighted pooled estimate of the 95th percentiles (95% CI) for bronchodilator response were 284 ml (263 to 305) absolute change in forced expiratory volume in 1 s from baseline (ΔFEV1); 12.0% (11.2% to 12.8%) change relative to initial value (%ΔFEV1i); and 10.0% (9.5% to 10.5%) change relative to predicted value (%ΔFEV1p). The corresponding mean changes in forced vital capacity (FVC) were 322 ml (271 to 373) absolute change from baseline (ΔFVC); 10.5% (8.9% to 12.0%) change relative to initial value (ΔFVCi); and 9.2% (7.9% to 10.5%) change relative to predicted value (ΔFVCp). The proportion who exceeded the above threshold values in the subgroup with spirometrically defined Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 2 and higher (FEV1/FVC <0.7 and FEV1% predicted <80%) were 11.1%, 30.8% and 12.9% respectively for the FEV1-based thresholds and 22.6%, 28.6% and 22.1% respectively for the FVC-based thresholds.ConclusionsThe results provide reference values for bronchodilator responses worldwide that confirm guideline estimates for a clinically significant level of BDR in bronchodilator testing.

Thorax: the Cappuccino years

“…The use of the acute bronchodilator response has had a serious mauling in two studies evaluating this measure cross-sectionally and longitudinally in big populations 44 45. When something can neither be measured repeatedly nor shown to relate to any important patient event, it's time to abandon it.…”

The double macchiato years; awards for the best basic science and epidemiology papers in 2012

“…Both concerned bronchodilator responsiveness. In 4000 ‘healthy’ non-smokers taking part in the worldwide Burden of Obstructive Lung Disease survey the pooled estimate of the upper 95% confidence limit for FEV 1 response was 280 mls or 12% from baseline 22. We thought we knew this but now we know it for sure.…”

Bronchodilator response of advanced lung function parameters depending on COPD severity

“…31 Additional inhalation of SAMA increased the response, especially in patients with FEV 1 %p ,65, to 6% (210 mL). The continuous analysis did not detect higher response in more severe patients (nonsignificant slope), but the intercept was significant and thereby in accordance with the response analysis.…”