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Lázár Z, Horváth A, Kiss-Dala S, Abonyi-Tóth Z, Csoma B, Kontz K, Tamási L, Müller V. Assessment of bronchodilator responsiveness to salbutamol or ipratropium using different criteria in treatment-naïve patients with asthma and COPD. Eur Clin Respir J 2024; 11:2328434. [PMID: 38529514 PMCID: PMC10962294 DOI: 10.1080/20018525.2024.2328434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/06/2024] [Indexed: 03/27/2024] Open
Abstract
Background The criteria for significant bronchodilator responsiveness (BDR) were published in 2005 by the European Respiratory Society/American Thoracic Society, which were revised in 2021, however, data on the agreement between these two recommendations in untreated patients with airflow limitation are missing. Aims We aimed to study BDR to salbutamol (SABA) or ipratropium bromide (SAMA) in patients with suspected bronchial asthma or COPD at initial clinical presentation using the 2005 and 2021 criteria and explore clinical factors associated with BDR+. Methods Symptomatic, treatment-naïve patients with expiratory airflow limitation (n = 105, 57 men, age (mean ± standard deviation): 65 ± 10 years) underwent BDR testing with 400 mcg salbutamol (day 1) or 80 mcg ipratropium bromide (day 2) and BDR was measured after 15 and 30 minutes. Clinical factors with risk for BDR+ were assessed with binomial logistic regression analysis. Results We found a good agreement between the number of 2005-BDR+ and 2021-BDR+ patients at 15 and 30 minutes post-salbutamol and post-ipratropium (88.6-94.8%). More patients showed BDR+ after 30 minutes than following 15 minutes using either criterion. When results at 30 minutes are considered, the number of patients with 2005-BDR+ (82%) was higher than that of 2021-BDR+ (75%), with the proportion of SAMA+ patients being higher than that of SABA+ (2005: 70% vs. 49%, Fisher exact p < 0.01; 2021: 64% vs. 41%, p = 0.001). 2005-BDR+ and 2021-BDR+ to SABA were associated with decreasing pre-BD FEV1% predicted and the presence of cough. More patients with asthma were in the SABA+ group compared to the SAMA+ group (2005: 71% vs. 53%, Fischer exact p = 0.04; 2021: 77% vs. 52%, p = 0.02). Conclusions Fewer patients show BDR+ according to the 2021 criteria in comparison with the 2005 recommendations, and protocols for BDR testing may consider the assessment of response to both SABA and SAMA after 30 minutes.
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Affiliation(s)
- Zsófia Lázár
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Alpár Horváth
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
- Medical Department, Chiesi Hungary Ltd., Budapest, Hungary
| | | | | | - Balázs Csoma
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Katalin Kontz
- Health and Social Public Benefit Nonprofit Ltd., Dunakeszi, Hungary
| | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
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Beasley R, Hughes R, Agusti A, Calverley P, Chipps B, del Olmo R, Papi A, Price D, Reddel H, Müllerová H, Rapsomaniki E. Prevalence, Diagnostic Utility and Associated Characteristics of Bronchodilator Responsiveness. Am J Respir Crit Care Med 2024; 209:390-401. [PMID: 38029294 PMCID: PMC10878375 DOI: 10.1164/rccm.202308-1436oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/29/2023] [Indexed: 12/01/2023] Open
Abstract
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 (ΔFEV1 or ΔFVC ⩾12% and ⩾200 ml) and 2021 (ΔFEV1 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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Affiliation(s)
- Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Rod Hughes
- Research and Early Development, Respiratory and Immunology, Clinical, AstraZeneca, Cambridge, United Kingdom
| | - Alvar Agusti
- University of Barcelona, Respiratory Institute, Clinic Barcelona, IDIBAPS, and CIBERES, Barcelona, Spain
| | - Peter Calverley
- University of Liverpool Institute of Life Course and Medical Sciences, Liverpool, United Kingdom
| | - Bradley Chipps
- Capital Allergy & Respiratory Disease Center, Sacramento, California
| | - Ricardo del Olmo
- Diagnostic and Treatment Department of María Ferrer Hospital & IDIM CR, Buenos Aires, Argentina
| | - Alberto Papi
- Research Centre on Asthma and Chronic Obstructive Pulmonary Disease, University of Ferrara, Ferrara, Italy
| | - David Price
- Observational and Pragmatic Research Institute, Singapore
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Helen Reddel
- Woolcock Institute of Medical Research, Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University
- Sydney Local Health District, Sydney, Australia; and
| | - Hana Müllerová
- BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
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Alexis A, Punjabi NM, Grealis K, Wanner A. A comparative study of bronchodilator response: utilizing pre-bronchodilator versus predicted normal values. BMC Pulm Med 2024; 24:54. [PMID: 38273287 PMCID: PMC10809550 DOI: 10.1186/s12890-024-02859-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 01/09/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND A positive bronchodilator response has been defined as a 12% increase in the forced expiratory volume in one second (FEV1) or forced vital capacity (FVC) from their respective pre-bronchodilator values, combined with at least a 0.2 L absolute change. Recent recommendations suggested the use of the percent change in FEV1 and FVC relative to their predicted normal values without having applied them in patients with airflow obstruction. The aim of the current study was to compare the two approaches over a wide range of pre-bronchodilator FEV1 and FVC values. METHODS A retrospective review of consecutive patients undergoing spirometry and bronchodilator testing was completed. The change in FEV1 and FVC with a bronchodilator was expressed relative to the pre-bronchodilator and predicted normal FEV1 and FVC. RESULTS In 1,040 patients with a non-paradoxical change in FEV1, 19.0% had a ≥ 12% change in FEV1 using their pre-bronchodilator value compared to 5.7% using their predicted normal value. For FVC, the respective values were 12.7% vs. 5.8%. The difference was retained in patients with a ≥ 0.2 L change in FEV1 or FVC. In unobstructed patients, the upper threshold (two standard deviations above the mean) of the bronchodilator response was 14% for FEV1 and 10% for FVC using predicted normal values. CONCLUSIONS Expressing the percent change in FEV1 and FVC relative to predicted normal values reduces the over-estimation of the bronchodilator response, especially in patients with a very low pre-bronchodilator FEV1, including in those with a ≥ 0.2 L change in FEV1. Irrespective of pre-bronchodilator values, a ≥ 14% change in FEV1 and ≥ 10% change in FVC relative to the predicted normal values could be considered a positive bronchodilator response.
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Affiliation(s)
- Afe Alexis
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Miami, Miller School of Medicine, 1951 NW 7th Avenue, 33146, Miami, FL, USA
| | - Naresh M Punjabi
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Miami, Miller School of Medicine, 1951 NW 7th Avenue, 33146, Miami, FL, USA.
| | - Kyle Grealis
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Miami, Miller School of Medicine, 1951 NW 7th Avenue, 33146, Miami, FL, USA
| | - Adam Wanner
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Miami, Miller School of Medicine, 1951 NW 7th Avenue, 33146, Miami, FL, USA
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Beydon N, Rosenfeld M. Comparison of bronchodilator responsiveness in asthmatic children using 2021 or 2005 ATS/ERS guidelines. Pediatr Pulmonol 2024; 59:233-235. [PMID: 37846750 DOI: 10.1002/ppul.26728] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/26/2023] [Accepted: 10/07/2023] [Indexed: 10/18/2023]
Affiliation(s)
- Nicole Beydon
- AP-HP Sorbonne Université, Unité d'Exploration Fonctionnelle Respiratoire et INSERM U938, Hôpital Armand-Trousseau, et Hôpital Saint Antoine, Paris, France
| | - Margaret Rosenfeld
- Seattle Children's Research Institute and Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
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Haouzi P, McCully J, Nathani A, Majumdar U, Ickes K, Smith B, Khabbaza J. Arithmetic Behind a Positive Bronchodilator Response. Chest 2024; 165:172-175. [PMID: 37541337 DOI: 10.1016/j.chest.2023.07.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/06/2023] Open
Affiliation(s)
- Philippe Haouzi
- Cleveland Clinic, Respiratory Institute, Department of Pulmonary Medicine, Cleveland, OH; Cleveland Clinic Lerner Research Institute, Cleveland, OH.
| | - Jonathan McCully
- Cleveland Clinic, Respiratory Institute, Department of Pulmonary Medicine, Cleveland, OH
| | - Avantika Nathani
- Cleveland Clinic, Respiratory Institute, Department of Pulmonary Medicine, Cleveland, OH
| | - Uddalak Majumdar
- Cleveland Clinic, Respiratory Institute, Department of Pulmonary Medicine, Cleveland, OH
| | - Kathryn Ickes
- Cleveland Clinic, Respiratory Institute, Department of Pulmonary Medicine, Cleveland, OH
| | - Brigita Smith
- Cleveland Clinic, Respiratory Institute, Department of Pulmonary Medicine, Cleveland, OH
| | - Joseph Khabbaza
- Cleveland Clinic, Respiratory Institute, Department of Pulmonary Medicine, Cleveland, OH
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Chaiwong W, Deesomchok A, Pothirat C, Duangjit P, Liwsrisakun C. Impact of the new European respiratory (ERS)/American Thoracic Society (ATS) pulmonary function test interpretation guidelines 2021 on the interpretation of bronchodilator responsiveness in subjects with airway obstruction. Respir Med 2023; 220:107460. [PMID: 37949150 DOI: 10.1016/j.rmed.2023.107460] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/09/2023] [Accepted: 11/04/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The impact of the new 2021 European Respiratory Society (ERS)/American Thoracic Society (ATS) pulmonary function test interpretation guidelines on the interpretation of bronchodilator responsiveness (BDR) in subjects with airway obstruction is still required. Therefore, the objective of this study was to explore the agreement between the 2005 and 2021 ERS/ATS criteria regarding the interpretation of the BDR. Moreover, we explore the factors that influenced the discordance of positive bronchodilator responsiveness (BDR+) between these two criteria. METHODS The agreement regarding the interpretation of BDR + between the two criteria was assessed using kappa (κ). The percentage of agreement in the interpretation of BDR + between the two criteria was calculated. The factors that influenced the discordance of BDR + between these two criteria were also analyzed. RESULTS A total of 500 subjects with a mean age of 60.5 ± 15.6 years, 62.2% male were included. The study observed a good level of agreement in the interpretation of BDR + between the two criteria with kappa values = 0.782. The percentages of agreement on the interpretation of BDR + between the two criteria were high, with values = 90.6%. Male sex was the only factor that influenced the discordance of BDR + between these two criteria. CONCLUSION A good level of agreement was observed in the interpretation of BDR + between the 2005 and 2021 criteria. Therefore, the 2005 and 2021 ERS/ATS criteria for BDR can be used interchangeably. However, the discordance of BDR + between these two criteria could be affected by sex.
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Affiliation(s)
- Warawut Chaiwong
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Athavudh Deesomchok
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Chaicharn Pothirat
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Pilaiporn Duangjit
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Chalerm Liwsrisakun
- Division of Pulmonary, Critical Care, and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
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Wang Z, Li Y, Lin J, Huang J, Zhang Q, Wang F, Tan L, Liu S, Gao Y, Peng S, Fang H, Weng Y, Li S, Gao Y, Zhong N, Zheng J. Prevalence, risk factors, and mortality of COPD in young people in the USA: results from a population-based retrospective cohort. BMJ Open Respir Res 2023; 10:e001550. [PMID: 37451700 PMCID: PMC10351298 DOI: 10.1136/bmjresp-2022-001550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 06/09/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) has been considered a disease of the elderly, but it could also occur in young people aged 20-50 years. However, the characteristics and prognosis of COPD in such young people remain unclear. METHODS Our retrospective cohort study was based on the National Health and Nutrition Examination Survey (NHANES). Participants who 20-50 years old at baseline and completed the pulmonary function test were enrolled in our study cohort. These participants were followed up to 31 December 2019. The sample weight and Taylor Linearization Procedures were adapted to make representative estimations of prevalence and baseline characteristics. The weighted logistic regression model was used to assess the risk factors. The propensity score method and Cox proportional hazard models were applied to calculate the risk of mortality. RESULTS The weighted prevalence of COPD in young people in the USA was 1.64% and it increased with age, with a higher prevalence in males than females (2.59% vs 0.72%, p<0.001). The proportion of Global Initiative for COPD 1-2 was 96.7%. Males (OR=4.56, 95% CI: 2.74 to 7.61), non-Hispanic black (OR=2.77; 95% CI: 1.14 to 6.75), non-Hispanic white (OR=4.93; 95% CI: 2.16 to 11.28) and smoking (current smoking, OR=2.36; 95% CI: 1.40 to 3.98; ever smoking, OR=1.92; 95% CI: 1.05 to 3.51; passive smoking, OR=2.12; 95% CI: 1.41 to 3.20) were shown to be independent risk factors for COPD in young people. Compared with those matched by sex, age and race, the young people with COPD had a higher risk of all-cause death (HR=3.314, p<0.001). CONCLUSION COPD in young people has a low prevalence in the USA and its independent risk factors included male, race (non-Hispanic black and non-Hispanic white) and smoking. Young COPD has a higher risk of all-cause mortality than the matched non-COPD.
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Affiliation(s)
- Zihui Wang
- National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Yun Li
- National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Junfeng Lin
- National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Jinhai Huang
- National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Qing Zhang
- National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Fengyan Wang
- National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Lunfang Tan
- National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Shuyi Liu
- National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Yuan Gao
- Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Shiyin Peng
- Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Heai Fang
- Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Yuting Weng
- Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Shiyin Li
- Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Yi Gao
- National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Nanshan Zhong
- National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
- Guangzhou National Laboratory, Guangzhou, Guangdong, People's Republic of China
| | - Jinping Zheng
- National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
- Guangzhou National Laboratory, Guangzhou, Guangdong, People's Republic of China
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Lu R, Li Y, Hu C, Pan P, Zhao Q, He R. Nebulization versus metered-dose inhaler and spacer in bronchodilator responsiveness testing: a retrospective study. Ther Adv Respir Dis 2023; 17:17534666231214134. [PMID: 38073272 PMCID: PMC10712271 DOI: 10.1177/17534666231214134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 10/27/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The recommended delivery mode for bronchodilators in bronchodilator responsiveness (BDR) testing remains controversial. OBJECTIVE To compare the efficacy of salbutamol administration using a nebulizer versus a metered-dose inhaler (MDI) with spacer in BDR testing. DESIGN A retrospective study. METHODS This study examined the data of patients with chronic obstructive pulmonary disease who completed BDR testing between 1 December 2021 and 30 June 2022, at Xiangya Hospital, Central South University. After administering 400 μg of salbutamol through an MDI with spacer or 2.5 mg using a nebulizer, the changes in forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were analyzed in patients with moderate-to-very severe spirometric abnormalities [pre-bronchodilator FEV1 percentage predicted values (FEV1%pred) ⩽59%]. Significant responsiveness was assessed as >12% and >200 mL improvement in FEV1 and/or FVC or >10% increase in FEV1%pred or FVC percentage predicted values (FVC%pred) from pre- to post-bronchodilator administration. RESULTS Of the enrolled 894 patients, 83.2% were male (median age, 63 years). After propensity score matching, 240 pairs of patients were selected. The increment in FEV1 and increased FEV1 relative to the predicted value (ΔFEV1%pred) were significantly higher in patients <65 years and those with severe spirometric abnormalities in the nebulization group than patients in the MDI group (all p < 0.05). Compared with MDI with spacer, patients who used nebulization had a 30 mL greater increase in ΔFEV1 (95% CI: 0.01-0.05, p = 0.004) and a 1.09% greater increase in ΔFEV1%pred (95% CI: 0.303-1.896, p = 0.007) from baseline. According to the > 12% and >200 mL increase criterion, the significant BDR rate with nebulization was 1.67 times higher than that with an MDI with spacer (OR = 1.67, 95% CI: 1.13-2.47, p = 0.009). CONCLUSION Salbutamol delivered using a nebulizer may be preferable to an MDI with spacer in certain circumstances. Nebulization has the potential to increase responsiveness to salbutamol in BDR testing.
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Affiliation(s)
- Rongli Lu
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Hunan, China
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Hunan, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan, China
| | - Ying Li
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Hunan, China
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Hunan, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan, China
| | - Chengping Hu
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Hunan, China
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Hunan, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan, China
| | - Pinhua Pan
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Hunan, China
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Hunan, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan, China
| | - Qiaohong Zhao
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Hunan, China
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Hunan, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan, China
| | - Ruoxi He
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, 87th Xiangya Road, Changsha, Hunan 410008, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan, China
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