Knox-Brown B, Algharbi F, Mulhern O, Potts J, Harrabi I, Janson C, Nielsen R, Agarwal D, Malinovschi A, Juvekar S, Denguezli M, Gíslason T, Ahmed R, Nafees A, Koul PA, Obaseki D, Anand MP, Loh LC, Dias HB, Rodrigues F, Mannino D, Elbiaze M, El Rhazi K, Mejza F, Devereux G, Franssen FM, El Sony A, Wouters E, Al Ghobain M, Mortimer K, Rashid A, Osman R, Studnicka M, Cardoso J, Burney P, Amaral AF. Bronchodilator responsiveness and future chronic airflow obstruction: a multinational longitudinal study.
EClinicalMedicine 2025;
81:103123. [PMID:
40083442 PMCID:
PMC11905823 DOI:
10.1016/j.eclinm.2025.103123]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2024] [Revised: 01/31/2025] [Accepted: 02/04/2025] [Indexed: 03/16/2025] Open
Abstract
Background
Bronchodilator responsiveness testing is mainly used for diagnosing asthma. We aimed to investigate whether it is associated with progression to chronic airflow obstruction over time.
Methods
The multinational Burden of Obstructive Lung Disease cohort study surveyed adults, aged 40 years and above, at baseline and followed them up after a mean of 9.1 years. Recruitment took place between January 2, 2003 and December 26, 2016. Follow-up measurements were collected between January 29, 2019 and October 24, 2021. On both occasions, study participants provided information on respiratory symptoms, health status and several environmental and lifestyle exposures. They also underwent pre- and post-bronchodilator spirometry. We defined bronchodilator responsiveness at baseline using the American Thoracic Society and European Respiratory Society (ATS/ERS) 2022 definition, and the presence of chronic airflow obstruction at follow-up as a post-bronchodilator forced expiratory volume in 1 s to forced vital capacity ratio (FEV1/FVC) less than the lower limit of normal. We used multi-level regression models to estimate the association between baseline bronchodilator responsiveness and incident chronic airflow obstruction. We stratified analyses by gender and performed a sensitivity analysis in never smokers.
Findings
We analysed data from 3701 adults with 56% being women. Compared to those without bronchodilator responsiveness at baseline, those with bronchodilator responsiveness had 36% increased risk of developing chronic airflow obstruction (RR: 1.36, 95%CI 1.04, 1.80). This effect was stronger in women (RR: 1.45, 95%CI 1.09, 1.91) than men (RR: 1.07, 95%CI 0.51, 2.24). Never smokers with bronchodilator responsiveness also were at greater risk of incident chronic airflow obstruction (RR: 1.48, 95%CI 1.01, 2.20).
Interpretation
Bronchodilator responsiveness appears to be a risk factor for incident chronic airflow obstruction. It is important that future studies in other large population-based cohorts replicate these findings.
Funding
National Heart and Lung Institute, UK Medical Research Council, and Wellcome Trust.
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