Bronchodilator Responsiveness Defined by the 2005 and 2021 ERS/ATS Criteria in Patients with Asthma as Well as Chronic Obstructive Pulmonary Disease

Yun Li; Junfeng Lin; Zihui Wang; Zhufeng Wang; Lunfang Tan; Shuyi Liu; Jinhai Huang; Yi Gao; Jinping Zheng

doi:10.2147/COPD.S385733

Bronchodilator Responsiveness Defined by the 2005 and 2021 ERS/ATS Criteria in Patients with Asthma as Well as Chronic Obstructive Pulmonary Disease

Int J Chron Obstruct Pulmon Dis. 2022 Oct 17:17:2623-2633. doi: 10.2147/COPD.S385733. eCollection 2022.

Authors

Yun Li^#¹, Junfeng Lin^#¹, Zihui Wang^#¹, Zhufeng Wang¹, Lunfang Tan¹, Shuyi Liu¹, Jinhai Huang¹, Yi Gao¹, Jinping Zheng¹

Affiliation

¹ National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China.

^# Contributed equally.

Abstract

Background: In the 2021 ERS/ATS interpretive strategies for routine lung function tests, a positive bronchodilator response (BDR) was updated as a change of >10% relative to the predicted value in forced expiratory volume in 1 second (FEV₁) or forced vital capacity (FVC). We aimed to explore the differences between the 2005 and 2021 ERS/ATS criteria applied to patients with asthma as well as chronic obstructive pulmonary disease (COPD).

Methods: BDR test data about asthma patients aged 6-80 years and COPD patients aged 18-80 years were derived from the National Respiratory Medicine Center, First Affiliated Hospital of Guangzhou Medical University, from January 2017 to March 2022. BDR results defined by the 2005 and 2021 ERS/ATS criteria were named 2005-BDR and 2021-BDR, respectively. We compared differences between 2005-BDR and 2021-BDR and analyzed the trend in the proportion of positive BDR (BDR+) with the level of airflow obstruction.

Results: A total of 4457 patients with asthma and 7764 patients with COPD were included in the analysis. The percentages of 2005-BDR+ and 2021-BDR+ were 63.32% and 52.84% for asthma, 30.92% and 22.94% for COPD, respectively. Of patients with 2005-BDR+, 81.86% for asthma and 70.18% for COPD showed 2021-BDR+ results, and these patients had higher FEV₁%pred, FVC%pred (all P<0.05). Whichever BDR criterion was adopted, the proportion of BDR+ had an upward linear trend with the increased degree of airflow obstruction in COPD, but exhibited an approximate inverted U-shaped curve in asthma. In COPD, the proportion of BDR_FEV1 was negatively associated with the degree of airflow obstruction, while BDR_FVC was positively associated (all P<0.05).

Conclusion: Compared with 2005-BDR+, the proportion of 2021-BDR+ reduced markedly in patients with asthma and COPD, but their trends with the degree of airflow obstruction did not change. Patients with consistent BDR+ had higher initial FEV₁%pred and FVC%pred.

Keywords: ATS; American Thoracic Society; ERS; European Respiratory Society; asthma; bronchodilator responsiveness testing; chronic obstructive pulmonary disease; pulmonary function test.

MeSH terms

Asthma* / diagnosis
Asthma* / drug therapy
Bronchodilator Agents / adverse effects
Forced Expiratory Volume
Humans
Pulmonary Disease, Chronic Obstructive* / diagnosis
Pulmonary Disease, Chronic Obstructive* / drug therapy
Severity of Illness Index
Vital Capacity

Substances

Bronchodilator Agents

Grants and funding

This work was supported by grants from the National Key Research and Development Program of China (No. 2018YFC1311900) and Medical Scientific Research Foundation of Guangdong Province (C2021073).