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      Bronchodilator reversibility in asthma and COPD: findings from three large population studies.

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          Abstract

          Bronchodilator response (BDR) testing is used as a diagnostic method in obstructive airway diseases. The aim of this investigation was to compare different methods for measuring BDR in participants with asthma and chronic obstructive pulmonary disease (COPD) and to study to the extent to which BDR was related to symptom burden and phenotypic characteristics.Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were measured before and 15 min after 200 μg of salbutamol in 35 628 subjects aged ≥16 years from three large international population studies. The subjects were categorised in three groups: current asthma (n=2833), COPD (n=1146) and no airway disease (n=31 649). Three definitions for flow-related reversibility (increase in FEV1) and three for volume-related reversibility (increase in FVC) were used.The prevalence of bronchodilator reversibility expressed as increase FEV1 ≥12% and 200 mL was 17.3% and 18.4% in participants with asthma and COPD, respectively, while the corresponding prevalence was 5.1% in those with no airway disease. In asthma, bronchodilator reversibility was associated with wheeze (OR 1.36, 95% CI 1.04-1.79), atopy (OR 1.36, 95% CI 1.04-1.79) and higher exhaled nitric oxide fraction, while in COPD neither flow- nor volume-related bronchodilator reversibility was associated with symptom burden, exacerbations or health status after adjusting for pre-bronchodilator FEV1Bronchodilator reversibility was at least as common in participants with COPD as those with asthma. This indicates that measures of reversibility are of limited value for distinguishing asthma from COPD in population studies. However, in asthma, bronchodilator reversibility may be a phenotypic marker.

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          Author and article information

          Journal
          Eur. Respir. J.
          The European respiratory journal
          European Respiratory Society (ERS)
          1399-3003
          0903-1936
          September 2019
          : 54
          : 3
          Affiliations
          [1 ] Dept of Medical Sciences, Respiratory Allergy and Sleep Research, Uppsala University, Uppsala, Sweden christer.janson@medsci.uu.se.
          [2 ] Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College London, London, UK.
          [3 ] Dept of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden.
          [4 ] Unit of Epidemiology and Medical Statistics, Dept of Diagnostics and Public Health, University of Verona, Verona, Italy.
          [5 ] Fondation FMC VIA-LR, Montpellier, France.
          [6 ] Euforea, Brussels, Belgium.
          [7 ] Allergy Centre Charité, Dept of Dermatology and Allergy, Charité Universitätsmedizin Berlin, Berlin, Germany.
          [8 ] Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA.
          [9 ] Personalized Medicine Clinic Asthma and Allergy Humanitas Research Hospital, Milan, Italy.
          [10 ] Dept of Medicine, Unit for Heart and Lung disease, Karolinska Institutet, Stockholm, Sweden.
          [11 ] ISGlobal, Barcelona, Spain.
          [12 ] Universitat Pompeu Fabra (UPF), Barcelona, Spain.
          [13 ] CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
          [14 ] Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Dept of Population Health, University of Oxford, Oxford, UK.
          [15 ] Dept of Immunology and Allergy, Medical University of Lodz, Lodz, Poland.
          [16 ] Centre for Heart Lung Innovation (Tan, Sin), University of British Columbia, St. Paul's Hospital Vancouver, Vancouver, BC, Canada.
          [17 ] Dept of Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden.
          Article
          13993003.00561-2019
          10.1183/13993003.00561-2019
          31221806

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