Assessing bronchodilator response by changes in per cent predicted forced expiratory volume in one second

• Authors: Octavian Ioachimescu, Emory University; Jose A Ramos, Cleveland Clinic Foundation; Michael Hoffman, Cleveland Clinic Foundation; Kevin McCarthy, Cleveland Clinic Foundation; James K Stoller, Cleveland Clinic Foundation
• Journal Title: JOURNAL OF INVESTIGATIVE MEDICINE
• Volume: Volume 69, Number 5
• Publisher: BMJ PUBLISHING GROUP | 2021-06-01, Pages 1027-1034
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1136/jim-2020-001663
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Medicine, General & Internal; Medicine, Research & Experimental; General & Internal Medicine; Research & Experimental Medicine; pulmonary disease; chronic obstructive; respiratory physiological phenomena; respiratory system; respiration disorders; REVERSIBILITY; RESPONSIVENESS; CRITERIA

Abstract

In pulmonary function testing by spirometry, bronchodilator responsiveness (BDR) evaluates the degree of volume and airflow improvement in response to an inhaled short-acting bronchodilator (BD). The traditional, binary categorization (present vs absent BDR) has multiple pitfalls and limitations. To overcome these limitations, a novel classification that defines five categories (negative, minimal, mild, moderate and marked BDR), and based on % and absolute changes in forced expiratory volume in 1 s (FEV 1), has been recently developed and validated in patients with chronic obstructive pulmonary disease, and against multiple objective and subjective measurements. In this study, working on several large spirometry cohorts from two different institutions (n=31 598 tests), we redefined the novel BDR categories based on delta post-BD-pre-BD FEV 1 % predicted values. Our newly proposed BDR partition is based on several distinct intervals for delta post-BD-pre-BD % predicted FEV 1 using Global Lung Initiative predictive equations. In testing, training and validation cohorts, the model performed well in all BDR categories. In a validation set that included only normal baseline spirometries, the partition model had a higher rate of misclassification, possibly due to unrestricted BD use prior to baseline testing. A partition that uses delta % predicted FEV 1 with the following intervals ≤0%, 0%-2%, 2%-4%, 4%-8% and >8% may be a valid and easy-to-use tool for assessing BDR in spirometry. We confirmed in our cohorts that these thresholds are characterized by low variance and that they are generally gender-independent and race-independent. Future validation in other cohorts and in other populations is needed.