Clinical value of bronchodilator response for diagnosing asthma in steroid-naïve adults

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Abstract

Spirometry and testing for bronchodilator response have been recommended to detect asthma, and a bronchodilator response (BDR) of ≥12% and ≥200 mL has been suggested to confirm asthma. However, the clinical value of bronchodilation tests in newly diagnosed steroid-naïve adult patients with asthma remains unknown. We evaluated the sensitivity of BDR in FEV1 as a diagnostic test for asthma in a real-life cohort of participants in the Seinäjoki Adult Asthma Study (SAAS). In the diagnostic phase, 369 spirometry tests with bronchodilation were performed for 219 steroid-naïve patients. The fulfilment of each test threshold was assessed. According to the algorithm of the National Institute for Health and Care Excellence, we divided the patients into obstructive (FEV11/FVC<0.70) and non-obstructive (FEV1/FVC≥0.70) groups. Of the overall cohort, 35.6% fulfilled ΔFEV1≥12% and ≥200mL for the initial FEV1, 18.3% fulfilled ΔFEV1≥15% and ≥400 mL for the initial FEV1 and 36.1% fulfilled ΔFEV1≥9% of predicted FEV1 at least once. One-third (31%) of these steroid-naïve patients was obstructive (pre-bronchodilator FEV1/FVC<0.7). Of the obstructive patients, 55.9%, 26.5% and 48.5%, respectively, met the same thresholds. In multivariate logistic regression analysis, different thresholds recognized different kinds of asthma patients. In steroid-naïve adult patients, the current BDR threshold (ΔFEV1≥12% and ≥200 mL) has low diagnostic sensitivity (36%) for asthma. In obstructive patients, sensitivity is somewhat higher (56%) but far from optimal. If the first spirometry test with bronchodilation is not diagnostic but asthma is suspected, spirometry should be repeated, and other lung function tests should be used to confirm the diagnosis.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: Dr. Tuomisto reports personal fees and non-financial support from Boehringer-Ingelheim, personal fees from Astra Zeneca, outside the submitted work; .Conflict of interest: Dr. Ilmarinen is an employee of GlaxoSmithKline. Dr. Ilmarinen reports personal fees from Mundipharma, personal fees from AstraZeneca, personal fees from Novartis, outside the submitted work.Conflict of interest: Dr. Lehtimäki reports personal fees from AstraZeneca, personal fees from Boehringer Ingelheim, personal fees from Chiesi, personal fees from Circassia, personal fees from GSK, personal fees from Novartis, personal fees from Mundipharma, personal fees from Orion Pharma, personal fees from Sanofi, personal fees from Teva, outside the submitted work; .Conflict of interest: Dr. Niemelä has nothing to disclose.Conflict of interest: Dr. Tommola reports personal fees from Astra Zeneca, personal fees and non-financial support from Boehringer ingelheim, personal fees from Pfizer, grants from Orion research foundation, personal fees from Chiesi, personal fees from GSK, outside the submitted work; .Conflict of interest: Dr. Kankaanranta reports grants, personal fees and non-financial support from AstraZeneca, personal fees from Chiesi Pharma AB, personal fees and non-financial support from Boehringer-Ingelheim, personal fees from Novartis, personal fees from Mundipharma, personal fees and non-financial support from Orion Pharma, personal fees from SanofiGenzyme, personal fees from GlaxoSmithKline, outside the submitted work; .
Original languageEnglish
JournalErj Open Research
Volume7
Issue number4
DOIs
Publication statusPublished - 13 Dec 2021
Publication typeA1 Journal article-refereed

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