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

Leena E. Tuomisto, Pinja Ilmarinen, Lauri Lehtimäki, Onni Niemelä, Minna Tommola, Hannu Kankaanranta
ERJ Open Research 2021 7: 00293-2021; DOI: 10.1183/23120541.00293-2021
Leena E. Tuomisto
1Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
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  • ORCID record for Leena E. Tuomisto
  • For correspondence: leena.tuomisto@epshp.fi
Pinja Ilmarinen
1Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
2Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Lauri Lehtimäki
2Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
3Allergy Centre, Tampere University Hospital, Tampere, Finland
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Onni Niemelä
2Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
4Dept of Laboratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
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Minna Tommola
1Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
5Dept of Respiratory Medicine, Central Finland Central Hospital, Jyväskylä, Finland
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Hannu Kankaanranta
1Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
2Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
6Krefting Research Centre, Dept of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
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Figures

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  • FIGURE 1
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    FIGURE 1

    Flow chart of the study to obtain a sample of spirometry tests with bronchodilator in the Seinäjoki Adult Asthma Study study.

  • FIGURE 2
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    FIGURE 2

    Percentages of asthma patients fulfilling the commonly used thresholds to define bronchodilator response. ΔFEV1: change in forced expiratory volume in 1 s; FEV1: forced expiratory volume in 1 s.

  • FIGURE 3
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    FIGURE 3

    Venn diagram of the asthma patients (N=219) fulfilling the bronchodilator response thresholds of absolute volume 200 mL, change in forced expiratory volume in 1 s (ΔFEV1)  ≥12% of the initial FEV1 and ΔFEV1 % of the predicted FEV1 ≥9%.

Tables

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  • TABLE 1

    Characteristics of the study patients and lung function from spirometry showing the highest reversibility at the diagnostic phase in steroid-naïve patients

    CharacteristicsStudy patients (N=219)
    Age, years47±15
    Age of asthma onset, years47±15
    Female126 (57.5%)
    BMI, kg·m-227.1 (24.0–30.4)
    Height, cm170±10
    Smoking history113 (51.6%)
    Current smokers45 (20.5%)
    Pack-years#15 (5–22)
    Atopy¶67 (34.3%)
    Blood eosinophils ×109 per L0.25 (0.17–0.40)
    Total IgE, kU·L−180 (34–170)
    Pre-BD FEV1, L2.77±0.89
    Pre-BD FEV1, % predicted78±17
    Post-BD FEV1, L3.06±0.95
    Post-BD FEV1, % predicted86±17
    Pre-BD FVC, L3.74±1.11
    Pre-BD FVC, % predicted87±16
    Post-BD FVC, L3.95±1.12
    Post-BD FVC, % predicted92±16
    Pre-BD FEV1/FVC0.75 (0.68–0.81)
    Post-BD FEV1/FVC0.79 (0.72–0.84)

    Data are presented as mean±sd, n (%) or median (interquartile range). BMI: body mass index; Ig: immunoglobulin; FEV1: forced expiratory volume in 1 s; BD: bronchodilator; FVC: forced vital capacity. #: Among those with any smoking history. ¶: At least one positive skin prick test for common allergens.

    • TABLE 2

      Bronchodilator responses in spirometry with the highest reversibility chosen from each steroid-naïve asthma patient (N=219)

      Mean±sdMedian (IQR)Patients
      ΔFEV1, mL294±270230 (130–400)219
      ΔFVC, mL210±354130 (30–300)219
      ΔFEV1, % of the initial FEV111.6±10.79.5 (4.8–15.3)219
      ΔFVC, % of the initial FVC6.6±10.93.7 (0.8–8.5)219
      ΔFEV1, % of the predicted FEV18.3±7.27.0 (3.9–10.8)219

      IQR: interquartile range; FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity. The data are not normally distributed. The mean values are shown to make it easier to compare results with other studies.

      • TABLE 3

        Multivariable odds ratios for factors at the diagnostic visit associated with the fulfilment of thresholds of change in forced expiratory value in 1 s (ΔFEV1)  >9% of predicted FEV1 and ΔFEV1 ≥12% and 200 mL of the initial FEV1

        ΔFEV1 ≥9% of predicted FEV1p-valueΔFEV1 ≥12% of the initial FEV1+200 mLp-value
        Age ≥45 years1.54 (0.73–3.22)0.2581.72 (0.77–3.85)0.190
        Male0.71 (0.33–1.50)0.3650.43 (0.19–1.00)0.050
        Symptoms, AQ201.10 (0.97–1.14)0.2281.02 (0.94–1.11)0.630
        Total IgE <100 kU·L−12.06 (0.97–4.37)0.0602.84 (1.24–6.51)0.014
        Blood eosinophils >0.25×109 per L1.90 (0.89–4.10)0.0972.55 (1.10–5.88)0.029
        Post-bronchodilator FEV1/FVC<0.7 and ≥10 pack-years0.26 (0.60–1.11)0.6900.39 (0.11–1.43)0.155
        Pre-bronchodilator FEV1 <80% predicted#6.03 (2.11–17.21)<0.00115.93 (5.00–50.80)<0.001
        Pre-bronchodilator FVC >90% predicted#4.71 (1.68–13.18)0.0032.90 (0.99–8.53)0.053

        Ig: immunoglobulin; FVC: forced vital capacity; FEV1: forced expiratory volume in 1 s; AQ20: Airways Questionnaire 20. #: Measured from the spirometry with highest reversibility. Data are presented as ORs (95% CIs). BMI and smoking were not significantly associated with the thresholds and were excluded from the model. Statistically significant associations are presented in bold.

        • TABLE 4

          Bronchodilator responses in steroid-naïve asthma patients with pre-bronchodilator (pre-BD) forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC)  <0.7 versus FEV1/FVC ≥0.7 (N=219)

          pre-BD FEV1/FVC ≥0.7 (n=151)pre-BD FEV1/FVC <0.7 (n=68)p-value
          ΔFEV1, mL210 (110–370)285 (180–478)0.002
          ΔFVC, mL110 (20–240)200 (90–320)0.012
          ΔFEV1, % of the initial FEV17.3 (3.8–12.5)13.5 (9.3–19.4)<0.001
          ΔFVC % of the initial FVC3.0 (0.5–6.6)6.4 (2.2–8.5)0.008
          ΔFEV1, % of the predicted FEV16.0 (3.2–9.8)8.9 (5.8–13.2)0.001

          Data are presented as the median (interquartile range). Spirometry showing the highest reversibility chosen from each patient.

          • TABLE 5

            Different thresholds of bronchodilator response in steroid-naïve asthma patients with pre-bronchodilator forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC)  <0.7 versus FEV1/FVC ≥0.7 measured from spirometry with the highest reversibility chosen from each patient (N=219)

            pre-BD FEV1/FVC ≥0.7 (n=151)pre-BD FEV1/FVC <0.7 (n=68)p-value
            Absolute change ≥200 mL80 (53.0%)48 (70.6%)0.018
            Absolute change ≥400 mL32 (21.2%)20 (29.4%)0.229
            ΔFEV1 % of the initial FEV1 ≥12% and 200 mL40 (26.5%)38 (55.9%)<0.001
            ΔFEV1 % of the initial FEV1 ≥15% and 400 mL21 (13.9%)18 (26.5%)0.035
            ΔFEV1 % of the initial FEV1 ≥12% and 400 mL26 (17.2%)19 (27.9%)0.074
            ΔFEV1 % of the initial FEV1 ≥15% and 200 mL27 (17.9%)30 (44.1%)<0.001
            ΔFEV1 % of the predicted FEV1 ≥8%58 (38.4%)38 (55.9%)0.019
            ΔFEV1 % of the predicted FEV1 ≥9%46 (30.5%)33 (48.5%)0.015
            ΔFEV1 % of the predicted FEV1 ≥10%37 (24.5%)29 (42.6%)0.010
            None of the thresholds was fulfilled70 (46.4%)19 (27.9%)0.012

            Data are presented as n (%).

            Supplementary Materials

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              Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.

              Supplementary material 00293-2021.SUPPLEMENT

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            Clinical value of bronchodilator response for diagnosing asthma in steroid-naïve adults
            Leena E. Tuomisto, Pinja Ilmarinen, Lauri Lehtimäki, Onni Niemelä, Minna Tommola, Hannu Kankaanranta
            ERJ Open Research Oct 2021, 7 (4) 00293-2021; DOI: 10.1183/23120541.00293-2021

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            Clinical value of bronchodilator response for diagnosing asthma in steroid-naïve adults
            Leena E. Tuomisto, Pinja Ilmarinen, Lauri Lehtimäki, Onni Niemelä, Minna Tommola, Hannu Kankaanranta
            ERJ Open Research Oct 2021, 7 (4) 00293-2021; DOI: 10.1183/23120541.00293-2021
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