TY - JOUR T1 - Bronchodilator reversibility as a diagnostic test for adult asthma: findings from the population-based Tasmanian Longitudinal Health Study JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00042-2020 VL - 7 IS - 1 SP - 00042-2020 AU - Daniel J. Tan AU - Caroline J. Lodge AU - Adrian J. Lowe AU - Dinh S. Bui AU - Gayan Bowatte AU - David P. Johns AU - Garun S. Hamilton AU - Paul S. Thomas AU - Michael J. Abramson AU - E. Haydn Walters AU - Jennifer L. Perret AU - Shyamali C. Dharmage Y1 - 2021/01/01 UR - http://openres.ersjournals.com/content/7/1/00042-2020.abstract N2 - Bronchodilator reversibility (BDR) is often used as a diagnostic test for adult asthma. However, there has been limited assessment of its diagnostic utility. We aimed to determine the discriminatory accuracy of common BDR cut-offs in the context of current asthma and asthma–COPD overlap (ACO) in a middle-aged community sample.The Tasmanian Longitudinal Health Study is a population-based cohort first studied in 1968 (n=8583). In 2012, participants completed respiratory questionnaires and spirometry (n=3609; mean age 53 years). Receiver operating characteristic (ROC) curves were fitted for current asthma and ACO using continuous BDR measurements. Diagnostic parameters were calculated for different categorical cut-offs.Area under the ROC curve (AUC) was highest when BDR was expressed as change in forced expiratory volume in 1 s (FEV1) as a percentage of initial FEV1, as compared with predicted FEV1. The corresponding AUC was 59% (95% CI 54–64%) for current asthma and 87% (95% CI 81–93%) for ACO. Of the categorical cut-offs examined, the European Respiratory Society/American Thoracic Society threshold (≥12% from baseline and ≥200 mL) was assessed as providing the best balance between positive and negative likelihood ratios (LR+ and LR−, respectively), with corresponding sensitivities and specificities of 9% and 97%, respectively, for current asthma (LR+ 3.26, LR− 0.93), and 47% and 97%, respectively, for ACO (LR+ 16.05, LR− 0.55).With a threshold of ≥12% and ≥200 mL from baseline, a positive BDR test provided a clinically meaningful change in the post-test probability of disease, whereas a negative test did not. BDR was more useful as a diagnostic test in those with co-existent post-bronchodilator airflow obstruction (ACO).Using the commonly adopted threshold, a positive BDR test provides a meaningful change in post-test probability of adult asthma, whereas a negative test does not. Discriminatory accuracy is much greater in those with coexistent post-BD airflow obstruction. https://bit.ly/3gPvlm8 ER -