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Significant bronchodilator responsiveness and "reversibility" in a population sample.
Heather A Prentice1, David M Mannino, Glyn G Caldwell
1University of Kentucky, Lexington, 40536, USA. haprenti@uab.edu
COPD
|September 22, 2010
Summary
Bronchodilator responsiveness in Chronic Obstructive Pulmonary Disease (COPD) is distinct from reversibility of airway obstruction. Many patients with COPD do not show significant changes in obstruction status after bronchodilator use.
Area of Science:
- Pulmonology
- Respiratory Medicine
- Clinical Trials
Background:
- Chronic Obstructive Pulmonary Disease (COPD) diagnosis often relies on reversibility testing post-bronchodilator.
- Current guidelines recommend assessing lung function after bronchodilator administration for COPD.
- The terms 'bronchodilator responsiveness' and 'reversibility of obstruction' are frequently used interchangeably in clinical practice.
Purpose of the Study:
- To compare bronchodilator responsiveness with changes in obstruction status in a population-based COPD sample.
- To investigate the relationship between significant bronchodilator responsiveness and full, partial, or 'inverse' reversibility of airway obstruction.
- To determine if bronchodilator responsiveness equates to reversibility of obstruction in COPD patients.
Main Methods:
- A population-based sample from Southeastern Kentucky (Burden of Lung disease project) was utilized.
- Spirometry was performed pre- and post-bronchodilation on 440 adult participants.
- COPD classification used modified Global Obstructive Lung Disease (GOLD) criteria, analyzing FEV1/FVC ratio and bronchodilator response (≥12% improvement in FEV1 or FVC).
Main Results:
- Only 7.3% of participants showed full reversibility (obstructed to unobstructed), and 4.3% showed 'inverse' reversibility (unobstructed to obstructed).
- 14.8% of participants exhibited significant bronchodilator responsiveness.
- Among those with full reversibility, only 28.1% had bronchodilator responsiveness; conversely, 52.6% with 'inverse' reversibility showed responsiveness. Critically, only 29.2% of all responsive subjects changed obstruction categories.
Conclusions:
- Significant bronchodilator responsiveness is not synonymous with reversibility of airway obstruction in COPD.
- Clinical definitions and assessments of bronchodilator effects in COPD require careful differentiation.
- Interchangeable use of these terms may lead to misinterpretation of COPD severity and treatment response.
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