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Employing the Forced Oscillation Technique for the Assessment of Respiratory Mechanics in Adults

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Bronchodilator response in patients with normal baseline spirometry.

Matthew J Hegewald¹, Ryan G Townsend, Jaron T Abbott

¹Division of Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA. mhegewald@scmc.org

Respiratory Care

|March 16, 2012

Summary

A positive bronchodilator response in patients with normal spirometry is rare, occurring in 3.1% of cases. Bronchodilator testing may be unnecessary for individuals with normal spirometry and an FEV1 above 90% of predicted.

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Area of Science:

Pulmonary Medicine
Respiratory Physiology

Background:

Spirometry assesses airflow limitation reversibility via bronchodilator response.
The frequency of positive bronchodilator response in patients with normal baseline spirometry is not well-described.

Purpose of the Study:

To determine the frequency of positive bronchodilator response in adults with normal baseline spirometry.
To identify demographic factors associated with a positive bronchodilator response in this population.

Main Methods:

Retrospective analysis of adult patients from two academic pulmonary function testing labs over seven years.
Included patients with normal baseline spirometry (FEV1, FVC, FEV1/FVC within normal limits).
Calculated frequency of positive bronchodilator response (12% and 200 mL increase in FEV1 or FVC) and analyzed demographic associations.

Main Results:

3.1% (43 of 1,394) of patients with normal spirometry showed a positive bronchodilator response.
Response rates varied by pre-bronchodilator FEV1: 6.9% for > lower limit of normal to 90% predicted, 1.9% for 90-100% predicted, and 0% for >100% predicted.
Lower FEV1/FVC quartiles and older age were associated with a higher frequency of response.

Conclusions:

The frequency of a positive bronchodilator response in patients with normal baseline spirometry is 3.1%.
Patients with normal spirometry and FEV1 >90% predicted have a low probability of a positive response.
Bronchodilator testing can potentially be omitted in patients with normal spirometry and FEV1 >90% predicted.