Impact of ERS/ATS 2022 bronchodilator response guidelines in asthma control

To determine whether the bronchodilator response (BDR) according to the new cutoff values is associated with worse asthma control compared with the 2005 definition.

Prospective study on moderate to severe asthma patients under clinical follow-up. Patients were classified based on the BDR using both ERS/ATS 2022 and 2005 thresholds. We collected clinical and functional data, along with exacerbations over a one-year follow-up period.

Among the 198 patients included, mean age was 60.2 years-old (SD 16.3), with 74.7% being women and 69.7% having severe asthma. According to the 2005 threshold, 46 (23.2%) showed bronchodilator responsiveness, whereas with the 2022 recommendations decreased to 38 (19.2%). The agreement between the 2005 and 2022 ERS/ATS criteria for BDR positivity was 92.17%, with a Cohen's kappa coefficient of 0.76 (p < 0.001). Using the 2022 cutoff values, patients with BDR had a significantly lower mean asthma control test score (19.9 vs 22.5; p = 0.001), while no difference was observed with the 2005 criteria. The relative risk of exacerbations after one year follow-up was 1.23 (CI 95% 1-1.25) with the 2022 recommendations, compared to 1.09 (CI 95% 0.88-1.38) with the 2005 criteria.

The use of the new BDR criteria could provide a valuable marker of asthma control, allowing for better risk stratification and more informed therapeutic decisions.