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Author (up) Quanjer, P.H.; Ruppel, G.L.; Langhammer, A.; Krishna, A.; Mertens, F.; Johannessen, A.; Menezes, A.M.B.; Wehrmeister, F.C.; Perez-Padilla, R.; Swanney, M.P.; Tan, W.C.; Bourbeau, J. url  doi
  Title Bronchodilator Response in FVC Is Larger and More Relevant Than in FEV1 in Severe Airflow Obstruction Type Journal Article
  Year 2017 Publication Chest Abbreviated Journal Chest  
  Volume 151 Issue 5 Pages 1088-1098  
  Keywords Adolescent; Adult; Aged; Aged, 80 and over; Airway Obstruction/*diagnosis/physiopathology; Asthma/*diagnosis/physiopathology; *Bronchodilator Agents; Canada; Child; Child, Preschool; Female; Forced Expiratory Volume/*physiology; Healthy Volunteers; Humans; Latin America; Male; Middle Aged; Netherlands; New Zealand; Norway; Pulmonary Disease, Chronic Obstructive/*diagnosis/physiopathology; Severity of Illness Index; Treatment Outcome; United States; Vital Capacity/*physiology; Young Adult; airways obstruction; asthma; bronchodilator responsiveness; chronic obstructive pulmonary disease; respiratory physiology  
  Abstract BACKGROUND: Recommendations on interpreting tests of bronchodilator responsiveness (BDR) are conflicting. We investigated the dependence of BDR criteria on sex, age, height, ethnicity, and severity of respiratory impairment. METHODS: BDR test data were available from clinical patients in the Netherlands, New Zealand, and the United States (n = 15,278; female subjects, 51.7%) and from surveys in Canada, Norway, and five Latin-American countries (n = 16,250; female subjects, 54.7%). BDR calculated according to FEV1, FVC, and FEV1/FVC was expressed as absolute change, a percentage of the baseline level (% baseline), a percentage of the predicted value (% predicted), and z score. RESULTS: Change (Delta) in FEV1 and FVC, in milliliters, was unrelated to the baseline value but was biased toward age, height, sex, and level of airways obstruction; DeltaFEV1 was significantly lower in African Americans. In 1,106 subjects with low FEV1 (200-1,621 mL) the FEV1 increased by 12% to 44.7% relative to baseline but < 200 mL. Expressing BDR as a percentage of the predicted value or as a z score attenuated the bias and made the 200-mL criterion redundant, but reduced positive responses by half. DeltaFEV1 % baseline increased with the level of airflow obstruction but decreased with severe obstruction when expressed as z scores or % predicted; DeltaFVC, however expressed, increased with the level of airflow obstruction. CONCLUSIONS: Expressing FEV1 responsiveness as % baseline spuriously suggests that responsiveness increases with the severity of respiratory impairment. Expressing change in FEV1 or FVC as % predicted or as z scores eliminates this artifact and renders the required 200-mL minimum increase redundant. In severe airways obstruction DeltaFVC should be critically evaluated as an index of clinically important relief of hyperinflation, with implications for bronchodilator drug trials.  
  Address Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, QC, Canada  
  Corporate Author Thesis  
  Publisher Place of Publication Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 0012-3692 ISBN Medium  
  Area Expedition Conference  
  Notes PMID:28040521 Approved no  
  Call Number HUNT @ maria.stuifbergen @ Serial 1971  
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