Evaluation of bronchodilator response in patients with airway obstruction

AbstractThe aim of this study was to define the most useful index of expressing bronchodilator response and to distinguish between asthma and COPD.A prospective study was carried out of bronchodilator response in 142 asthmatics and 58 COPD patients in a university hospital.Reversibility was expressed as: 1. absolute change (Δabs); 2. % of initial (Δ%init); 3. % of predicted (Δ%pred) and 4. % of maximum possible response (Δ%max). Dependence on forced expirations volume in 1 sec (FEV1) as % of predicted and sensitivity and specificity for diagnosis of asthma were established.A relationship between Δabs and initial FEV1 was not found in asthma (Δabs vs. % initial FEV1. r = 0·07) or COPD (r = 0·02). Δ%pred did not show a correlation in asthma (r = 0·10) or COPD (r = 0·06). Δ%init was dependent on the baseline value in asthma (r = 0·38, P ≤ 0·001) but not in COPD (r = 0·18, P = n.s.). Δmax was dependent in both. The combination of best sensitivity and specificity to separate asthma and COPD was obtained with Δabs (70·4 or 70·6%). The worst specificity for asthma diagnosis was obtained with Δ% init (50%). The best likelihood ratios were obtained with Δabs and Δ%pred and the worst likelihood ratio with Δ%initΔ%init is not recommended as an index for differential diagnosis between asthma and COPD; 2) Δ%init overscores bronchodilator response in patients with low FEV1. The independence of each bronchodilator response index should be verified in clinical trials for each selected sample