CHEST Guidelines-Reclassification-of-Bronchodilator-Reversibility-i

Reclassification-of-Bronchodilator-Reversibility-i

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In response to recent findings published in CHEST, new criteria for Bronchodilator Reversibility (BDR) in asthma, proposed by Quanjer et al., aim to address biases inherent in the traditional European Respiratory Society/American Thoracic Society (ERS/ATS) criteria. The traditional criteria (a 12% and 200 mL increase in FEV1 and/or FVC) may disproportionately increase the likelihood of BDR in patients with declining lung function. The new approach employs z-scores (ΔzFEV1 ≥ 0.78 or ΔzFVC ≥ 0.64) to standardize assessments, mitigating existing biases.<br /><br />This new BDR classification was analyzed in the U-BIOPRED adult asthma cohort to assess its impact on BDR prevalence and associated clinical characteristics. Of the 499 individuals tested, 55% were originally classified as BDR-positive per ERS/ATS criteria. Applying the z-score criteria reclassified 12% of participants, revealing that 9% no longer met the BDR criteria while 3% gained BDR status. Additionally, 10% of participants experienced a change in the type of BDR classification.<br /><br />BDR classifications, either by FEV1 alone or both FEV1 and FVC, correlated with worse lung function, higher BMI, and poorer asthma control and quality of life compared to those with only FEV1 BDR. This underscores the significance of considering FVC BDR independently from FEV1 BDR in clinical interpretations.<br /><br />The study advocates for the inclusion of the newly established z-score criteria in clinical guidelines due to its impact on correctly identifying asthma severity indicators. Moreover, distinct clinical profiles between different BDR types reinforce the necessity for individualized assessment strategies in asthma management. The research was supported by the Innovative Medicines Initiative and the European Union's Seventh Framework Program.

Keywords

Bronchodilator Reversibility

BDR criteria

asthma

Quanjer et al.

z-scores

FEV1

FVC

U-BIOPRED cohort

asthma management

clinical guidelines