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Bronchodilator reversibility in the GAN severe asthma cohort

Background: Positive bronchodilator reversibility (BDR) is a diagnostic criterion for asthma. However, patients with asthma may exhibit a negative BDR response. Aim: To describe the frequency of positive and negative BDR response in patients with severe asthma and study associations with phenotypic...

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Main Authors: Milger-Kneidinger, Katrin (Author) , Skowasch, Dirk (Author) , Hamelmann, Eckard (Author) , Mümmler, Carlo (Author) , Idzko, Marco (Author) , Gappa, Monika (Author) , Jandl, M (Author) , Körner-Rettberg, C (Author) , Ehmann, R (Author) , Schmidt, O (Author) , Taube, C (Author) , Holtdirk, A (Author) , Timmermann, H (Author) , Buhl, R (Author) , Korn, Stephanie (Author)
Format: Article (Journal)
Language:English
Published: 2023
In: Journal of investigational allergology and clinical immunology
Year: 2023, Volume: 33, Issue: 6, Pages: 445-456
ISSN:1698-0808
DOI:10.18176/jiaci.0850
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.18176/jiaci.0850
Verlag, lizenzpflichtig, Volltext: https://www.jiaci.org/summary/vol33-issue6-num2795
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Author Notes:Milger K, Skowasch D, Hamelmann E, Mümmler , Idzko M, Gappa M, Jandl M, Körner-Rettberg C, Ehmann R, Schmidt O, Taube C, Holtdirk A, Timmermann H, Buhl R, Korn S
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Summary:Background: Positive bronchodilator reversibility (BDR) is a diagnostic criterion for asthma. However, patients with asthma may exhibit a negative BDR response. Aim: To describe the frequency of positive and negative BDR response in patients with severe asthma and study associations with phenotypic characteristics. Methods: A positive BDR response was defined as an increase in FEV1 >200 mL and >12% upon testing with a short-acting ß-agonist. Results: BDR data were available for 793 of the 2013 patients included in the German Asthma Net (GAN) severe asthma registry. Of these, 250 (31.5%) had a positive BDR response and 543 (68.5%) a negative BDR response. Comorbidities significantly associated with a negative response were gastroesophageal reflux disease (GERD) (28.0% vs 40.0%, P<.01) and eosinophilic granulomatosis with polyangiitis (0.4% vs 3.0%; P<.05), while smoking history (active: 2.8% vs 2.2%; ex: 40.0% vs 41.7%) and comorbid chronic obstructive pulmonary disease (COPD) (5.2% vs 7.2%) were similar in both groups. Patients with a positive BDR response had worse asthma control (median Asthma Control Questionnaire 5 score, 3.4 vs 3.0, P<.05), more frequently reported dyspnea at rest (26.8% vs 16.4%, P<.001) and chest tightness (36.4% vs 26.2%, P<.001), and had more severe airway obstruction at baseline (FEV1% predicted, 56 vs 64, P<.001) and higher fractional exhaled nitric oxide (FeNO) levels (41 vs 33 ppb, P<0.05). There were no differences in diffusion capacity of the lung for carbon monoxide, single breath (% pred, 70% vs 71%). Multivariate linear regression analysis identified an association between positive BDR response and lower baseline FEV1% (P<.001) and chest tightness (P<.05) and a negative association between BDR and GERD (P<.05). Conclusion: In this real-life setting, most patients with severe asthma had a negative BDR response. Interestingly, this was not associated with smoking history or COPD, but with lower FeNO and presence of GERD.
Item Description:Gesehen am 04.11.2024
Physical Description:Online Resource
ISSN:1698-0808
DOI:10.18176/jiaci.0850

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