Bronchodilator Responsiveness in Tobacco-Exposed People With or Without COPD.

TitleBronchodilator Responsiveness in Tobacco-Exposed People With or Without COPD.
Publication TypePublication
AuthorsFortis S, Quibrera PM, Comellas AP, Bhat SP, Tashkin DP, Hoffman EA, Criner GJ, Han MK, R Barr G, Arjomandi M, Dransfield MB, Peters SP, Dolezal BA, Kim V, Putcha N, Rennard SI, Paine R, Kanner RE, Curtis JL, Bowler RP, Martinez FJ, Hansel NN, Krishnan JA, Woodruff PG, Barjaktarevic IZ, Couper D, Anderson WH, Cooper CB
Corporate AuthorsSubpopulations and Intermediate Outcome Measures in COPD Study Investigators
Date Published2022 Nov 15

BACKGROUND: Bronchodilator responsiveness (BDR) in obstructive lung disease varies over time and may be associated with distinct clinical features.RESEARCH QUESTION: Is consistent BDR over time (always present) differentially associated with obstructive lung disease features relative to inconsistent (sometimes present) or never (never present) BDR in tobacco-exposed people with or without COPD?STUDY DESIGN AND METHODS: We retrospectively analyzed data from 2,269 tobacco-exposed participants in the Subpopulations and Intermediate Outcome Measures in COPD Study with or without COPD. We used various BDR definitions: change of ≥ 200 mL and ≥ 12% in FEV (FEV-BDR), change in FVC (FVC-BDR), and change in in FEV, FVC or both (ATS-BDR). Using generalized linear models adjusted for demographics, smoking history, FEV % predicted after bronchodilator administration, and number of visits that the participant completed, we assessed the association of BDR group: (1) consistent BDR, (2) inconsistent BDR, and (3) never BDR with asthma, CT scan features, blood eosinophil levels, and FEV decline in participants without COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage 0) and the entire cohort (participants with or without COPD).RESULTS: Both consistent and inconsistent ATS-BDR were associated with asthma history and greater small airways disease (%parametric response mapping functional small airways disease) relative to never ATS-BDR in participants with GOLD stage 0 disease and the entire cohort. We observed similar findings using FEV-BDR and FVC-BDR definitions. Eosinophils did not vary consistently among BDR groups. Consistent BDR was associated with FEV decline over time relative to never BDR in the entire cohort. In participants with GOLD stage 0 disease, both the inconsistent ATS-BDR group (OR, 3.20; 95% CI, 2.21-4.66; P < .001) and consistent ATS-BDR group (OR, 9.48; 95% CI, 3.77-29.12; P < .001) were associated with progression to COPD relative to the never ATS-BDR group.INTERPRETATION: Demonstration of BDR, even once, describes an obstructive lung disease phenotype with a history of asthma and greater small airways disease. Consistent demonstration of BDR indicated a high risk of lung function decline over time in the entire cohort and was associated with higher risk of progression to COPD in patients with GOLD stage 0 disease.

Alternate JournalChest
PubMed ID36395858
Grant ListR01 HL150023 / HL / NHLBI NIH HHS / United States
U01 HL137880 / HL / NHLBI NIH HHS / United States
U24 HL141762 / HL / NHLBI NIH HHS / United States
Manuscript Full Title: 
Bronchodilator Responsiveness in Tobacco-Exposed People With or Without COPD.
Manuscript Lead/Corresponding Author Affiliation: 
Clinical Center: Iowa (University of Iowa)
Manuscript Status: 
Published and Public