Bronchodilator responsiveness and future chronic airflow obstruction: a multinational longitudinal study.

IF 9.6 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

EClinicalMedicine Pub Date : 2025-02-21 eCollection Date: 2025-03-01 DOI:10.1016/j.eclinm.2025.103123

Ben Knox-Brown, Fahad Algharbi, Octavia Mulhern, James Potts, Imed Harrabi, Christer Janson, Rune Nielsen, Dhiraj Agarwal, Andrei Malinovschi, Sanjay Juvekar, Miriam Denguezli, Thorarinn Gíslason, Rana Ahmed, Asaad Nafees, Parvaiz A Koul, Daniel Obaseki, Mahesh Padukudru Anand, Li Cher Loh, Hermínia Brites Dias, Fátima Rodrigues, David Mannino, Mohammed Elbiaze, Karima El Rhazi, Filip Mejza, Graham Devereux, Frits M E Franssen, Asma El Sony, Emiel Wouters, Mohammed Al Ghobain, Kevin Mortimer, Abdul Rashid, Rashid Osman, Michael Studnicka, Joao Cardoso, Peter Burney, Andre F S Amaral

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引用次数: 0

Abstract

Background: Bronchodilator responsiveness testing is mainly used for diagnosing asthma. We aimed to investigate whether it is associated with progression to chronic airflow obstruction over time.

Methods: The multinational Burden of Obstructive Lung Disease cohort study surveyed adults, aged 40 years and above, at baseline and followed them up after a mean of 9.1 years. Recruitment took place between January 2, 2003 and December 26, 2016. Follow-up measurements were collected between January 29, 2019 and October 24, 2021. On both occasions, study participants provided information on respiratory symptoms, health status and several environmental and lifestyle exposures. They also underwent pre- and post-bronchodilator spirometry. We defined bronchodilator responsiveness at baseline using the American Thoracic Society and European Respiratory Society (ATS/ERS) 2022 definition, and the presence of chronic airflow obstruction at follow-up as a post-bronchodilator forced expiratory volume in 1 s to forced vital capacity ratio (FEV₁/FVC) less than the lower limit of normal. We used multi-level regression models to estimate the association between baseline bronchodilator responsiveness and incident chronic airflow obstruction. We stratified analyses by gender and performed a sensitivity analysis in never smokers.

Findings: We analysed data from 3701 adults with 56% being women. Compared to those without bronchodilator responsiveness at baseline, those with bronchodilator responsiveness had 36% increased risk of developing chronic airflow obstruction (RR: 1.36, 95%CI 1.04, 1.80). This effect was stronger in women (RR: 1.45, 95%CI 1.09, 1.91) than men (RR: 1.07, 95%CI 0.51, 2.24). Never smokers with bronchodilator responsiveness also were at greater risk of incident chronic airflow obstruction (RR: 1.48, 95%CI 1.01, 2.20).

Interpretation: Bronchodilator responsiveness appears to be a risk factor for incident chronic airflow obstruction. It is important that future studies in other large population-based cohorts replicate these findings.

Funding: National Heart and Lung Institute, UK Medical Research Council, and Wellcome Trust.

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来源期刊

EClinicalMedicine Medicine-Medicine (all)

CiteScore

18.90

自引率

1.30%

发文量

506

审稿时长

22 days

期刊介绍： eClinicalMedicine is a gold open-access clinical journal designed to support frontline health professionals in addressing the complex and rapid health transitions affecting societies globally. The journal aims to assist practitioners in overcoming healthcare challenges across diverse communities, spanning diagnosis, treatment, prevention, and health promotion. Integrating disciplines from various specialties and life stages, it seeks to enhance health systems as fundamental institutions within societies. With a forward-thinking approach, eClinicalMedicine aims to redefine the future of healthcare.