Milger K, Skowasch D, Hamelmann E, Mümmler C, Idzko M, Gappa M, Jandl M, Körner-Rettberg C, Ehmann R, Schmidt O, Taube C, Holtdirk A, Timmermann H, Buhl R, Korn S
Department of Medicine V, University Hospital, LMU Munich, Munich, Germany.
Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Munich, Germany.
J Investig Allergol Clin Immunol. 2023 Dec 14;33(6):446-456. doi: 10.18176/jiaci.0850. Epub 2022 Aug 24.
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.
A positive BDR response was defined as an increase in FEV1 >200 mL and >12% upon testing with a short-acting ß-agonist.
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 egative 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).
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.
支气管扩张剂可逆性试验阳性（BDR）是哮喘的一项诊断标准。然而，哮喘患者可能表现出BDR试验阴性反应。目的：描述重度哮喘患者中BDR试验阳性和阴性反应的频率，并研究其与表型特征的相关性。
BDR试验阳性反应定义为使用短效β受体激动剂测试时，第一秒用力呼气容积（FEV1）增加>200 mL且>12%。
德国哮喘网（GAN）重度哮喘登记研究纳入的2013例患者中，793例有BDR试验数据。其中，250例（31.5%）BDR试验阳性，543例（68.5%）BDR试验阴性。与阴性反应显著相关的合并症为胃食管反流病（GERD）（28.0%对40.0%，P<0.01）和嗜酸性肉芽肿性多血管炎（0.4%对3.0%；P<0.05），而两组的吸烟史（现吸烟者：2.8%对2.2%；既往吸烟者：40.0%对41.7%）和合并慢性阻塞性肺疾病（COPD）（5.2%对7.2%）相似。BDR试验阳性的患者哮喘控制更差（哮喘控制问卷5评分中位数，3.4对3.0，P<0.05），静息时呼吸困难（26.8%对16.4%，P<0.001）和胸闷（36.4%对26.2%，P<0.001）的报告更频繁，基线时气道阻塞更严重（预测FEV1%，56对64，P<0.001），呼出一氧化氮分数（FeNO）水平更高（41对
