University Of Tasmania
152507 - Bronchodilator reversibility as a diagnostic test for adult asthma.pdf (3.42 MB)
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Bronchodilator reversibility as a diagnostic test for adult asthma: findings from the population-based Tasmanian Longitudinal Health Study

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posted on 2023-05-21, 12:13 authored by Tan, DJ, Lodge, CJ, Lowe, AJ, Bui, DS, Bowatte, G, Johns, DP, Hamilton, GS, Thomas, PS, Abramson, MJ, Eugene WaltersEugene Walters, Perret, JL, Dharmage, SC
Bronchodilator reversibility (BDR) is often used as a diagnostic test for adult asthma. However, there has been limited assessment of its diagnostic utility. We aimed to determine the discriminatory accuracy of common BDR cut-offs in the context of current asthma and asthma-COPD overlap (ACO) in a middle-aged community sample. The Tasmanian Longitudinal Health Study is a population-based cohort first studied in 1968 (n=8583). In 2012, participants completed respiratory questionnaires and spirometry (n=3609; mean age 53 years). Receiver operating characteristic (ROC) curves were fitted for current asthma and ACO using continuous BDR measurements. Diagnostic parameters were calculated for different categorical cut-offs. Area under the ROC curve (AUC) was highest when BDR was expressed as change in forced expiratory volume in 1 s (FEV1) as a percentage of initial FEV1, as compared with predicted FEV1. The corresponding AUC was 59% (95% CI 54-64%) for current asthma and 87% (95% CI 81-93%) for ACO. Of the categorical cut-offs examined, the European Respiratory Society/American Thoracic Society threshold (≥12% from baseline and ≥200 mL) was assessed as providing the best balance between positive and negative likelihood ratios (LR+ and LR-, respectively), with corresponding sensitivities and specificities of 9% and 97%, respectively, for current asthma (LR+ 3.26, LR- 0.93), and 47% and 97%, respectively, for ACO (LR+ 16.05, LR- 0.55). With a threshold of ≥12% and ≥200 mL from baseline, a positive BDR test provided a clinically meaningful change in the post-test probability of disease, whereas a negative test did not. BDR was more useful as a diagnostic test in those with co-existent post-bronchodilator airflow obstruction (ACO).


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Erj Open Research








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European Respiratory Society

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Copyright 2021 ERS. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0

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Socio-economic Objectives

Evaluation of health and support services not elsewhere classified; Social class and inequalities

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