A statistical approach for assessment of bronchodilator responsiveness in pulmonary function testing.
OBJECTIVE
Because published criteria for bronchodilator responsiveness are based on population variability and compare only the single best measures before and after intervention, we hypothesized that the variability of the FEV1 and FEV3 of each patient would better determine that patient's responsiveness.


METHODS
Five 3-s forced expiratory maneuvers were used for each of 3 sequential portions of the study: baseline, after nebulized saline solution, and after nebulized albuterol.


METHODS
Clinical pulmonary function laboratory in a county/university teaching hospital.


METHODS
Fifty consecutive adult patients with obstruction referred for routine testing and thought to be able to complete the study. (The primary diagnoses were found to be equally divided between asthma, bronchitis, and emphysema; equal numbers had very severe, severe, moderate, mild, or minimal obstruction.)


RESULTS
The primary finding was that 36 patients were found to be responders (consistent and statistically significant FEV1 and FEV3 improvement after albuterol). The 14 identified as nonresponders would have been so categorized by all other published criteria. For assessing responsiveness, we found FEV3 measures preferable to vital capacity measures, because the latter depends on the duration of the maneuver.


CONCLUSIONS
The percentage of responders identified is higher than recognized by any other published criteria. Most criteria would not have identified the responders with very severe or minimal airways obstruction.
Hansen
J E
JE
Department of Medicine, Harbor-UCLA Medical Center.
Casaburi
R
R
Goldberg
A S
AS
D000336:Aerosols; D000420:Albuterol; D016084:Bronchoconstriction / Q000187:drug effects*; D001993:Bronchodilator Agents; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects*; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012129:Respiratory Function Tests / Q000706:statistics & numerical data*; D012965:Sodium Chloride; D014797:Vital Capacity / Q000187:drug effects
D000336:Aerosols; D001993:Bronchodilator Agents; D012965:Sodium Chloride; D000420:Albuterol