title: Airflow reversibility and long-term outcomes in patients with COPD without comorbidities.
abstract: BACKGROUND
  The forced expiratory volume at first second (FEV(1)) during spirometry reflects the severity of chronic obstructive pulmonary disease (COPD) and is known to be an important prognostic factor. It is uncertain whether the response to short-acting bronchodilators may predict long-term outcomes such as hospitalizations and mortality.
  
  
  METHODS
  We retrospectively studied a total of 1203 consecutive COPD patients without significant comorbidities during a mean (±SD) of 69 ± 39 months of follow-up. At baseline the subjects were classified as those with positive or negative bronchodilator test (BDT) and also in quartiles of absolute bronchodilator response to 400 μg of salbutamol. Hospital visits and mortality were the end points.
  
  
  RESULTS
  A positive bronchodilator test was observed in 332 (27.6%) of the patients. There were 73 (21.9%) deaths in patients with a positive BDT versus 253 (28.7%) in those with a negative BDT (p = 0.04). In adjusted Cox regression analysis a positive BDT was significantly associated with a prolonged time to first hospitalization. After stratifying the population by quartiles of response to BDT, a dose-response relationship was observed with the best outcomes in the quartile with highest level of airflow reversibility, even after controlling for age, sex, BMI, smoking status and baseline postbronchodilator FEV(1).
  
  
  CONCLUSIONS
  In a large population of well characterized COPD patients without significant comorbidities, those demonstrating higher levels of reversibility at baseline presented better long-term outcomes even after controlling for other known prognostic factors.
authors.affiliation: Respiratory Department, Hospital Universitario Miguel Servet & IIS Aragon, Zaragoza, Spain; Ciber de Enfermedades Respiratorias (CIBERES), Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Marín
authors.affiliation: Respiratory Department, Hospital Universitario Miguel Servet & IIS Aragon, Zaragoza, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Ciudad
authors.affiliation: Respiratory Department, Hospital Universitario Miguel Servet & IIS Aragon, Zaragoza, Spain.
authors.forename: Virginia
authors.initials: V
authors.lastname: Moya
authors.affiliation: Respiratory Department, Hospital Universitario Miguel Servet & IIS Aragon, Zaragoza, Spain; Ciber de Enfermedades Respiratorias (CIBERES), Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Carrizo
authors.affiliation: Respiratory Department, Hospital Universitario Miguel Servet & IIS Aragon, Zaragoza, Spain.
authors.forename: Salvador
authors.initials: S
authors.lastname: Bello
authors.affiliation: Institute of Respiratory Diseases, Sassari University, Sassari, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Piras
authors.affiliation: Brigham and Women's Hospital, Boston, USA.
authors.forename: Bartolomé R
authors.initials: BR
authors.lastname: Celli
authors.affiliation: Pneumology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Ciber de Enfermedades Respiratorias (CIBERES), Spain. Electronic address: mmiravitlles@vhebron.net.
authors.forename: Marc
authors.initials: M
authors.lastname: Miravitlles
mesh_terms: D001985:Bronchial Provocation Tests; D001993:Bronchodilator Agents; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality / Q000503:physiopathology*; D012189:Retrospective Studies; D014797:Vital Capacity / Q000187:drug effects
chemical_list: D001993:Bronchodilator Agents
keywords: Bronchodilator test; COPD; Hospitalization; Mortality; Reversibility