2021 Update on the Definition of Post-bronchodilator Response for FEV1 and FVC: Clinical and Physiological Characteristics of Responders Compared to the 2005 Criteria
Bibliographic record
Abstract
Abstract Rationale The 2021 ATS/ERS criteria to identify a positive post-BD response was modified to an increase of FEV1 and/or FVC of at least 10% of their predicted value. This differed from the 2005 criteria that required the increase of at least 200 ml and 12% of pre-BD value. We aimed at comparing the prevalence of BD response between the two criteria and to compare the clinical and physiological characteristics of subjects according to their BD response across diagnostic criteria. Methods We retrospectively studied a random selection of patients who underwent pre- and post-bronchodilator spirometry at our center between 01-2021 and 12-2022. Using patients with a positive response to BD according to the 2005 criteria as a “control“ group, we compared their clinical characteristics with those that had no response to BD according to the 2021 criteria with the goal of identifying the significant variables associated with the “loss“ of BD response using the 2021 criteria. Results300 patients were recruited [mean age 58±16 years, 139 males (33%)], of which 75 (18%) had a history of asthma and 83 (20%) were currently of inhaled corticosteroids. Overall, 89 patients (30%) subjects had a positive BD response according to the 2005 criteria (2005+) and 77 (26%) had a positive BD response according to the 2021 criteria (2021+). 16 patients (5%) had a positive BD response only according to the 2005 criteria (2005+/2021-), while 4 (1%) had the opposite result (2005-/2021+). Compared to the other patients, those with 2005+/2021- response were of similar age and sex, had similar proportions of smoking and asthma history, but had statistically significantly lower values of pre-BD FEV1 [1.56(0.48) vs 2.07(0.89) liters, p=0.03 and 55(11) vs 72(21) %predicted, p=0.002] and FVC [72(15) vs 86(19) %predicted, p=0.006]. In linear regression analysis, pre-BD FEV1 was related to the post-BD change in FEV1 when using the 2005 (beta-coefficient -0.27, p<0.001) but not the 2021 (beta-coefficient -0.07, p=0.21) criteria. Response to methacholine challenge testing and serum eosinophil were similar between the groups. Conclusion In our retrospective analysis of patients referred for pre- and post-BD testing, the main factor associated with a modification in test positivity result between the 2005 and 2021 criteria was a lower baseline FEV1 value. This supports the notion that using significance criteria based on pre-BD FEV1 may overestimate the presence of BD response in patients with more severe baseline airway obstruction and supports the change to the 2021 criteria.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.008 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.006 | 0.003 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".