BACKGROUND The prevalence and diagnostic utility of bronchodilator responsiveness (BDR) in a real-life setting is unclear. We explored this uncertainty in patients aged ≥12 years with physician-assigned diagnoses of asthma, asthma and COPD, or COPD in NOVELTY, a prospective cohort study in primary and secondary care in 18 countries. METHODS The proportion of patients with a positive BDR test in each diagnostic category was calculated using 2005 (∆FEV1 or ∆FVC ≥12% and ≥200mL) and 2021 (∆FEV1 or ∆FVC >10% predicted) ERS/ATS criteria. RESULTS We studied 3,519 patients with physician-assigned diagnosis of asthma, 833 with asthma+COPD, and 2,436 with COPD. The prevalence of BDR was 19.7% (asthma), 29.6% (asthma+COPD) and 24.7% (COPD) using 2005 criteria; 18.1%, 23.3% and 18.0% respectively using 2021 criteria. Using 2021 criteria, in patients diagnosed with asthma, BDR was associated with higher FeNO, lower lung function, higher symptom burden, more frequent hospital admissions, greater use of triple therapy, oral corticosteroids or biologics; in patients diagnosed with COPD, BDR (2021) was associated with lower lung function and higher symptom burden. CONCLUSIONS BDR prevalence in patients with chronic airway diseases on treatment ranges from 18-30%, being modestly lower with the 2021 compared with 2005 ERS/ATS criteria, and is associated with lower lung function and greater symptom burden. These observations question the validity of BDR as a key diagnostic tool for asthma managed in clinical practice or as a standard inclusion criterion for clinical trials of asthma, and instead suggest BDR be considered a treatable trait for chronic airways disease.

中文翻译：

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支气管扩张剂反应性的患病率、诊断实用性和相关特征。

背景 支气管扩张剂反应性（BDR）在现实生活中的患病率和诊断效用尚不清楚。我们在 NOVELTY（一项针对 18 个国家的初级和二级护理的前瞻性队列研究）中探讨了年龄≥12 岁、医生指定诊断为哮喘、哮喘和慢性阻塞性肺病或慢性阻塞性肺病的患者的这种不确定性。方法 使用 2005 年（ΔFEV1 或 ΔFVC ≥12% 且 ≥200mL）和 2021 年（ΔFEV1 或 ΔFVC > 10% 预测）ERS/ATS 标准计算每个诊断类别中 BDR 测试呈阳性的患者比例。结果 我们研究了 3,519 名医生指定诊断为哮喘的患者、833 名患有哮喘+慢性阻塞性肺病的患者以及 2,436 名患有慢性阻塞性肺病的患者。根据 2005 年标准，BDR 的患病率为 19.7%（哮喘）、29.6%（哮喘+慢性阻塞性肺病）和 24.7%（慢性阻塞性肺病）；使用 2021 年标准分别为 18.1%、23.3% 和 18.0%。使用 2021 年标准，在诊断为哮喘的患者中，BDR 与较高的 FeNO、较低的肺功能、较高的症状负担、更频繁的住院、更多地使用三联疗法、口服皮质类固醇或生物制剂相关；在诊断为 COPD 的患者中，BDR (2021) 与较低的肺功能和较高的症状负担相关。结论 接受治疗的慢性气道疾病患者的 BDR 患病率范围为 18-30%，与 2005 年 ERS/ATS 标准相比，2021 年略有降低，并且与较低的肺功能和较高的症状负担相关。这些观察结果质疑 BDR 作为临床实践中管理的哮喘的关键诊断工具或作为哮喘临床试验的标准纳入标准的有效性，并建议将 BDR 视为慢性气道疾病的可治疗特征。