Trial reportThorax1993
Variability of bronchodilator response and effects of inhaled corticosteroid treatment in obstructive airways disease. Dutch CNSLD Study Group.
Trial report in Thorax, 1993. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
13 citing papers in PubMed, 5 syntheses or guidelines pooled it, 56 citations in OpenAlex.
- Inhaled corticosteroids versus placebo for stable chronic obstructive pulmonary disease.The Cochrane database of systematic reviews · 2023Pooled it
- Inhaled anticholinergics and short-acting beta(2)-agonists versus short-acting beta2-agonists alone for children with acute asthma in hospital.The Cochrane database of systematic reviews · 2014Pooled it
- Long-acting inhaled therapy (beta-agonists, anticholinergics and steroids) for COPD: a network meta-analysis.The Cochrane database of systematic reviews · 2014Pooled it
- Inhaled corticosteroids for stable chronic obstructive pulmonary disease.The Cochrane database of systematic reviews · 2012Pooled it
- Anticholinergic agents for chronic asthma in adults.The Cochrane database of systematic reviews · 2004Pooled it
- Diagnostic accuracy of the bronchodilator response in children.The Journal of allergy and clinical immunology · 2013Trial
- Prevalence, Diagnostic Utility and Associated Characteristics of Bronchodilator Responsiveness.American journal of respiratory and critical care medicine · 2024Article
- COPD - do the right thing.BMC family practice · 2021Review
- Clinical value of bronchodilator response for diagnosing asthma in steroid-naïve adults.ERJ open research · 2021Article
- Self-reported racial/ethnic discrimination and bronchodilator response in African American youth with asthma.PloS one · 2017Article
- The role of inhaled and/or nasal corticosteroids on the bronchodilator response.Korean journal of pediatrics · 2010Article
- Overlap Between Asthma and COPD: Where the Two Diseases Converge.Allergy, asthma & immunology research · 2010Article
- Spirometric changes in obstructive disease: after all, how much is significant?Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e TisilogiaArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn the day to day care of obstructive airways diseases (asthma and chronic obstructive pulmonary disease) important decisions such as disease classification and choice of therapy are based on assessment of the bronchodilator response. However, surprisingly little is known of the long term course of the bronchodilator response in patients with obstructive airways disease.
methodsData from a multicentre trial were used in which 274 patients aged 18-60 years with airways obstruction were selected with PC20 < 8 mg/ml and FEV1 < 95% CI of predicted. FEV1 was measured before and 20 minutes after 1000 micrograms terbutaline and 40 minutes after an additional 80 micrograms ipratropium bromide. Data were analysed from 185 patients who were followed up for 21 months (five measurements). Four different expressions of bronchodilator response (BDR) were examined for change under long term therapy, long term variability, and prognostic value in predicting response to inhaled corticosteroids.
resultsThere was a significant reduction in BDR of 117 ml after three months of treatment with a beta 2 agonist plus a corticosteroid (BA + CS), but not after bronchodilators only. Significant reductions with BA + CS were also found in BDR as a percentage of initial FEV1, and in BDR as a percentage of predicted FEV1. Bronchodilator tests were quite variable (SD 186 ml or 11% of initial value) and less than half of the patients could consistently be classified as "irreversible" with recommended cutoff levels. The bronchodilator response at the start of the study proved to be a poor predictor of improvement in FEV1 under BA + CS treatment (correct prediction 60%).
conclusionsBronchodilator responses decrease substantially with inhaled corticosteroid therapy, and within subject variability is considerable both in asthma and chronic obstructive pulmonary disease. Dichotomous decisions on whether patients are "irreversible" according to any single bronchodilator measurement should therefore be made with great caution. The bronchodilator response cannot be used accurately as a predictor of response to inhaled corticosteroids in obstructive airways disease.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.