MA Ziwen 1,2,3,4 # , ZHANG Li 1,2,3,4 , DENG Ke 1,2,4 , WANG Ji 1,2,4 , LI Min 1,4,5 , WANG Gang 1,2,4
  • 1. Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
  • 2. State Key Laboratory of Respiratory Health and Multimobidity, Chengdu, Sichuan 610041, P. R. China;
  • 3. Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
  • 4. Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
  • 5. Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P. R. China;
WANG Gang, Email: wong-gang@126.com
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Objective To investigate factors influencing the results of bronchodilator reversibility tests (BDT) in mild to moderate asthma, and to develop a model predicting the result of BDT in this population. Methods  A cross-sectional study was designed to recruit patients with forced expiratory volume in the first second (FEV1) ≥ 70% predicted from the Australasian Severe Asthma Network during 2014 to 2021, whose asthma diagnosis was confirmed by a positive bronchial challenge test. Structural questionnaires, BDT, fractional exhaled nitric oxide (FeNO), induced sputum and peripheral blood sampling were conducted. Patients were further divided into positive group and negative group according to their BDT result. Then the comparative analysis between two groups, correlation analysis, and multivariate logistical regression were performed. Logistic models for predicting BDT result were developed using variables screened through LASSO regression. Results  A total of 334 patients were included. Compared with the BDT negative group (n=240), the BDT positive group (n=94) was found to have worse airway obstruction in lung function, asthma control and quality of life, higher eosinophil counts in both peripheral blood and induced sputum, and higher FeNO. According to the multivariate regression, the positive BDT results significantly correlated with Asthma Control Questionnaire score, Asthma Questionnaire of Life Quality score, FEV1%pred, MMEF%pred, FEV1/FVC, blood and sputum eosinophil counts and FeNO. A total of 326 patients were included in the training set, and FEV1%pred, MMEF%pred, FEV1/FVC, smoking pack years, blood and sputum eosinophil counts and FeNO were then screened out by LASSO regression as stable predictors. The areas under the receiver operating characteristic curve of the 3 prediction models (P<0.001) constructed using the variables above ranged from 0.810 to 0.834. Internal validation was performed, and both the discrimination (0.810, 0.834 and 0.812, respectively) and the calibration (0.135, 0.133 and 0.192, respectively) of the models were acceptable. Conclusion  The BDT results of patients with mild to moderate asthma were associated with asthma control, lung function, systemic or airway eosinophilia and FeNO, and models including lung function, eosinophils, and FeNO, etc. could predict the BDT results well.

Citation: MA Ziwen, ZHANG Li, DENG Ke, WANG Ji, LI Min, WANG Gang. Construction of models in predicting the result of bronchodilator reversibility test in mild to moderate asthmatics. Chinese Journal of Respiratory and Critical Care Medicine, 2023, 22(3): 189-196. doi: 10.7507/1671-6205.202303080 Copy

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