Ital J Pediatr. 2025 Nov 11;51(1):299. doi: 10.1186/s13052-025-02142-0.
ABSTRACT
BACKGROUND: The 2021 updated guidelines revised the bronchodilator responsiveness (BDR) positivity criteria to an increase in FEV₁ or FVC of > 10% of the predicted value. This new standard aims to reduce the impact of baseline lung function variability in determining BDR. However, it should be noted that supporting evidence for children and young adults is limited and thus cannot provide fully substantiated recommendations. The study systematically compare the test results of the BDR diagnostic criteria in the 2005 and 2021 versions of the ERS/ATS guidelines in a clinical setting in children of different age groups with asthma and to explore the reasons for the differences.
METHODS: This was a single-center, retrospective, cross-sectional study. The applications of the 2005 and 2021 versions of BDR standards in different age groups(4-5 years, 6-11 years, 12-18 years) with asthma was compared, the lung-function characteristics of children with inconsistent results were analyzed, and the trend of the proportion of BDR + changing with the degree of airflow obstruction was analyzed.
RESULTS: A total of 1,525 children with asthma were included in this study. There is a significant difference in the number of inconsistent group between the two methods (P < 0.01). In each age group, the number of people in the 2005 + 2021- group was higher than that in the 2005-2021 + group. The kappa consistency test revealed the kappa values of all age groups to be > 0.80 (P < 0.01) and consistent. The inconsistent group had lower lung-function values than the consistent group. The 2005BDR-2021BDR + group of lung-function values were higher than 2005BDR + 2021BDR- group. The analysis revealed that only Z-FEV1 (OR = 0.773, 95% CI: 0.650 to 0.919, p = 0.004) was an independent factor of Inconsistent results.The trends of 2005BDR + and 2021BDR + were consistent with the degree of airflow obstruction, indicating a weak positive correlation.
CONCLUSIONS: The kappa test showed that the results of 2005BDR and 2021BDR were consistent, but there were differences between the inconsistent groups. Z-FEV1 is an independent factor affecting the inconsistent results, so baseline data is the main reason for the inconsistent results of the two methods. The 2021BDR standard may reduce the influence of baseline lung function when determining the results. The positive rate obtained based on the two evaluation criteria maintained the same trend with the degree of airflow obstruction. All showed a weak positive correlation.
PMID:41219993 | DOI:10.1186/s13052-025-02142-0
