{"doi":"10.1186/s12890-024-02859-4","title":"A comparative study of bronchodilator response: utilizing pre-bronchodilator versus predicted normal values","abstract":"Abstract Background A positive bronchodilator response has been defined as a 12% increase in the forced expiratory volume in one second (FEV 1 ) or forced vital capacity (FVC) from their respective pre-bronchodilator values, combined with at least a 0.2 L absolute change. Recent recommendations suggested the use of the percent change in FEV 1 and FVC relative to their predicted normal values without having applied them in patients with airflow obstruction. The aim of the current study was to compare the two approaches over a wide range of pre-bronchodilator FEV 1 and FVC values. Methods A retrospective review of consecutive patients undergoing spirometry and bronchodilator testing was completed. The change in FEV 1 and FVC with a bronchodilator was expressed relative to the pre-bronchodilator and predicted normal FEV 1 and FVC. Results In 1,040 patients with a non-paradoxical change in FEV 1 , 19.0% had a ≥ 12% change in FEV 1 using their pre-bronchodilator value compared to 5.7% using their predicted normal value. For FVC, the respective values were 12.7% vs. 5.8%. The difference was retained in patients with a ≥ 0.2 L change in FEV 1 or FVC. In unobstructed patients, the upper threshold (two standard deviations above the mean) of the bronchodilator response was 14% for FEV 1 and 10% for FVC using predicted normal values. Conclusions Expressing the percent change in FEV 1 and FVC relative to predicted normal values reduces the over-estimation of the bronchodilator response, especially in patients with a very low pre-bronchodilator FEV1, including in those with a ≥ 0.2 L change in FEV 1 . Irrespective of pre-bronchodilator values, a ≥ 14% change in FEV 1 and ≥ 10% change in FVC relative to the predicted normal values could be considered a positive bronchodilator response.","journal":"BMC Pulmonary Medicine","year":2024,"id":446323,"datarank":0.29188652235829704,"base_score":1.9459101490553132,"endowment":1.9459101490553132,"self_citation_contribution":0.29188652235829704,"citation_network_contribution":0.0,"self_endowment_contribution":0.29188652235829704,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":6,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9602,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":271787,"name":"Naresh M. Punjabi","orcid":"0000-0003-1701-1550","position":1,"is_corresponding":false},{"id":1263632,"name":"K. Grealis","orcid":null,"position":2,"is_corresponding":false},{"id":465717,"name":"Adam Wanner","orcid":"0000-0002-7201-1556","position":3,"is_corresponding":false},{"id":1263631,"name":"A. Alexis","orcid":null,"position":0,"is_corresponding":true}],"reference_count":11,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T02:01:50.465308Z","pmid":"38273287","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}