ANZSRS ORAL PRESENTATIONS
WINDS OF CHANGE: BRONCHODILATOR RESPONSIVENESS
FROM MORE THAN ONE DIRECTION
, SOUTHWELL P
, MICALOS P
, SWANNEY M
Canterbury District Health Board, Christchurch, New Zealand,
Sturt University, Orange, Australia,
Charles Sturt University, Bathurst,
Positive bronchodilator responsiveness (BR) using cur-
rent American Thoracic Society and European Respiratory Society
(ATS/ERS) criteria, purportedly ensures spirometric variability is signiﬁ-
cantly exceeded. The ATS/ERS guidelines acknowledge there is no clear
consensus about what constitutes bronchodilator responsiveness in sub-
jects with airﬂow obstruction.
This study investigated the individual variability in multiple spiro-
metric parameters in patients having reversibility tests. We address how
spirometric variability can inform current guidelines for identifying a clini-
cally signiﬁcant bronchodilator response.
102 consenting participants performed slow vital capacity
(SVC) and ﬂow volume loops (FVL) before and after Salbutamol adminis-
tration. Measurement of symptom control used the clinical chronic
obstructive pulmonary disease questionnaire and dyspnoea and wheeze
used the visual analogue scale. Two determinants of BR: ATS/ERS cri-
teria and a t-score calculation were compared by correlation with the sub-
jective measurements of respiratory impairment.
63 participants had positive bronchodilator responses by t-
score calculation compared with 16 by current ATS/ERS guidelines. T-
scores showed a weaker correlation with subjective measures of respira-
tory impairment than per cent and absolute change. Inspiratory vital
capacity (IVC), SVC, and inspiratory capacity (IC) correlated more
strongly with symptom control, wheeze and dyspnoea than FEV
The mean individual variability and standard deviation (SD) for each
parameter is shown in the table.
Pre-bronchodilator Post bronchodilator
101 2.58 (0.98) 1.89 (1.46) 2.74 (1.00) 1.67 (1.45)
FVC 101 3.60 (1.09) 1.64 (1.27) 3.71 (1.06) 1.35 (1.45)
FIVC 97 3.57 (1.06) 2.29 (2.06) 3.63 (1.07) 1.89 (1.61)
SVC 100 3.56 (1.08) 1.91 (1.22) 3.74 (1.03) 1.45 (1.04)
IC 100 2.83 (0.80) 2.95 (2.56) 3.03 (0.82) 2.33 (1.50)
*CV = Coefﬁcient of Variation;
The low individual variability may explain the poorer dis-
criminatory ability of BR by t-score because a smaller change is required
to be considered signiﬁcant. T-scores may overestimate bronchodilator
responsiveness, particularly in patients with normal spirometry at base-
line. Spirometry values that are less inﬂuenced by dynamic compression
have potential utility in bronchodilator response testing. Ongoing recruit-
ment will allow further investigation into the utility of t-scores and alterna-
tive spirometry values for participants with airway obstruction.
Spirometry, variability, bronchodilator response
Nomination for New Investigator Award
ASSESSING THE SUITABILITY OF FRACTIONAL EXHALED
NITRIC OXIDE (FENO) CUT-OFF RANGES FOR ABORIGINAL AND/OR
TORRES STRAIT ISLANDER CHILDREN AND YOUNG ADULTS
, CHANG A
, CHATFIELD M
, PETSKY H
, MCELREA M
Centre For Children's Health Research, South Brisbane, Australia,
Indigenous Respiratory Outreach Care (IROC) Program, Chermside,
Department of Respiratory and Sleep Medicine, LCCH, South
QIMR Berghofer Medical Research Institute,
School of Nursing and Midwifery, GU, Nathan,
Fractional exhaled nitric oxide (FeNO) is used as
a non-invasive measure of eosinophilic airway inﬂammation. It is unknown
how appropriate the recommended FeNO cut-off ranges are for Aboriginal
and/or Torres Strait Islander patients. Our aim was to assess the distribu-
tion of healthy Aboriginal and/or Torres Strait Islander FeNO results
according to current American Thoracic Society cut-off guidelines.
We measured FeNO (using Aerocrine NioxMINO) in
991 Indigenous children and young adults (aged 3 to 25 years) from seven
Queensland communities. Questionnaires and medical charts were reviewed
to identify healthy participants (no respiratory and/or atopic illness ever).
Acceptable FeNO measurements were achieved by 553 chil-
dren (≤12 years) and 288 adults (>12 years). Participants with a history of
respiratory and/or atopy conditions were excluded resulting in a healthy
cohort of children (n=401, 72.5%) and adults (n=193, 67%). The geomet-
ric mean FeNO results for children and adults were 11.1ppb and 12.5ppb
respectively. Table 1 summarises the distribution of healthy FeNO results
for each ethnic group according to current cut-off ranges.
88% 7% 5% (n=51) 90% 6% 4%
83% 6% 11% (n=87) 83% 10% 7%
85% 8% 7% (n=55) 87% 9% 4%
Is=Islander, Both=Aboriginal and Torres Strait Islander
Although the majority of participants had FeNO results
within the age-respective normal ranges, we found a proportion of healthy
participants with elevated FeNO results in all groups. The greatest propor-
tion of elevated results was seen in Torres Strait Islander children and
adults, and Aboriginal/Torres Strait Islander children. This suggests that
the recommended cut-off ranges may not be appropriate for these groups.
Further investigation is still needed.
FeNO, Aboriginal and/or Torres Strait Islander, cut-off ranges
Nomination for New Investigator Award: Yes
IROC Program (Qld Health), CRE for Indigenous
Lung Health in Children and TPCH Foundation. NHRMC PhD Scholarship
(TB), NHMRC Practitioner Fellowship (AC).
Editorial material and organization © 2018 Asian Paciﬁc Society of Respirology.
Copyright of individual abstracts remains with the authors.
Respirology (2018) 23 (Suppl. 1), 4–9