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Publications

Journal Article Ahead of print

PubMed: 42468621 DOI: 10.1016/j.jaip.2026.07.012

Frequency and Clinical Relevance of Residual Bronchodilator Responsiveness in Adults with Asthma.

J Allergy Clin Immunol Pract

Authors: Vera Veith, Frauke Pedersen, Espen Elias Groth, Henrik Watz, Nicole Maison, Bianca Schaub, Erika von Mutius, Gesine Hansen, Anna-Maria Dittrich, Folke Brinkmann, Matthias Kopp, Thomas Bahmer, Benjamin Waschki, Klaus F Rabe, Mustafa Abdo

Affiliations

  • LungenClinic Grosshansdorf GmbH, Grosshansdorf, Germany, and Airway Research Center North (ARCN), Germany; German Center for Lung Research (DZL).
  • LungenClinic Grosshansdorf GmbH, Grosshansdorf, Germany, and Airway Research Center North (ARCN), Germany; German Center for Lung Research (DZL).
  • LungenClinic Grosshansdorf GmbH, Grosshansdorf, Germany, and Airway Research Center North (ARCN), Germany; German Center for Lung Research (DZL).
  • Department of Pneumology, University Hospital, Luebeck, Germany, and Airway Research Center North (ARCN), Germany; German Center for Lung Research (DZL).
  • Department of Allergology and Pneumology, Dr. von Hauner Children's Hospital, LMU University Hospital, Ludwig-Maximilians-Universität München (LMU), Munich, Germany; German Center for Lung Research (DZL), CPC-M, LMU Munich, Germany; Institute of Asthma and Allergy Prevention (IAP), Helmholtz Munich - German Research Center for Environmental Health (GmbH), Munich, Germany.
  • Department of Allergology and Pneumology, Dr. von Hauner Children's Hospital, LMU University Hospital, Ludwig-Maximilians-Universität München (LMU), Munich, Germany; German Center for Lung Research (DZL), CPC-M, LMU Munich, Germany; German Center for Child and Adolescent Health (DZKJ), Dr von Hauner Children's Hospital, LMU, Munich, Germany.
  • German Center for Lung Research (DZL), CPC-M, LMU Munich, Germany; Institute of Asthma and Allergy Prevention (IAP), Helmholtz Munich - German Research Center for Environmental Health (GmbH), Munich, Germany.
  • Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany, and Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Germany; German Center for Lung Research (DZL).
  • Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany, and Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Germany; German Center for Lung Research (DZL).
  • University Children's Hospital, Luebeck, Germany, and Airway Research Center North (ARCN), Germany; German Center for Lung Research (DZL).
  • Department of Paediatric Respiratory Medicine, Inselspital, University Children's Hospital of Bern, University of Bern, Bern, Switzerland.
  • Internal Medicine Department I, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany.
  • LungenClinic Grosshansdorf GmbH, Grosshansdorf, Germany, and Airway Research Center North (ARCN), Germany; German Center for Lung Research (DZL).
  • LungenClinic Grosshansdorf GmbH, Grosshansdorf, Germany, and Airway Research Center North (ARCN), Germany; German Center for Lung Research (DZL); Internal Medicine Department I, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany.
  • LungenClinic Grosshansdorf GmbH, Grosshansdorf, Germany, and Airway Research Center North (ARCN), Germany; German Center for Lung Research (DZL); Internal Medicine Department I, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany.

Abstract

BACKGROUND

Bronchodilator responsiveness (BDR) reflects airflow variability in asthma and is typically assessed after withholding therapy. However, its relevance under ongoing maintenance therapy remains unclear.

OBJECTIVE

To investigate the frequency and clinical relevance of residual bronchodilator responsiveness (rBDR) in patients with asthma receiving maintenance therapy.

METHODS

In 248 adults with moderate-to-severe asthma receiving inhaled corticosteroids (ICS), with or without long-acting bronchodilators, rBDR was assessed according to ERS/ATS 2005 and 2022 criteria. Maintenance therapy was continued, while short-acting bronchodilators were withheld for at least 12 hours before spirometry. Type-2 biomarkers, lung function including small airway function, patient-reported outcomes, and exacerbation rates were analysed according to rBDR status.

RESULTS

rBDR was present in approximately 23% of patients and was consistent across both ERS/ATS criteria. Maintenance therapy did not differ by rBDR status. Patients with rBDR had higher type-2 biomarkers, despite high-dose ICS, including sputum eosinophils and FeNO, more frequent fixed airflow obstruction, and greater small airway dysfunction. They also exhibited increased clinical disease burden, with poorer asthma control and frequent exacerbations, independent of underlying lung function and type-2 inflammation.

CONCLUSION

Residual bronchodilator responsiveness is frequent and identifies patients with refractory type 2 inflammation and poor disease control. rBDR integrates inflammatory activity and functional impairment into a simple, widely available measure and may serve as a practical marker to identify residual disease burden and guide treatment optimization in routine clinical care.

MeSH

Bronchodilator Agents, Lung, Hypersensitivity, Airway Obstruction, Biomarkers, Maintenance, Spirometry, Cost Of Illness, Therapeutics, Asthma