Impact of ERS/ATS 2022 bronchodilator response guidelines in asthma control

The aim of this study was to determine whether the BDR according to the new cut-off values is associated with worse asthma control compared with the 2005 definition. We conducted a prospective study on moderate to severe asthma patients under clinical follow-up. Patients were classified based on the BDR using both ERS/ATS 2022 and 2005 thresholds. We collected clinical and functional data, along with exacerbations over a one-year follow-up period. Among the 198 patients included, mean age was 60.2 years-old (SD 16.3), with 74.7% being women and 69.7% having severe asthma. According to the 2005 threshold, 46 (23.2%) showed bronchodilator responsiveness, whereas with the 2022 recommendations decreased to 38 (19.2%). The agreement between the 2005 and 2022 ERS/ATS criteria for BDR positivity was 92.17%, with a Cohen’s kappa coefficient of 0.76 (p < 0.001). Using the 2022 cut-off values, patients with BDR had a significantly lower mean asthma control test (ACT) score (19.9 vs 22.5; p = 0.001), while no difference was observed with the 2005 criteria. The relative risk of exacerbations after 1 year follow-up was 1.23 (CI 95% 1-1.25) with the 2022 recommendations, compared to 1.09 (CI 95% 0.88- 1.38) with the 2005 criteria. The use of the new BDR criteria could provide a valuable marker of asthma control, allowing for better risk stratification and more informed therapeutic decisions.