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Nicola A. Hanania, MD, FCCP; Bartolome R. Celli, MD, FCCP; James F. Donohue, MD, FCCP; Ubaldo J. Martin, MD, FCCP
Author and Funding Information

From the Section of Pulmonary and Critical Care Medicine, Asthma Clinical Research Center (Dr Hanania), Baylor College of Medicine; Division of Pulmonary and Critical Care Medicine (Dr Celli), Brigham and Women’s Hospital, Harvard University; Division of Pulmonary Disease and Critical Care Medicine (Dr Donohue), University of North Carolina at Chapel Hill; and Clinical Research, Respiratory and Inflammation Therapeutic Area (Dr Martin), AstraZeneca LP.

Correspondence to: Nicola A. Hanania, MD, FCCP, Baylor College of Medicine, 1504 Taub Loop, Houston, TX 77030; e-mail: hanania@bcm.tmc.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Hanania has received research grant support from Boehringer Ingelheim, AstraZeneca, GlaxoSmithKline, Novartis, and Pfizer and has served as a consultant for GlaxoSmithKline, Novartis, and Pfizer and on the Speakers Bureaus of GlaxoSmithKline, Boehringer Ingelheim, and AstraZeneca. Dr Celli has received grants from GlaxoSmithKline, Boehringer Ingelheim, Forrest Medical, and AstraZeneca to the division he heads to complete research studies. He has received advisory board payments from GlaxoSmithKline, Boehringer Ingelheim, Almirall, and AstraZeneca. Dr Donohue has received grant monies from Boehringer Ingelheim, Novartis, Johnson & Johnson, National Institutes of Health, and Alpha-1 Foundation, has served as a consultant for Novartis, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Pfizer, and Merck, and has participated in speaking activities for Boehringer Ingelheim, Pfizer, GlaxoSmithKline, and AstraZeneca. Dr Martin is a salaried employee at AstraZeneca LP holding company and receives shares/stock as part of a compensation package.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(4):1118-1119. doi:10.1378/chest.12-0231
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To the Editor:

We thank Dr Hansen for his thoughtful review of our review article.1 Dr Hansen suggests that bronchodilator response would be better evaluated using the variability of the individual being tested rather than using population-based limits. He further suggests that it should include data from tests other than “the best of three,” as has been traditionally used in most studies. We believe that these comments are interesting and appropriate. However, the intent of our work was to critically review the literature using the existing thresholds accepted by most professional societies, including the American Thoracic Society,2 and, thus, our analyses were limited to the published data on hand.

We agree with Dr Hansen that on occasion, such as the case of patients with very low FEV1, a statistically significant change in FEV1 from baseline based on the individual’s variability may indeed be clinically important even if the mean change is lower than the agreed-upon threshold of 200 mL. However, careful interpretation of such a response should always be undertaken to avoid the overestimation of a significant clinical response, especially if the absolute change is below the normal variability of the test or below the minimal clinically important difference, which for the FEV1 is suggested to be around 100 mL.3 The use of the approach proposed by Hansen, although interesting, needs to be further explored in future studies.

Hanania NA, Celli BR, Donohue JF, Martin UJ. Bronchodilator reversibility in COPD. Chest. 2011;1404:1055-1063 [CrossRef] [PubMed]
 
American Thoracic SocietyAmerican Thoracic Society Standardization of spirometry: 1994 update. Am J Respir Crit Care Med. 1995;1523:1107-1136 [PubMed]
 
Donohue JF. Minimal clinically important differences in COPD lung function. COPD. 2005;21:111-124 [CrossRef] [PubMed]
 

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References

Hanania NA, Celli BR, Donohue JF, Martin UJ. Bronchodilator reversibility in COPD. Chest. 2011;1404:1055-1063 [CrossRef] [PubMed]
 
American Thoracic SocietyAmerican Thoracic Society Standardization of spirometry: 1994 update. Am J Respir Crit Care Med. 1995;1523:1107-1136 [PubMed]
 
Donohue JF. Minimal clinically important differences in COPD lung function. COPD. 2005;21:111-124 [CrossRef] [PubMed]
 
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