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Rebuttal From Drs Hansen and PorszaszRebuttal From Drs Hansen and Porszasz

James E. Hansen, MD, FCCP; Janos Porszasz, MD, PhD
Author and Funding Information

From the David Geffen School of Medicine at UCLA and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center.

CORRESPONDENCE TO: James E. Hansen, MD, FCCP, Department of Medicine, Harbor-UCLA Medical Center, Box 405, Torrance, CA 90502; e-mail: jhansen @labiomed.org


FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(3):542-544. doi:10.1378/chest.14-0618
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Extract

We welcome the opportunity to respond to Drs Pellegrino and Brusasco.1 We are concerned primarily with their statement that “the acute response to bronchodilators is relatively easy to interpret when changes in FEV1 or FVC exceed the thresholds of their natural intraday variability (ie, 12% of baseline and 200 mL), thus, unequivocally indicating bronchodilation.”1

To test this statement with real data,2 we identified the most severe 44 of 316 patients with their initial highest FEV1 < 1.00 L (Table 1). We sorted them into three categories depending on their response to nebulized albuterol. Importantly, both the preaerolized and postaerosolized albuterol variability of these patients’ FEV1 values were low (the postdrug variabilities are not presented). Considering the highest and lowest predrug FEV1 values of each patient with an FEV1 < 1.00 L, the range of predrug highest and lowest individual values was between 10 and 200 mL with a mean ± SD of 56 ± 40 mL. All these results were from a retrospective analysis of patients routinely studied in a clinical laboratory; thus, we believe that this population is highly relevant to the topic.

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