Comparison of bronchodilator test thresholds: ATS/ERS 2005 vs. ERS/ATS 2022

The ATS/ERS 2005 standard defines a significant bronchodilator response (BDR) in terms of FEV₁ as an increase of ≥12% and ≥200 mL, while ERS/ATS 2022 proposes a ≥10% increase in percent predicted FEV₁. Data from 482 children aged 4-17 years, all diagnosed with asthma,  were analyzed to evaluate the concordance between these two thresholds. Results showed substantial agreement (Cohen’s kappa = 0.83) between the two criteria, with 93.1% concordance across the pediatric asthma cohort. While the ERS/ATS 2022 threshold classified slightly more children as bronchodilator responders, particularly among those with preserved lung function, this did not significantly alter overall clinical interpretation. However, among children with baseline airway obstruction, ERS/ATS 2022 identified significantly more positive cases than ATS/ERS 2005, suggesting greater sensitivity in this subgroup. These findings support the applicability of ERS/ATS 2022 in pediatric practice but highlight the need for further research in specific clinical contexts. These results contribute to the ongoing discussion on optimal bronchodilator response thresholds and may help streamline asthma management in children by offering reliable and consistent diagnostic criteria.

Submitted: Oct 03, 2024
Accepted: Sep 26, 2025
Published: Sep 30, 2025