Bronchoconstriction in Response to Deep Inhalation During Spirometry Testing

Haynes, Jeffrey M

doi:10.4187/respcare.03995

Cited by 2 publications

(2 citation statements)

References 18 publications

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“…First, in some asthma patients, deep inhalation can produce paradoxical bronchoconstriction during spirometry testing ( 9 ). This is why we performed the test on the first day with more than three measurements, but no spirometric changes were found.…”

Section: Discussionmentioning

confidence: 99%

Paradoxical bronchoconstriction caused by β2-adrenoceptor agonists

Ayed

Khalifa

Mokaddem

et al. 2020

dti

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Introduction: Salbutamol and terbutaline are short-acting β2 adrenergic agonists that produce bronchial smooth muscle relaxation and are widely used in obstructive pulmonary diseases. Nevertheless, their use has been the cause of a paradoxical bronchoconstriction, which is a rare and potentially serious adverse reaction. The aim of this study is to report a case of paradoxical bronchoconstriction caused by β2 adrenergic agonists. Methods: This case is about a 50-year-old asthmatic patient who describes a history of repeated acute asthma attacks after salbutamol inhalation or terbutaline nebulization. A double-blind crossover study was performed over 3 days, in order to compare the effects of each bronchodilator. Forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and maximal expiratory flow 25-75 (MEF25-75) were measured. Results: On the first day, a bronchoconstriction caused by deep and repeated inhalations was eliminated. On the second day, an airway obstruction was confirmed by a decrease in FEV1 at 40% from baseline values after nebulization of a standard dose of terbutaline. On the third day, a spirometry was performed before and after nebulization of a standard dose of ipratropium bromide, and there were no significant changes in the spirometric parameters. Finally the patient was discharged with a written warning mentioning the danger of salbutamol and terbutaline use. Conclusion: Salbutamol and terbutaline are generally well-tolerated β2 adrenergic agonists. Nevertheless, in rare cases, these substances can cause a paradoxical bronchoconstriction. Doctors must therefore remain vigilant about its side effect and possibly investigate each case.

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Section: Discussionmentioning

confidence: 99%

Paradoxical bronchoconstriction caused by β2-adrenoceptor agonists

Ayed

Khalifa

Mokaddem

et al. 2020

dti

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“…[3031323334] Some investigators have suggested that a fall in FEV1 or FVC postbronchodilator administration is common and likely related to spontaneous variability in repeated measurements. [353637] Burns and Gibson[38] theorized that deep inhalation in the presence of obstruction might cause large swings in intrathoracic pressure, resulting in airway edema and worsening airway smooth muscle shortening. Hodder et al .…”

Section: Discussionmentioning

confidence: 99%

Determining the optimal time to assess the reversibility of airway obstruction

et al. 2019

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Context:The optimal time to interpret bronchodilator reversibility remains controversial. This time may affect a positive diagnosis and manage asthma and chronic obstructive pulmonary disease (COPD).Aims:We sought to document the time when maximum respiratory function is reached after inhalation of salbutamol and to define the optimal time of bronchodilator response to assess the reversibility or non reversibility of airway obstruction.Subjects and Methods:This prospective analytical study was spread over 8 months and included 58 patients with asthma or COPD with airway obstruction. Spirometry was performed before and at 5, 10, 15, 20, and 30 min after salbutamol inhalation (200 mcg) administered through pressurized metered-dose inhalers and large volume spacer.Results:After salbutamol inhalation, the mean individual peak bronchodilation occurred at 20 min for the forced vital capacity and at 30 min for the forced expiratory volume in 1 s. The percentage of reversible patients in our sample was guideline dependent. It increased from 53% to 67.2% when using the American Thoracic Society/European Respiratory Society definition compared to using the Global Initiative for Chronic Obstructive Lung Disease. The maximum number of reversible patients was significantly different at 20 min compared to 5 and 10 min.Conclusions:Interpreting bronchodilator reversibility after 20 min was the ideal time to judge the reversibility or nonreversibility in obstructive ventilatory disorders in adults.

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Bronchoconstriction in Response to Deep Inhalation During Spirometry Testing

Cited by 2 publications

References 18 publications

Paradoxical bronchoconstriction caused by β2-adrenoceptor agonists

Paradoxical bronchoconstriction caused by β2-adrenoceptor agonists

Determining the optimal time to assess the reversibility of airway obstruction

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