Flow and volume responses after routine salbutamol reversibility testing in mild to very severe COPD

Schermer, Tjard; Heijdra, Yvonne F.; Zadel, Sabina; Bemt, Lisette van den; Winter, Leandra Boonman‐de; Dekhuijzen, Richard; Smeele, Ivo

doi:10.1016/j.rmed.2006.09.024

Cited by 49 publications

(55 citation statements)

References 23 publications

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“…(4) In recent years, some studies have demonstrated that, in COPD patients, increases in vital capacity and inspiratory capacity reflect reduced residual volume, which correlates with decreased dyspnea and improved exercise performance, even in the absence of improved FEV 1 . (5,6) Therefore, the variation in FEV 1 might not suffice as an indicator of reversibility in this particular case. (7) In fact, there is no consensus regarding the best technique to evaluate the effect of bronchodilator administration in COPD patients.…”

Section: Introductionmentioning

confidence: 95%

Broncodilatação na DPOC: muito além do VEF1-efeito do salbutamol nas propriedades resistivas e reativas do sistema respiratório

et al. 2009

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Objective: Current debates on the bronchodilator response in COPD patients and whether the variation in FEV 1 can be considered as an indicator of complete reversibility in such patients motivated us to conduct this study. The objective of the study was to determine the effect of albuterol on the resistive and reactive properties of the respiratory system in COPD patients. Methods: We evaluated 70 patients with COPD, divided into two groups based on spirometry findings: bronchodilator (BD)-negative (n = 39); and BD-positive (n = 31). We used the forced oscillation technique (FOT) to evaluate the following parameters: resistance at the intercept (R 0 ), associated with the total resistance of the respiratory system; mean resistance (Rm), associated with central airway resistance; dynamic compliance (Cdyn); and the slope of resistance (S) and mean reactance (Xm), both of which are associated with the homogeneity of the respiratory system. Results: The use of albuterol resulted in significant reductions in R 0 (p < 0.00002) and Rm (p < 0.0002). There were also significant increases in S (p < 0.0001), Cdyn (p < 0.0001) and Xm (p < 0.00004). These modifications occurred in both groups, the changes in FOT parameters being greater than those observed for spirometric parameters. Conclusions: The use of albuterol improved the resistive and reactive properties of the respiratory system of the COPD patients under study. These changes occurred regardless of the FEV 1 -based classification, thereby indicating that the use of this parameter in isolation might not suffice to identify the physiological effects involved.Keywords: Pulmonary disease, chronic obstructive; Bronchodilator agents; Spirometry; Albuterol. ResumoObjetivo: Atualmente existem importantes debates na literatura sobre a resposta broncodilatadora em pacientes com DPOC e se a variação do VEF1 pode ser considerada uma indicação completa de reversibilidade neste caso particular. O objetivo deste estudo foi investigar o efeito do salbutamol nas propriedades resistivas e elásticas do sistema respiratório de portadores de DPOC. Métodos: Foram avaliados 70 indivíduos com DPOC, classificados através da espirometria em dois grupos: broncodilatador (BD)-negativo (n = 39); e BD-positivo (n = 31). Utilizou-se a técnica de oscilações forçadas (TOF) para avaliar os seguintes parâmetros: a resistência no intercepto (R 0 ), associada à resistência total do sistema respiratório; a resistência média (Rm), relacionada à resistência de vias aéreas centrais; e a complacência dinâmica (Cdyn); assim como o coeficiente angular da resistência (S) e a reatância média (Xm), relacionados com a homogeneidade do sistema respiratório. Resultados: O uso do salbutamol resultou em reduções significativas de R 0 (p < 0,00002) e Rm (p < 0,0002). Foram também observadas elevações significativas em S (p < 0,0001), Cdyn (p < 0,0001) e Xm (p < 0,00004). Estas alterações ocorreram tanto nos dois grupos, tendo sido observadas maiores modificações nos parâmetros da TOF do que nos parâmetros da ...

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Section: Introductionmentioning

confidence: 95%

Broncodilatação na DPOC: muito além do VEF1-efeito do salbutamol nas propriedades resistivas e reativas do sistema respiratório

et al. 2009

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“…The topic of whether the bronchodilator response in FEV 1 is limited in COPD patients has been discussed, 4 and studies have explored the reversibility of FEV 1 , forced vital capacity (FVC) and FEV 1 /FVC based on disease stage (based on GOLD stages). 5,6 Other studies suggest that the reversibility of FEV 1 is not a useful tool in COPD and that there might be many other relevant parameters when evaluating the response. 4 In some studies, other advanced lung function parameters are used to evaluate the response, [7][8][9][10][11][12][13] but there is no information about the clinically significant response and the parameters that are most effective to use.…”

Section: Introductionmentioning

confidence: 99%

Bronchodilator response of advanced lung function parameters depending on COPD severity

Jarenbäck

Eriksson

Peterson

et al. 2016

5.2 Monitoring Airway Disease

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“…About 50% of patients with COPD use long-acting bronchodilators, to achieve maximum airway dilatation [5]. Although these agents improve symptoms, recently doubt re-emerged concerning their safety, especially in terms of cardiovascular conditions.…”

Section: Introductionmentioning

confidence: 99%

“…Despite smoking cessation programs, approximately 50% of COPD patients continue to smoke [5,15]. Although the effects of smoking and bronchodilators on mortality in COPD patients have been extensively studied, their interaction surprisingly has not.…”

Section: Introductionmentioning

confidence: 99%

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Bronchodilation and Smoking Interaction in COPD: A Cohort Pilot Study to Assess Cardiovascular Risk

Dijk

Lenders²,

Holtman³

et al. 2011

Respiration

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Background: Smoking and bronchodilator treatment are both extensively studied as key elements in patients with chronic obstructive pulmonary disease. However, little is known about whether or not these elements interact in terms of developing cardiovascular diseases in patients with COPD. Objectives: To explore to what extent the risk of developing ischemic cardiovascular disease in COPD patients is mediated by smoking status, use of bronchodilators and – specifically – their interaction. Methods: We performed an observational pilot study on a relatively healthy Dutch COPD cohort from a primary care diagnostic center database with full information on spirometry tests, smoking status, bronchodilator use and other prescribed medication. We defined first ischemic cardiovascular events as primary outcome, measured by first prescription of antiplatelet drugs and/or nitrates. Unadjusted analyses by Kaplan-Meier were followed by adjusted Cox’ proportional hazards. Results: 845 COPD patients, totaling 2,169 observation years, were included in the analyses. We observed an increased risk for nonfatal ischemic cardiovascular events by smoking (adjusted HR = 3.58, p = 0.001) and a protective effect of bronchodilators (adjusted HR = 0.43, p = 0.01). Although the protective effect of bronchodilators appears to be substantially minimized in patients that persist in smoking, we could not statistically confirm a hazardous interaction between bronchodilators and smoking (HR 2.50, p = 0.21). Conclusion: Our study reveals bronchodilators may protect from ischemic cardiovascular events in a relatively ‘healthy’ COPD population. We did not confirm a hazardous interaction between bronchodilators and smoking, although we observed current smokers benefit substantially less from the protective effect of bronchodilators.

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Flow and volume responses after routine salbutamol reversibility testing in mild to very severe COPD

Cited by 49 publications

References 23 publications

Broncodilatação na DPOC: muito além do VEF1-efeito do salbutamol nas propriedades resistivas e reativas do sistema respiratório

Broncodilatação na DPOC: muito além do VEF1-efeito do salbutamol nas propriedades resistivas e reativas do sistema respiratório

Bronchodilator response of advanced lung function parameters depending on COPD severity

Bronchodilation and Smoking Interaction in COPD: A Cohort Pilot Study to Assess Cardiovascular Risk

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