Resposta a broncodilatador na espirometria: que parâmetros e valores são clinicamente relevantes em doenças obstrutivas?

Rodrigues, Roberto; Pereira, Carlos Alberto de Castro

doi:10.1590/s0102-35862001000100007

Cited by 11 publications

(25 citation statements)

References 59 publications

(100 reference statements)

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“…In a previous study, in which the BHT max V EI was sequentially measured in the postoperative period, the authors reported that the test was easy to perform, was well accepted by patients, and was an interesting tool to be used in the clinical follow-up of patients in the postoperative period, having aided in detecting complications during that period. (22)(23)(24)(25)(26) However, that study did not evaluate the role of bronchodilator use in the BHT max V EI .…”

Section: Discussionmentioning

confidence: 99%

Efeito do broncodilatador no tempo de apneia voluntária máxima em pacientes com distúrbios ventilatórios obstrutivos

et al. 2011

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Objective: To identify the role of bronchodilators in the maximal breath-hold time in patients with obstructive lung disease (OLD). Methods: We conducted a case-control study including patients with OLD and a control group. Spirometric tests were performed prior to and after the use of a bronchodilator, as were breath-hold tests, using an electronic microprocessor and a pneumotachograph as a flow transducer. Respiratory flow curves were displayed in real time on a portable computer. The maximal breath-hold times at end-inspiratory volume and at end-expiratory volume (BHT max V EI and BHT max V EE , respectively) were determined from the acquired signal. Results: A total of 35 patients with OLD and 16 controls were included. Prior to the use of a bronchodilator, the BHT max V EI was significantly lower in the OLD group than in the control group (22.27 ± 11.81 s vs. 31.45 ± 15.73 s; p = 0.025), although there was no significant difference between the two groups in terms of the post-bronchodilator values (24.94 ± 12.89 s vs. 31.67 ± 17.53 s). In contrast, BHT max V EE values were significantly lower in the OLD group than in the control group, in the pre-and post-bronchodilator tests (16.88 ± 6.58 s vs. 22.09 ± 7.95 s; p = 0.017; and 21.22 ± 9.37 s vs. 28.53 ± 12.46 s; p = 0.024, respectively). Conclusions: Our results provide additional evidence of the clinical usefulness of the breath-hold test in the assessment of pulmonary function and add to the existing knowledge regarding the role of the bronchodilator in this test. Keywords:Respiratory function tests; Pulmonary disease, chronic obstructive; Bronchodilator agents; Apnea. ResumoObjetivo: Identificar o papel do broncodilatador no tempo de apneia voluntária máxima em pacientes com distúrbios ventilatórios obstrutivos (DVOs). Métodos: Estudo caso-controle incluindo pacientes com DVOs e grupo controle. Foram realizadas espirometrias antes e após o uso de broncodilatador, assim como testes de apneia respiratória, utilizando-se um microprocessador eletrônico e um pneumotacógrafo como transdutor de fluxo. As curvas de fluxo respiratório foram exibidas em tempo real em um computador portátil, e os tempos de apneia voluntária inspiratória e expiratória máximos (TAVIM e TAVEM, respectivamente) foram determinados a partir do sinal adquirido. Resultados: Um total de 35 pacientes com DVOs e 16 controles foram incluídos no estudo. O TAVIM sem o uso de broncodilatador foi significativamente menor no grupo DVO que no grupo controle (22,27 ± 11,81 s vs. 31,45 ± 15,73; p = 0,025), mas essa diferença não foi significativa após o uso de broncodilatador (24,94 ± 12,89 s vs. 31,67 ± 17,53 s). Os valores de TAVEM foram significativamente menores no grupo DVO que no grupo controle antes (16,88 ± 6,58 s vs. 22,09 ± 7,95 s; p = 0,017) e após o uso de broncodilatador (21,22 ± 9,37 s vs. 28,53 ± 12,46 s; p = 0,024). Conclusões: Estes resultados fornecem uma evidência adicional da utilidade clínica do teste de apneia na avaliação da função pulmonar e do papel do broncodilatador n...

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Section: Discussionmentioning

confidence: 99%

Efeito do broncodilatador no tempo de apneia voluntária máxima em pacientes com distúrbios ventilatórios obstrutivos

et al. 2011

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“…(5,15,27) Some authors have reported that patients with COPD develop progressive air trapping upon exertion without altering total lung capacity, presenting increased functional residual capacity and decreased IC. (28)(29) By reducing this dynamic hyperinflation, bronchodilator use can increase IC and decrease the functional residual capacity.…”

Section: Discussionmentioning

confidence: 99%

“…(2)(3) Although some studies showed poor response to bronchodilators in FEV1 in patients with COPD, these drugs have always been the main therapeutic resource used to combat this illness and are widely prescribed. (2)(3)(4)(5) The functional limitation in patients with COPD, classically determined through the measurement of FEV 1 , correlates well with limited exercise tolerance, ability to perform day-to-day activities, severity of dyspnea and lower quality of life. Spirometry, and FEV 1 in particular, is a good marker for the staging of the disease.…”

Section: Introductionmentioning

confidence: 99%

“…(3) Although it has not been well established in the literature, some studies have shown that bronchodilators may reduce dyspnea, independent of any improvement in spirometric values. (5)(6)(7) In addition, patients who respond to bronchodilators have been shown to also respond better to long-term treatment with corticosteroids and long-acting bronchodilators, thereby improving prognoses. (4,8) The principal double-blind, randomized studies involving large samples of patients with COPD assessed FEV 1 as the main outcome measure.…”

Section: Introductionmentioning

confidence: 99%

“…(5,10) In various studies involving patients with airway obstruction, there was response to bronchodilators using parameters other than FEV 1 (5,(11)(12)(13)(14)(15)(16)(17) . Based on these assumptions, we proposed this study with the objective of assessing the frequency of an FEV 1 response to a bronchodilator in a group of patients with COPD, correlating this response to clinical data, comparing the groups with and without an FEV 1 response and assessing other functional parameters (forced vital capacity -FVC; slow vital capacity -SVC; inspiratory capacity -IC; residual volume -RV; airway resistance -AR; and specific airway conductance -sGaw).…”

Section: Introductionmentioning

confidence: 99%

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O volume expiratório forçado no primeiro segundo não é suficiente para avaliar resposta broncodilatadora em doença pulmonar obstrutiva crônica

2005

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Objective: To assess the frequency of variation in forced expiratory volume in one second after bronchodilator use in a sample of patients with chronic obstructive pulmonary disease, correlating such variation with clinical and demographic variables and evaluating the frequency of response presented in forced vital capacity, slow vital capacity, inspiratory capacity, residual volume, airway resistance and specific airway conductance. Methods: A total of 64 patients with chronic obstructive pulmonary disease were submitted to whole body plethysmography, and reversibility of bronchoconstriction after the administration 400 µg of fenoterol was quantified. Results: A response in forced expiratory volume in one second was observed in 31% of the patients. Excluding patients presenting a response in forced expiratory volume in one second, 5% presented responses in 5 of the other 6 parameters, 10% presented responses in 4 parameters, 17.5% in 3 parameters, 27.5% in 2 parameters, and 25% in only 1 parameter. Conclusion: When included in the evaluation of bronchodilator response together with forced expiratory volume in one second, static lung volumes, airway resistance and airway conductance allowed a broader evaluation of those patients presenting a functional pharmacodynamic response. These results are in accordance with the observation that bronchodilator use provides clinical improvement and relief of dyspnea to many patients with chronic obstructive pulmonary disease, even to those in whom such treatment leads to no improvement in forced expiratory volume in one second. Original Article

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Vital capacity and inspiratory capacity as additional parameters to evaluate bronchodilator response in asthmatic patients: a cross sectional study

et al. 2012

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BackgroundBronchodilator response in patients with asthma is evaluated based on post-bronchodilator increase in forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). However, the need for additional parameters, mainly among patients with severe asthma, has already been demonstrated.MethodsThe aim of this study was to evaluate the usefulness of vital capacity (VC) and inspiratory capacity (IC) to evaluate bronchodilator response in asthma patients with persistent airflow obstruction. The 43 asthma patients enrolled in the study were stratified into moderate or severe airflow obstruction groups based on baseline FEV1. All patients performed a 6-minute walk test before and after the bronchodilator (BD). A bipolar visual analogue scale post-BD was performed to assess clinical effect. The correlation between VC and IC and clinical response, determined by visual analogue scale (VAS) and 6-minute walk test (6MWT), was investigated.ResultsPatients in the severe group presented: 1) greater bronchodilator response in VC (48% vs 15%, p = 0.02), 2) a significant correlation between VC variation and the reduction in air trapping (Rs = 0.70; p < 0.01), 3) a significant agreement between VC and VAS score (kappa = 0.57; p < 0.01). There was no correlation between IC and the reduction in air trapping or clinical data.ConclusionsVC may be a useful additional parameter to evaluate bronchodilator response in asthma patients with severe airflow obstruction.

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Resposta a broncodilatador na espirometria: que parâmetros e valores são clinicamente relevantes em doenças obstrutivas?

Cited by 11 publications

References 59 publications

Efeito do broncodilatador no tempo de apneia voluntária máxima em pacientes com distúrbios ventilatórios obstrutivos

Efeito do broncodilatador no tempo de apneia voluntária máxima em pacientes com distúrbios ventilatórios obstrutivos

O volume expiratório forçado no primeiro segundo não é suficiente para avaliar resposta broncodilatadora em doença pulmonar obstrutiva crônica

Vital capacity and inspiratory capacity as additional parameters to evaluate bronchodilator response in asthmatic patients: a cross sectional study

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