Small Airways Response to Bronchodilators in Adults with Asthma or COPD: A Systematic Review

Almeshari, Mohammed A; Alobaidi, Nowaf Y; Sapey, Elizabeth; Usmani, Omar; Stockley, Robert A.; Stockley, James

doi:10.2147/copd.s331995

Cited by 11 publications

(10 citation statements)

References 58 publications

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“…29 Therefore, Ax in a way provides more comprehensive information compared with the other three parameters, which may explain ΔAx (%) to be the only parameter that is significantly associated with BDR. Our results are supported by a recent systemic review, 30 which showed the percentage change among IOS parameters, including R5-R20, X5, Fres, and Ax, after bronchodilator administration in asthmatic patients was greatest in Ax. In recent work, 31 we analyzed spirometric and IOS data in patients with respiratory symptoms and preserved pulmonary function.…”

Section: Discussionsupporting

confidence: 90%

Potentiality of impulse oscillometry to evaluate bronchodilator reversibility in untreated adult patients with newly diagnosed asthma

Hsiao

Lin

Jeng

et al. 2022

Journal of the Chinese Medical Association

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Background: Identifying positive bronchodilator reversibility (BDR) helps the diagnosis of asthma. However, not all patients can adequately perform the forced expiration during the spirometry test. An alternative test is required. Impulse oscillometry (IOS) is an effort-independent technique that enables the measurement of lung mechanics during quiet tidal breathing. We investigated the potentiality of IOS to evaluate BDR in untreated adult patients with newly diagnosed asthma (UAPNDS). Methods: All UAPNDS (aged 20–80 years) who never smoke and underwent IOS and spirometry before and after salbutamol inhalation at their initial visit to the hospital from March 22, 2017, to December 31, 2019, were identified. A total of 323 patients were enrolled. Data from the medical record, including demographic characteristics, laboratory examination, spirometric data, and IOS parameters, were retrospectively reviewed. The associations of parameters with the positive BDR and the performance of parameters in predicting the positive BDR were evaluated by statistical methods. Results: Patients (n = 323) had a median age of 64 years and were mostly female (67.5%). Several variables, including serum total immunoglobulin level, blood eosinophil counts, blood eosinophil percentage (%), and two IOS parameters, were found to be different between the positive (n = 93) and negative BDR (n = 230) groups. Multivariate logistic regression analyses after adjustment by cofactors revealed that the percentage change of the area under the reactance curve between 5 Hz and resonant frequency [ΔAx (%)] after salbutamol inhalation was the only independent factor for the positive BDR. The area under the receiver operating characteristic curve of ΔAx (%) in predicting the positive BDR was 0.614 (p = 0.0013), and its optimal cutoff value was −53.8% (sensitivity, 39.78% and specificity, 80.43%). Conclusion: In addition to spirometry, ΔAx (%), an IOS parameter, may serve as a novel indicator to evaluate BDR in UAPNDS.

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Section: Discussionsupporting

confidence: 90%

Potentiality of impulse oscillometry to evaluate bronchodilator reversibility in untreated adult patients with newly diagnosed asthma

Hsiao

Lin

Jeng

et al. 2022

Journal of the Chinese Medical Association

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“…Another key feature missing in the included studies is the description of the use of short-acting bronchodilator response and its effect on oscillometry [ 47 ]. Previous studies have shown that airway impedance can be significantly altered upon short-acting bronchodilator administration in healthy individuals [ 48 – 50 ].…”

Section: Discussionmentioning

confidence: 99%

Reference equations for oscillometry and their differences among populations: a systematic scoping review

et al. 2022

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Respiratory oscillometry is gaining global attention over traditional pulmonary function tests for its sensitivity in detecting small airway obstructions. However, its use in clinical settings as a diagnostic tool is limited because oscillometry lacks globally accepted reference values. In this scoping review, we systematically assessed the differences between selected oscillometric reference equations with the hypothesis that significant heterogeneity existed between them. We searched bibliographic databases, registries and references for studies that developed equations for healthy adult populations according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A widely used Caucasian model was used as the standard reference and compared against other models using Bland–Altman and Lin's concordance correlational analyses. We screened 1202 titles and abstracts, and after a full-text review of 67 studies, we included 10 in our analyses. Of these, three models had a low-to-moderate agreement with the reference model, particularly those developed from non-Caucasian populations. Although the other six models had a moderate-to-high agreement with the standard model, there were still significant sex-specific variations. This is the first systematic analysis of the heterogeneity between oscillometric reference models and warrants the validation of appropriate equations in clinical applications of oscillometry to avoid diagnostic errors.

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“…Studies have shown measures of SA (i.e. MMEF and oscillometry techniques indices) can demonstrate a BDR in COPD [20]. However, there is no consensus about which test is most sensitive in assessing SA.…”

Section: Table 1 Baseline Demographics Across Groupsmentioning

confidence: 99%

“…A recent systematic review reported that studies exploring the use of tests of small airways (SA) in BDR assessment in COPD are few and involve small number of participants [20]. Despite this, the studies reported that BDR as defined by tests of SA could potentially identify specific groups of patients and suggested that, with the advent of ultra-fine particles inhalers, there may be specific treatment options for those with BDR detected in the SA [21,22].…”

Section: Introductionmentioning

confidence: 99%

The prevalence of bronchodilator responsiveness of the small airway (using mid-maximal expiratory flow) in COPD - a retrospective study

et al. 2022

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Background Bronchodilator responsiveness (BDR) using FEV1 is often utilised to separate COPD patients from asthmatics, although it can be present in some COPD patients. With the advent of treatments with distal airway deposition, BDR in the small airways (SA) may be of value in the management of COPD. We aimed to identify the prevalence of BDR in the SA, utilizing maximal mid-expiratory flow (MMEF) as a measure of SA. We further evaluated the prevalence of BDR in MMEF with and without BDR in FEV1 and its association with baseline demographics, including conventional airflow obstruction severity and smoking history. Methods Lung function data of ever-smoking COPD patients were retrospectively analysed. BDR was evaluated 20 min after administering 2.5 mg of salbutamol via jet nebulizer. Increase in percent change of ≥ 12% and absolute change of ≥ 200 ml was used to define a BDR in FEV1, whereas an increase percent change of MMEF ≥ 30% was used to define a BDR in MMEF. Patients were classified as one of three groups according to BDR levels: group 1 (BDR in MMEF and FEV1), group 2 (BDR in MMEF alone) and group 3 (no BDR in either measure). Result BDR in MMEF was present in 59.2% of the patients. Of note, BDR in MMEF was present in all patients with BDR in FEV1 (group 1) but also in 37.9% of the patients without BDR in FEV1 (group 2). Patients in group 1 were younger than in groups 2 and 3. BMI was higher in group 1 than in group 3. Baseline FEV1% predicted and FVC % predicted were also higher in groups 1 and 2 than in group 3. Conclusion BDR in the SA (evaluated by MMEF) is common in COPD, and it is also feature seen in all patients with BDR in FEV1. Even in the absence of BDR in FEV1, BDR in MMEF is detected in some patients with COPD, potentially identifying a subgroup of patients who may benefit from different treatment strategies.

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Small Airways Response to Bronchodilators in Adults with Asthma or COPD: A Systematic Review

Cited by 11 publications

References 58 publications

Potentiality of impulse oscillometry to evaluate bronchodilator reversibility in untreated adult patients with newly diagnosed asthma

Potentiality of impulse oscillometry to evaluate bronchodilator reversibility in untreated adult patients with newly diagnosed asthma

Reference equations for oscillometry and their differences among populations: a systematic scoping review

The prevalence of bronchodilator responsiveness of the small airway (using mid-maximal expiratory flow) in COPD - a retrospective study

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