The Use of Expiratory Forced Flows for Determining Response to Bronchodilator Therapy

Boushy, Samuel F.

doi:10.1378/chest.62.5.534

Cited by 23 publications

(15 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Despite this, few studies [6][7][8][9][10][11] have focused on the problem of the association between perception of dyspnoea and changes in airway calibre in patients with chronic obstructive pulmonary disease (COPD). Some of these studies dealing with the relationship between dyspnoea and bronchodilation have described ' perceivers ' and ' non-perceivers ' after acute administration of a bronchodilator agent [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Perception of bronchoconstriction in smokers with airflow limitation

et al. 2001

View full text Add to dashboard Cite

To our knowledge, no data have been provided as to whether and to what extent dynamic hyperinflation, through its deleterious effect on inspiratory muscle function, affects the perception of dyspnoea during induced bronchoconstriction in patients with chronic airflow obstruction. We hypothesized that dynamic hyperinflation accounts in part for the variability in dyspnoea during acute bronchoconstriction. We therefore studied 39 consecutive clinically stable patients whose pulmonary function data were as follows (% of predicted value): vital capacity (VC), 97.8% (S.D. 16.0%); functional residual capacity, 105.0% (18.8%); actual forced expiratory volume in 1 s (FEV(1))/VC ratio, 56.1% (6.3%). Perception of dyspnoea using the Borg scale was assessed during a methacholine-induced fall in FEV(1). The clinical score and the treatment score, the level of bronchial hyper-responsiveness and the cytological sputum differential count were also assessed. In each patient, the percentage fall in FEV(1) and the concurrent Borg rating were linearly related, with the mean slope (PD slope) being 0.09 (0.06). The percentage fall in FEV(1) accounted for between 41% and 94% of the variation in the Borg score. At a 20% fall in FEV(1), the decrease in inspiratory capacity (Delta IC) was 0.156 (0.050) litres. Patients were divided into three subgroups according to the PD slope (arbitrary units/% fall in FEV(1)): subgroup I [eight hypoperceivers; PD slope 0.026 (0.005)], subgroup II [26 moderate perceivers; 0.090 (0.037)] and subgroup III [five hyperperceivers; 0.200 (0.044)]. By applying stepwise multiple regression analysis with the PD slope as the dependent variable, and other characteristics (demographic, clinical and functional characteristics, smoking history, level of bronchial hyper-responsiveness and sputum cytological profile) as independent variables, Delta IC (r(2)=45%, P<0.00001) and to a lesser extent treatment score (r(2)=17.3%, P<0.0006), and to an even lesser extent age (r(2)=3%, P<0.05), independently predicted a substantial amount (r(2)=65.27%, P<0.00001) of the variability in the Borg slope. Thus acute hyperinflation, and to a lesser extent treatment score and age, account in part for the variability in the perception of dyspnoea after accounting for changes in FEV(1) during bronchoconstriction in patients with chronic airflow obstruction.

show abstract

Section: Introductionmentioning

confidence: 99%

Perception of bronchoconstriction in smokers with airflow limitation

et al. 2001

View full text Add to dashboard Cite

show abstract

“…Some investigators have found FEV| to be the best measurement for the evalua tion of bronchodilator response [7,8], while others have found FEF25-75 [9,10] or MEF50 [11,12] to be better parameters than FEV|. Our observations suggest that with the criteria for significant improve ment adopted in this study, no single mea surement of forced expiration can be con sidered adequate for the evaluation of bronchodilator response.…”

Section: Discussionmentioning

confidence: 68%

Measurement of Reversibility of Airways Obstruction: which Parameters to Use?

Noah¹,

Kabiraj²,

Algın³

et al. 1985

Respiration

View full text Add to dashboard Cite

Maximum expiratory flow-volume (MEFV) curves recorded before and after salbutamol inhalation on 100 patients with various lung diseases were studied. Improvement was found to occur more frequently in MEF₅₀, FEF_25-75, FVC and MEF₂₅, than in FEV₁, FEV₁/FVC%, or MTT. If improvement in only one of the first four parameters was taken as a measure of reversibility of airways obstruction, many cases showing improvement in the others were missed. Improvement in any of the last three parameters was rarely missed if improvement in any of the first four was present. It was concluded that there is no single best measurement for assessment of bronchodilator response. FVC, FEF_25-75, MEF₅₀ and MEF₂₅ should all be measured. A flow-volume record of forced expiration from which all these measurements can be derived would therefore be preferable for this purpose to the time-volume spirometer record from which only FVC and FEF_25-75 can be determined.

show abstract

“…Numerous studies [4, 9, 10, 11, 12, 14, 15]have failed to show a relationship between absolute change in FEV 1 after bronchodilation and initial FEV 1 . Some authors [16, 17, 18, 19, 20]found a relationship between absolute changes in FEV 1 and initial FEV 1 . However, whether this relationship persisted when initial FEV 1 was expressed as percentage of predicted values has not been verified.…”

Section: Discussionmentioning

confidence: 99%

Influence of Predicted FEV<sub>1</sub> on Bronchodilator Response in Asthmatic Patients

Ouksel

Meslier²,

Badatcheff-Coat³

et al. 2003

Respiration

View full text Add to dashboard Cite

Background: There is currently disagreement on the way of expressing the reversibility of airflow obstruction, with some evaluations based on the initial FEV₁ while others use predicted FEV₁ (according to age, gender and height). Objectives: To test the relevance of expressing bronchodilator response as a percentage of predicted FEV₁, we evaluated the influence of morphological data on the response to bronchodilators in a population with a large range of predicted values. Methods: We measured the change in FEV₁ after inhalation of 200 µg of salbutamol in 30 asthmatic subjects (15 adults and 15 children) in whom predicted FEV₁ ranged between 1.13 and 4.10 liters and analyzed the respective influence of initial and predicted FEV₁on bronchodilator response. Results: We have shown a significant relationship between the absolute variation in FEV₁, in liters, and predicted FEV₁ (p = 0.0019). There was also a significant relationship between the absolute variation in FEV₁ and initial FEV₁, in liters (p = 0.02). This relationship was no longer significant (p = 0.8) when the variation and initial FEV₁ were both expressed as percentages of predicted FEV₁. In addition, multiple regression analysis showed that predicted FEV₁ was the only independent variable correlating with the response to bronchodilators. Conclusion: This study showed the influence of predicted FEV₁ on bronchodilator response. This result provides an additional argument for expressing bronchodilator response as a percentage of predicted FEV₁.

show abstract

The Use of Expiratory Forced Flows for Determining Response to Bronchodilator Therapy

Cited by 23 publications

References 19 publications

Perception of bronchoconstriction in smokers with airflow limitation

Perception of bronchoconstriction in smokers with airflow limitation

Measurement of Reversibility of Airways Obstruction: which Parameters to Use?

Influence of Predicted FEV<sub>1</sub> on Bronchodilator Response in Asthmatic Patients

Contact Info

Product

Resources

About