Bronchodilator response of advanced lung function parameters depending on COPD severity

Jarenbäck, Linnea; Eriksson, Göran; Peterson, Stefan; Ankerst, Jaro; Bjermer, Leif; Tufvesson, Ellen

doi:10.2147/copd.s111573

Cited by 15 publications

(18 citation statements)

References 28 publications

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“…Accordingly, (iii) BDR is distinctive for each single parameter. In consequence, our study shows that (iv) BDR largely depends on the type and degree of pre-test dysfunction 49 and, therefore, the magnitude of the BDR was greater than expected, and as previously reported. 22 , 49–51 Unmistakably, it must be recognized that the overwhelming belief that COPD patients mostly present with an irreversible flow-limitation, is only based on the worldwide approach that reversibility mostly was assessed by simple spirometric measurements.…”

Section: Discussionsupporting

confidence: 88%

“… 45–49 Jarenbäck et al investigated the BDR based on advanced lung function parameters and brought to light that apart from flow response, also volume response, or a combination of both, have to be identified, if BDR is to be correctly assessed in COPD. 49 Topalovic et al and Borrill et al demonstrated that the specific airway conductance (sG aw ) could be a significant factor to differentiate asthma from COPD, 45 , 47 and regarding BDR, Saito et al showed that sG aw is a more sensitive measurement for detecting lung function changes in COPD patients than the more commonly used FEV 1 . 48 However, to our knowledge, none of these author groups evaluated measurements assessing airway dynamic parameters by the plethysmographic integral method featuring the parameters sR eff , sG eff , and sWOB.…”

Section: Discussionmentioning

confidence: 99%

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Bronchodilator Response in Patients with COPD, Asthma-COPD-Overlap (ACO) and Asthma, Evaluated by Plethysmographic and Spirometric z-Score Target Parameters

Kraemer

Smith

Gardin

et al. 2021

COPD

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Background Airflow reversibility criteria in COPD are still debated – especially in situations of co-existing COPD and asthma. Bronchodilator response (BDR) is usually assessed by spirometric parameters. Changes assessed by plethysmographic parameters such as the effective, specific airway conductance (sG eff ), and changes in end-expiratory resting level at functional residual capacity (FRC pleth ) are rarely appreciated. We aimed to assess BDR by spirometric and concomitantly measured plethysmographic parameters. Moreover, BDR on the specific aerodynamic work of breathing (sWOB) was evaluated. Methods From databases of 3 pulmonary centers, BDR to 200 g salbutamol was retrospectively evaluated by spirometric (∆FEV 1 and ∆FEF 25–75 ), and plethysmographic (∆sG eff , ∆FRC pleth , and ∆sWOB) parameters in a total of 843 patients diagnosed as COPD (478 = 57%), asthma-COPD-overlap (ACO) (139 = 17%), or asthma (226 = 27%), encountering 1686 BDR-measurement-sets (COPD n = 958; ACO n = 276; asthma n = 452). Results Evaluating z-score improvement taking into consideration the whole pre-test z-score range, highest BDR was achieved by combining ∆sG eff and ∆FRC detecting BDR in 62.2% (asthma: 71.4%; ACO: 56.7%; COPD: 59.8%), by ∆sG eff in 53.4% (asthma: 69.1%; ACO: 51.6%; COPD: 47.4%), whereas ∆FEV 1 only distinguished in 10.6% (asthma: 21.8%; ACO: 18.6%; COPD: 4.2%). Remarkably, ∆sWOB detected BDR in 49.4% (asthma: 76.2%; ACO: 47.8%; COPD: 46.9%). Conclusion BDR largely depends on the pre-test functional severity and, therefore, should be evaluated in relation to the pre-test conditions expressed as ∆z-scores, considering changes in airway dynamics, changes in static lung volumes and changes in small airway function. Plethysmographic parameters demonstrated BDR at a significant higher rate than spirometric parameters.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Bronchodilator Response in Patients with COPD, Asthma-COPD-Overlap (ACO) and Asthma, Evaluated by Plethysmographic and Spirometric z-Score Target Parameters

Kraemer

Smith

Gardin

et al. 2021

COPD

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“…Jarenbäck et al performed spirometry and body plethysmography at baseline and after bronchodilator. Their results stated that volume response does not follow the flow response (FEV1) and flow parameters were more significant in less advanced stage, whereas parameters reflecting volume response (FVC) were more prominent in patients with more severe stages of COPD [36]. Barjaktarevic et al showed that mild COPD (GOLD I) was characterized by greater BDR in terms of FEV1 than BDR in terms of FVC (35.6% vs 19.2%), a difference that was less marked in GOLD grades II and III.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic performance of lung volumes in assessment of reversibility in chronic obstructive pulmonary disease

et al. 2021

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Background Reversibility measured by spirometry in chronic obstructive pulmonary disease (COPD) is defined as an increase in forced expiratory volume in first second (FEV1) that is both more than 12% and 200 mL above the pre-bronchodilator value in response to inhaled bronchodilators. FEV1 only may not fully reverberate the changes caused by reduction in air trapping or hyperinflation. To date, the studies that examined the effect of inhaled bronchodilators (BD) on residual volume (RV) and total lung capacity (TLC) are limited. This study was carried out to assess the differences between flow and volume responses after bronchodilator reversibility testing in patients with different COPD GOLD stages (GOLD stage I to stage IV). Spirometry and whole body plethysmography were done before and 15 min after inhalation of 400 μg salbutamol. Results Majority (53.3%) of cases were volume responders, 18.7% were flow responders, 20% were flow and volume responders, and 8% were non responders. Significant increase in Δ FEV1% was found in 15% of cases while 55% showed a significant increase in Δ FVC (P= < 0.001). Mean difference of Δ FVC (L) post BD was significantly increased with advancing GOLD stage (P= 0.03). A cutoff point > 20% for Δ RV% had 70% sensitivity and 60% specificity and > 12% for Δ TLC% showed 90% sensitivity and 45% specificity for prediction of clinically significant response to BD based on FEV1. A cutoff point > 18% for Δ RV% had 78% sensitivity and 29% specificity and > 14% for Δ TLC% had 50% sensitivity and 70% specificity for prediction of clinically significant response to BD based on FVC. Conclusion ΔFEV1 underestimates the true effect of bronchodilators with advancing GOLD stage. Measurement of lung volumes in addition to the standard spirometric indices is recommended when determining bronchodilator response in COPD patients.

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“…Bronchodilator response of advanced lung function parameters depends on COPD severity. 17 In more severe cases of COPD patients, FVC remarkably rises after bronchodilator administration whereas FEV1 remains substantially constant, 7 isolated volume response to bronchodilators is a characteristic of severe emphysema in COPD patients. 6,9,18 In other words, FVC responders may suffer from more severe airway hyperresponsiveness, airway obstruction, and emphysema.…”

Section: Discussionmentioning

confidence: 99%

<p>Role of the Bronchodilator Test Defined by the Forced Vital Capacity in Chronic Obstructive Pulmonary Disease Phenotyping</p>

Wu¹,

Liu²,

Jiang³

2020

COPD

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In clinical practice, some chronic obstructive pulmonary disease (COPD) patients experienced a remarkable increase in forced vital capacity (FVC) after bronchodilator administration, whereas forced expiratory volume in the first second (FEV1) remains substantially unchanged. We assume this may relate to airway inflammatory type. We aim to analyze the clinical characteristics and explore the usefulness of the bronchodilator test, especially FVC, in this new COPD phenotype. Patients and Methods: A total of 346 COPD patients with exacerbation who underwent bronchodilator tests, fractional exhaled nitric oxide (FeNO) measurements and blood eosinophil counts were analyzed. The characteristics, FeNO levels, and blood eosinophil counts were compared between patients with and without significant bronchodilator responsiveness in terms of FVC. Results: Patients with significant FVC responsiveness displayed poorer lung function and higher FeNO levels compared with those without considerable FVC responsiveness (Z= −5.042 to −0.375, p=0.000-0.022). There is a discernible linear relationship between FeNO levels and FVC responsiveness to bronchodilator use (r=0.251, P=0.001). The application of bronchodilator responsiveness of FVC for detecting high FeNO levels in COPD patients exhibited relatively high sensitivity (61.8%) and specificity (86.7%). Conclusion:We demonstrated that COPD patients with significant FVC responsiveness had higher FeNO levels than non-responders and established a simple method for detecting high FeNO values. FVC responders may be identified as a separate group of COPD patients.

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Bronchodilator response of advanced lung function parameters depending on COPD severity

Cited by 15 publications

References 28 publications

Bronchodilator Response in Patients with COPD, Asthma-COPD-Overlap (ACO) and Asthma, Evaluated by Plethysmographic and Spirometric z-Score Target Parameters

Bronchodilator Response in Patients with COPD, Asthma-COPD-Overlap (ACO) and Asthma, Evaluated by Plethysmographic and Spirometric z-Score Target Parameters

Diagnostic performance of lung volumes in assessment of reversibility in chronic obstructive pulmonary disease

<p>Role of the Bronchodilator Test Defined by the Forced Vital Capacity in Chronic Obstructive Pulmonary Disease Phenotyping</p>

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