Bronchodilator responsiveness in patients with COPD

Tashkin, Donald P.; Celli, Bartolomé R.; Decramer, Marc; Liu, D; Burkhart, D; Cassino, Cara; Kesten, Steven

doi:10.1183/09031936.00129607

Cited by 299 publications

(241 citation statements)

References 23 publications

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“…CODE study participants had evidence of moderate to severe disease and evidence of airflow obstruction after administration of bronchodilator and were similarly excluded if they had a concomitant diagnosis of asthma. Even if patients with underlying asthma were inadvertently included in the analyses, there is increasing recognition that bronchodilator reversibility and asthma coexist in a substantial proportion of subjects with COPD (26,27). Even when including subjects from NHANES with doctor-diagnosed asthma, the role of the allergic phenotype on health outcomes was not substantially altered.…”

Section: Discussionmentioning

confidence: 99%

Effects of Allergic Phenotype on Respiratory Symptoms and Exacerbations in Patients with Chronic Obstructive Pulmonary Disease

Jamieson¹,

Matsui

Belli³

et al. 2013

Am J Respir Crit Care Med

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Rationale: Chronic obstructive pulmonary disease (COPD) guidelines make no recommendations for allergy diagnosis or treatment. Objectives: To determine whether an allergic phenotype contributes to respiratory symptoms and exacerbations in patients with COPD. Methods: Two separate cohorts were analyzed: National Health and Nutrition Survey III (NHANES III) and the COPD and domestic endotoxin (CODE) cohort. Subjects from NHANES III with COPD (n ¼ 1,381) defined as age . 40 years, history of smoking, FEV 1 /FVC , 0.70, and no diagnosis of asthma were identified. The presence of an allergic phenotype (n ¼ 296) was defined as self-reported doctor diagnosed hay fever or allergic upper respiratory symptoms. In CODE, former smokers with COPD (n ¼ 77) were evaluated for allergic sensitization defined as a detectable specific IgE to perennial allergens. Bivariate and multivariate models were used to determine whether an allergic phenotype was associated with respiratory symptoms and exacerbations. Measurements and Main Results: In NHANES III, multivariate analysis revealed that individuals with allergic phenotype were more likely to wheeze (odds ratio [OR], 2.1; P , 0.01), to have chronic cough (OR, 1.9; P ¼ 0.01) and chronic phlegm (OR, 1.5; P , 0.05), and to have increased risk of COPD exacerbation requiring an acute doctor visit (OR, 1.7; P ¼ 0.04). In the CODE cohort, multivariate analysis revealed that sensitized subjects reported more wheeze (OR, 5.91; P , 0.01), more nighttime awakening due to cough (OR, 4.20; P ¼ 0.03), increased risk of COPD exacerbations requiring treatment with antibiotics (OR, 3.79; P ¼ 0.02), and acute health visits (OR, 11.05; P , 0.01). An increasing number of sensitizations was associated with a higher risk for adverse health outcomes. Conclusions: Among individuals with COPD, evidence of an allergic phenotype is associated with increased respiratory symptoms and risk of COPD exacerbations.Keywords: atopy; allergic sensitization; allergy; chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD), a chronic disease of the airways, is caused by tobacco smoke and other air pollutant exposures (1). In the United States, COPD affects 14% of the adult population and is the third leading cause of death (2). Annually, COPD is responsible for 726,000 hospitalizations and over $32 billion in estimated cost, reflecting a large public health burden (3). Patients with COPD suffer significant morbidity, including respiratory symptoms that adversely affect quality of life and limit activity (4). Given the significant morbidity, understanding the different factors that contribute to symptom burden in COPD is an important focus of research.Allergic sensitization, assessed by allergen-specific IgE or skin prick testing, is a known risk factor for asthma (5, 6), and exposure to specific allergens in sensitized patients with asthma is known to worsen pulmonary symptoms (7,8). National and international guidelines recommend assessment of allergic sensitization and environmental exposur...

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Section: Discussionmentioning

confidence: 99%

Effects of Allergic Phenotype on Respiratory Symptoms and Exacerbations in Patients with Chronic Obstructive Pulmonary Disease

Jamieson¹,

Matsui

Belli³

et al. 2013

Am J Respir Crit Care Med

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“…Results from the recent studies indicate that patients with COPD demonstrate substantial acute bronchodilator reversibility using three different published criteria [15], suggesting that partial reversibility (FEV 1 change ≥12% after maximal bronchodilation) should no longer be an exclusion criterion in clinical trials.…”

Section: Discussionmentioning

confidence: 99%

Aclidinium bromide provides long-acting bronchodilation in patients with COPD

Chanez¹,

Burge²,

Dahl³

et al. 2010

Pulmonary Pharmacology & Therapeutics

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Aclidinium bromide is a novel, long-acting, muscarinic antagonist in phase III development for the maintenance treatment of COPD. This phase IIb study investigated the efficacy and safety of aclidinium for the treatment of moderate to severe COPD to establish the optimal dose for phase III studies. A total of 464 patients with moderate to severe stable COPD were randomised to double-blind, once-daily treatment with aclidinium (25, 50, 100, 200, or 400 μg), placebo, or openlabel tiotropium (18 μg) for 4 weeks. Spirometric measurements were performed at 22-24 h after the first dose and then at weekly intervals, and from 0.5-6 h post-dose on day 1 and day 29. Compared with placebo, aclidinium 200 μg and 400 μg significantly increased trough FEV 1 on day 29 versus baseline. During the first 6 h post-dose, the bronchodilatory effect of aclidinium (all doses) on day 1 was comparable to that on day 29. Time to peak FEV 1 was 3 h for aclidinium 100-400 μg. Aclidinium was well tolerated, with no dose-dependent effect on ECG, laboratory parameters, or adverse events. The incidence of AEs was generally comparable to placebo. Aclidinium produced sustained bronchodilation over 24 h and was well tolerated during this short-term study. Based on these data, aclidinium 200 μg was selected as the investigational dose for future clinical trials in COPD.

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“…Klasik olarak astım-KOAH ayırıcı tanısında yararlı olabileceğine inanılsa da, pratikte astım-KOAH ayırımın-da sanıldığı kadar yararlı bir test değildir. Son yıllarda yapılan çalışmalarda KOAH'lı olgularda da reversibilitenin olabileceği gösterilmiştir (10). arasındaki temel fark, başlangıç değerinin değerlendirilme-sindedir.…”

Section: Reversibiliteunclassified

Spirometry and Flow-Volume Curve

Demir¹

2017

Bulletin of Thoracic Surgery

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Spirometry is the essential part of a pulmonary function study and provides the most information. The two most important dynamic lung volumes measured are the forced vital capacity (FVC), and the forced expiratory volume in the 1st second (FEV 1 ). The third important parameter FEV 1 /FVC ratio is used to differantiate obstructive from restrictive lung disorder. The flow-volume curve is more informative and easier to interpret, as different disease produce distinct curve shapes. In this review spirometry and flow-volume curve will be discussed. SPİROMETRESpirometreler soluk alma ya da verme sırasında oluşan akım ya da volüm değişikliklerini zamanın türevi olarak ölçebilen aletlerdir. Solunum fonksiyonlarını değerlen-dirmede kullanılan en temel test yöntemidir. Spirometre solunum fonksiyon testleri içinde aslında sadece küçük bir bölümü oluştururken, pratik kullanım açısından en yaygın kullanılanıdır. Spirometre ilk kez 1846 yılında John Hutchinson adlı bir hekim tarafından kullanılmıştır (1). O günden bu yana da spirometreler özellikle teknolojideki gelişmelere koşut olarak gelişmiş ve yaygınlaşmıştır. Eskiden büyük hacim kaplayan sulu spirometreler kullanı-lırken günümüzde ceket cebine sığabilecek boyutlarda spirometreler mevcuttur.Spirometre; obstrüktif ve restriktif akciğer hastalıkları-nın tanısında, hastalığın şiddetini ve tedaviye yanıtını saptamada, meslek hastalıklarının tanı, tarama ve maluliyet değerlendirmesiyle preoperatif değerlendirmelerde rutin olarak kullanılır. Spirometrik değerlendirme klasik olarak zaman-volüm eğrisi ve akım-volüm halkası olarak iki farklı şekilde yapılır. Bilgisayar teknolojisindeki gelişmelerden önce klasik spirometreler ile akım-volüm halkası çizdirilmesi mümkün değildi. Akım-volüm halkası için geniş yer kaplayan ekstra aletlere gereksinim duyulurdu. Oysa yeni spirometrelerde eş zamanlı olarak hem zaman-volüm eğrisi hem de akım-volüm halkası çizdirilebilmektedir. Bu da hekimin sonuçları daha sağlıklı değerlendirmesini sağlamaktadır. Spirometre Endikasyonları

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Bronchodilator responsiveness in patients with COPD

Cited by 299 publications

References 23 publications

Effects of Allergic Phenotype on Respiratory Symptoms and Exacerbations in Patients with Chronic Obstructive Pulmonary Disease

Effects of Allergic Phenotype on Respiratory Symptoms and Exacerbations in Patients with Chronic Obstructive Pulmonary Disease

Aclidinium bromide provides long-acting bronchodilation in patients with COPD

Spirometry and Flow-Volume Curve

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