Effects of long-term bronchodilators in bronchiectasis patients with airflow limitation based on bronchodilator response at baseline

Abstract

PurposeThe association between positive bronchodilator response (BDR) at baseline and the effect of long-term bronchodilator therapy has not been well elucidated in patients with bronchiectasis. The aims of our study were to explore the association between positive BDR at baseline and lung-function improvement following long-term (3–12 months) bronchodilator therapy in bronchiectasis patients with airflow limitation.Materials and methodsThe medical records of 166 patients with clinically stable bronchiectasis who underwent baseline pre- and postbronchodilator spirometry and repeated spirometry after 3–12 months of bronchodilator therapy were retrospectively reviewed. For analysis, patients were divided into two groups, responders and poor responders, based on achievement of at least 12% and 200 mL in forced expiratory volume in 1 second (FEV1) following bronchodilator therapy from baseline FEV1.ResultsA total of 57 patients (34.3%) were responders. These patients were more likely to have positive BDR at baseline than poor responders (38.6% [22 of 57] vs 18.3% [20 of 109], P=0.004). This association persisted after adjustment for other confounding factors (adjusted odds ratio 2.298, P=0.034). However, we found FEV1 improved significantly following long-term bronchodilator therapy, even in patients without positive BDR at baseline (change in FEV1 130 mL, interquartile range −10 to 250 mL; P<0.001).ConclusionPositive BDR at baseline was independently associated with responsiveness to long-term bronchodilator therapy in bronchiectasis patients with airflow limitation. However, FEV1 improvement was also evident in bronchiectasis patients without positive BDR at baseline, suggesting that these patients can benefit from long-term bronchodilator therapy.

A comprehensive approach to lung function in bronchiectasis

“…Moreover, patients with reversible air trapping had more severe obstruction and higher baseline residual volume compared to non-reversible patients. This is in line with previous reports that studied FEV 1 reversibility both in bronchiectasis and COPD [15,16]. A low FEV 1 is associated with bronchiectasis exacerbations [42], however it remains unclear if the worsening of respiratory symptoms during these events is related to an acute further reduction in FEV 1 or could be due to an increase in air trapping.…”

“…Airway hyper-reactivity [39] and airflow reversibility have often been considered common in bronchiectasis, the latter ranging from 14% to 25% according to different studies [14,15,40]. Our findings are in line with those of Aksamit and colleagues [40] who recently found a significant acute bronchodilator response in terms of FEV 1 in 5% of cases out of a cohort of 963 bronchiectasis patients.…”

“…Some consideration should be made concerning the pragmatic approach we propose for the functional stratification of bronchiectasis patients. As it was previously shown, the degree of FEV 1 responsiveness to bronchodilators can vary over time [52] and during exposure to chronic inhaled treatment [15,52], and this might be true also for reversibility of air trapping. Moreover, we suggest that methacholine challenge should be performed in all patients with normal plethysmography at baseline but that symptoms compatible with bronchial hyper-reactivity.…”

“…Moreover, functional measurements other than FEV 1 , such as the degree of hyperinflation Abbreviations: ATS = American Thoracic Society; COPD = chronic obstructive pulmonary disease; DLCO = lung diffusion capacity; ERS = European Respiratory Society; FEV1 = Forced Expiratory Volume in 1 second; FEV1/VC = Tiffeneau index; FRC = functional residual capacity; IC = inspiratory Capacity; ICS = inhaled corticosteroids; LABA = long acting beta-2 agonists; LAMA = long acting muscarinic antagonists; LLN = lower limit of normal; RV = Residual Volume; sRaw = total specific airway resistances; TLC = total lung capacity; VA = alveolar volume; VC = slow vital capacity and lung diffusion capacity, seem to be independent predictors of mortality [12]. Notably, although distal airways proved to be crucial in the genesis of obstruction in bronchiectasis, responsiveness to bronchodilators has always been evaluated considering improvements in FEV 1 [13][14][15], which represents a rough indicator of small airways response in chronic obstructive diseases [16,17]. On the contrary, acute changes in static volumes and airway resistances demonstrated a higher sensitivity as markers of bronchodilation and have a close association with symptoms [16][17][18][19][20].…”

KMBARC registry: protocol for a multicentre observational cohort study on non-cystic fibrosis bronchiectasis in Korea

“…Third, the KMBARC has postbronchodilator spirometry results, which may provide useful information on the role of inhalers in those with bronchiectasis. It has been suggested that positive bronchodilator response can predict responsiveness to long-term bronchodilator therapy in patients with bronchiectasis 39. Fourth, the KMBARC has laboratory examination results such as neutrophil and eosinophil count, total bilirubin, uric acid, erythrocyte sedimentation rate and C-reactive protein.…”