Effects of Tiotropium With and Without Formoterol on Airflow Obstruction and Resting Hyperinflation in Patients With COPD

Noord, J.A. van; Aumann, Joseph; Janssens, E.; Verhaert, Jan; Smeets, J. J.; Mueller, Achim; Cornelissen, P. J. G.

doi:10.1378/chest.129.3.509

Cited by 255 publications

(153 citation statements)

References 27 publications

(27 reference statements)

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“…In addition to serving as an index for survival, IC has also emerged as a useful tool for assessing changes in gas trapping for various therapies. For example, Van Noord and co-workers 37 39 Notably, they found an increased RV in mild, moderate, and severe obstruction. They also observed that the largest change in percent of predicted following bronchodilator and the frequency of a positive response was greatest for RV ( Fig.…”

Section: Do Lung Volumes Tell Us Anything Meaningfulmentioning

confidence: 99%

What Is the Clinical Value of Lung Volumes?

Ruppel

2012

Respir Care

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Lung volumes are considered part of a complete pulmonary function test, but their value for enhancing clinical decision making is unknown. Unlike spirometry and diffusing capacity of the lung for carbon monoxide (D LCO ), which do contribute to confirming or excluding a diagnosis, there are few clear indications when lung volumes are discriminatory. Confirming "restriction" when vital capacity (VC) or FVC is reduced is perhaps the most important. A restrictive pattern can have many etiologies, and clinicians often use VC or FVC as a primary index of lung volume. This makes "physiologic" sense because, in healthy subjects, and in patients with true restriction, VC comprises most of the total lung capacity (TLC). Mixed obstruction-restriction and the nonspecific pattern (ie, reduced FVC and FEV 1 , normal FEV 1 /FVC and TLC) require measuring TLC to confirm the underlying physiology. In obesity, VC and TLC may remain within normal limits, but functional residual capacity (FRC) can exponentially decrease. Increased lung volumes, particularly residual volume (RV), are commonly observed in airway obstruction. TLC may be normal, but is frequently increased in the late stages of COPD. Hyperinflation and air-trapping are terms commonly used to reflect these changes, but are not well standardized. The variability of lung volumes related to degree of obstruction suggests that measuring gas-trapping may be needed to monitor therapy. Changes in inspiratory capacity, RV, or FRC may be important gauges of response to bronchodilators or other hyperinflation-reducing therapies. How lung volumes are measured may be important, especially in patients who have moderate or severe airway obstruction. Body plethysmography is often considered more accurate than gas dilution methods in the presence of obstruction. However, the differences between techniques are not completely understood. Newer approaches such as computed tomography, although not suitable for routine testing, may help to delineate the true underlying physiology.

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Section: Do Lung Volumes Tell Us Anything Meaningfulmentioning

confidence: 99%

What Is the Clinical Value of Lung Volumes?

Ruppel

2012

Respir Care

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“…1,2 Nonetheless, it has been shown that the use of spirometry is limited with only a third of newly diagnosed individuals with COPD actually having spirometry to confirm the presence of irreversible air flow obstruction. [3][4][5] Although appropriate therapy with inhaled medications have been demonstrated to reduce symptoms, improve health-related quality of life, and decrease the rate of acute exacerbations [6][7][8][9][10][11][12][13][14][15][16][17][18][19] , there is growing evidence that pharmacotherapy used to treat patients for COPD pose risks. 6,7,[20][21][22][23][24][25] Without spirometry, patients who have been diagnosed with COPD may be being medically managed without evidence of airways obstruction, leading to unnecessary exposure to risks and costs associated with COPD therapy.…”

Section: Introductionmentioning

confidence: 99%

Determinants of Spirometry Use and Accuracy of COPD Diagnosis in Primary Care

Joo

Fitzgibbon

et al. 2011

J GEN INTERN MED

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BACKGROUND: It is unclear if primary care physicians are following guidelines or using other patient characteristics and factors to determine when to perform spirometry in patients at risk for COPD. It is also unclear to what degree a diagnosis of COPD is accurately reflected by spirometry results. OBJECTIVES: To examine characteristics associated with use of spirometry in primary care for patients with increased risk for COPD and to determine the accuracy of COPD diagnosis in patients with spirometry. DESIGN: Retrospective cohort study. were not associated with use of spirometry. Of the 159 patients with a diagnosis of COPD, 93 (58.5%) met GOLD criteria and 81(50.9%) met lower limit of normal (LLN) criteria for COPD. CONCLUSION: Clinicians use spirometry more often among patients with symptoms suggestive of COPD but not more often among patients with current or past tobacco use. For patients who had a spirometry and a diagnosis of COPD, primary care physicians were accurate in their diagnosis only half of the time.KEY WORDS: chronic disease; diagnosis; health care delivery; chronic obstructive pulmonary disease; spirometry; quality of care.

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“…In addition, most people may prefer to exercise in the morning; the troublesome symptoms in morning hours will certainly influence their mood and QoL during the whole day. There is growing evidence that COPD shows diurnal variability in physiological parameters of lung function, such as inspiratory capacity, FEV 1 , FVC and peak expiratory flow (3,5,15). Early morning hours presented least FEV 1 values for COPD patients (16).…”

Section: Copd Symptoms and Health Statusmentioning

confidence: 99%

Perception of circadian variation of symptoms in Chinese patients with chronic obstructive pulmonary disease

Wang

Cai

et al. 2017

J. Thorac. Dis.

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Background: Although, the variable pattern of asthmatic symptoms is well recognized, little is known about the respiratory symptoms variability in patients of chronic obstructive pulmonary disease (COPD). The present study evaluated the variability of the respiratory symptoms in a day and their influence on the daily activities in a cohort of Chinese COPD patients. Methods: An observational cross-sectional study was conducted in 11 medical centers of China.Participants were outpatient ≥40 years old with stable COPD, post-bronchodilator forced expiratory volume in 1 second (FEV1) <80% predicted. Overall, data of 1,032 eligible patients were valid for final analysis.Results: Mean post bronchodilator FEV1 (predicted %) was 46.5%. Cough, expectoration and dyspnea were the most commonly observed symptoms (73.6%, 68.8% and 61.4%, respectively). Daily symptom variability was experienced by 50.2% of symptomatic patients. The wake up time in the morning was the worst and the most troublesome time during the day (39.3%), followed by the nighttime (21.3%). The morning activities were most affected by COPD symptoms. Multivariate analyses revealed that COPD assessment test (CAT) scores was the only factor correlated with patients' symptom variability [odds ratio (OR) =0.463, P<0.0001]. Conclusions: Patient-perceived symptoms vary during the day in Chinese COPD patients. They experience the greatest increase in respiratory symptoms early in the morning. This variation should be considered as a potential new target in the long-term COPD management.

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Effects of Tiotropium With and Without Formoterol on Airflow Obstruction and Resting Hyperinflation in Patients With COPD

Cited by 255 publications

References 27 publications

What Is the Clinical Value of Lung Volumes?

What Is the Clinical Value of Lung Volumes?

Determinants of Spirometry Use and Accuracy of COPD Diagnosis in Primary Care

Perception of circadian variation of symptoms in Chinese patients with chronic obstructive pulmonary disease

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