Partial and Maximal Expiratory Flow-Volume Curves in Normal and Asthmatic Subjects Before and After Inhalation of Metaproterenol

Berry, Richard B.; Fairshter, Ronald D.

doi:10.1378/chest.88.5.697

Cited by 29 publications

(18 citation statements)

References 20 publications

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“…Quite often, responses to bronchodilator therapy are unpredictably underestimated by FEV1 and/or FVC in comparison to airway resistance or flow measured during forced expiratory manoeuvres initiated from a volume below TLC (partial expiratory flow-volume manoeuvres) in both healthy subjects and patients with chronic airflow obstruction [8,101,102,[119][120][121][122]. These findings are probably due to the fact that deep inhalations tend to reduce airway calibre, especially after a bronchodilator [101,120].…”

Section: Bronchodilator Responsementioning

confidence: 99%

Interpretative strategies for lung function tests

Pellegrino¹

2005

European Respiratory Journal

4,924

4,636

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Section: Bronchodilator Responsementioning

confidence: 99%

Interpretative strategies for lung function tests

Pellegrino¹

2005

European Respiratory Journal

4,924

4,636

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“…Potential physiological explanations for this phenomenon are a reduced volume excursion due to lung hyperinflation, low elastic recoil, stress relaxation, altered airway-to-parenchymal interdependence, relative predominance of parenchymal hysteresis over airway hysteresis, and inhomogeneity of lung emptying during forced expiration (15,20,26). Whatever the underlying mechanisms, whose discussion is beyond the scope of this paper, it is a fact that airflow obstruction occurs after taking a full lung inflation in many COPD patients (8,13,25,26). The positive correlation between the slope of V part 30 vs. V E and the M/P ratio at rest observed in this study suggests that, in those subjects in whom deep inhalation causes bronchoconstriction, the increase in V E with exercise may also cause airway narrowing.…”

Section: Comments On Resultsmentioning

confidence: 99%

“…In subjects with chronic airflow obstruction, further airway narrowing is often observed after a deep inhalation is taken (8,13,25,31). Potential physiological explanations for this phenomenon are a reduced volume excursion due to lung hyperinflation, low elastic recoil, stress relaxation, altered airway-to-parenchymal interdependence, relative predominance of parenchymal hysteresis over airway hysteresis, and inhomogeneity of lung emptying during forced expiration (15,20,26).…”

Section: Comments On Resultsmentioning

confidence: 99%

“…In a number of COPD subjects, FRC decreases after a bronchodilator even in the absence of significant changes in forced expiratory volume in 1 s (FEV 1 ) or forced vital capacity (FVC) (21,25). The lack of sensitivity of FEV 1 and FVC to the effect of bronchodilators has been attributed to a bronchoconstrictor effect of the deep inhalation preceding the forced expiratory maneuver, which is often observed in chronic airway obstruction (8,13,25,26,31,37). It has therefore been postulated that the beneficial effect of bronchodilator treatments on symptoms and exercise tolerance may be overlooked by standard reversibility tests (21), and the reduction of lung hyperinflation at rest may be a better predictor of benefits on exercise tolerance (22).…”

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confidence: 99%

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Effects of exercise and β₂-agonists on lung function in chronic obstructive pulmonary disease

Corsico

Fulgoni

Beccaria

et al. 2002

Journal of Applied Physiology

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“…In patients with asthma, the predominant tendency is that spontaneous obstruction most often worsens after a deep inhalation [22], the more severe the degree of spontaneous obstruction, the greater the bronchoconstrictor effect of DI. At variance to this, quite consistently [23,24], M/P ratios increase during induced constriction.…”

Section: Discussionmentioning

confidence: 99%

Reduction in bronchodilation following a deep inhalation is poorly related to airway inflammation in asthma

Pacini

Filippelli²,

Duranti³

et al. 1999

Eur Respir J

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In patients with bronchial asthma, forced expiratory flows are differently sensitive to a previous volume history. A reduced ability of a deep inhalation (DI) to dilate obstructed airways has been hypothesized to be a physiological marker for the degree of airway responsiveness and to relate to the presence and magnitude of inflammation in the lung, even in mild stable asthma. However, there are at present doubts as to whether functional changes could be used as a substitute for airway inflammation studies.In order to investigate the interrelations among airway inflammation, bronchial hyperresponsiveness and effects of volume history, 58 consecutive asthmatics with mild to moderate asthma were studied. The effects of DI were assessed as the isovolumic ratio of flows from forced expiratory manoeuvres started from maximal (M) or partial (P) lung inflation. Airway inflammation was assessed by using induced sputum. Sputum was analysed for total and differential cell counts, and levels of eosinophil cationic protein (ECP) which reflects eosinophil activation. Airway responsiveness was assessed as the provocative concentration of histamine which caused a 20% fall in forced expiratory volume in one second (FEV1) from control (PC20).The M/P ratio was significantly related to ECP (r=-0.31, p<0.03) and eosinophils (r=-0.29, p<0.03), FEV1/vital capacity (VC) (r=0.32; p<0.01), clinical score (r=-0.33; p<0.03) and age (r=-0.41; p<0.0001). In a stepwise multiple regression analysis including age, score, baseline lung function, ECP, number of eosinophils and the response to b 2 -agonist, age (p<0.037) predicted a small amount of the variance in M/P ratio (r 2 =0.12). It is concluded that volume history response is substantially independent of both sputum outcomes (inflammatory cell number and eosinophil cationic protein) and bronchial hyperresponsiveness; rather it seems to be associated with anthropometric characteristics. Functional aspects do not provide information on eosinophilic, probably central, airway inflammation. Eur Respir J 1999; 14: 1055±1060. In patients with bronchial asthma maximal expiratory flow is affected by a deep inhalation (DI) varying from an increase, to no effect, to a decrease in expiratory flow. These changes relate to the site and mechanism of the obstructive process [1]. A reduction in bronchodilation following a DI has been shown to be positively related to the severity of airway inflammation [2]. An increase in the bronchodilator effect of a DI, after corticosteroid administration, has consistently been reported [2±4]. Furthermore, the bronchodilator effect of DI is inversely related to the degree of responsiveness to a subsequent methacholine challenge in mild asthma [5]. Thus, several lines of evidence suggest that the blunting of the dilator effect of DI during obstruction could serve as a physiological marker for the degree of airway responsiveness and may relate to the presence and magnitude of inflammation in the lung even in mild stable asthma [2].This hypothesis is based eithe...

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Partial and Maximal Expiratory Flow-Volume Curves in Normal and Asthmatic Subjects Before and After Inhalation of Metaproterenol

Cited by 29 publications

References 20 publications

Interpretative strategies for lung function tests

Interpretative strategies for lung function tests

Effects of exercise and β₂-agonists on lung function in chronic obstructive pulmonary disease

Reduction in bronchodilation following a deep inhalation is poorly related to airway inflammation in asthma

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Partial and Maximal Expiratory Flow-Volume Curves in Normal and Asthmatic Subjects Before and After Inhalation of Metaproterenol

Cited by 29 publications

References 20 publications

Interpretative strategies for lung function tests

Interpretative strategies for lung function tests

Effects of exercise and β2-agonists on lung function in chronic obstructive pulmonary disease

Reduction in bronchodilation following a deep inhalation is poorly related to airway inflammation in asthma

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Effects of exercise and β₂-agonists on lung function in chronic obstructive pulmonary disease