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Pleasants RA, Shaikh A, Henderson AG, Bayer V, Drummond MB. Changes in Peak Inspiratory Flow After Acute Bronchodilation: An Observational Study of Patients with Stable Chronic Obstructive Pulmonary Disease. J Aerosol Med Pulm Drug Deliv 2024; 37:171-179. [PMID: 38814000 DOI: 10.1089/jamp.2023.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024] Open
Abstract
Introduction: Identifying factors influencing peak inspiratory flow (PIF) is essential for aerosol drug delivery in stable patients with chronic obstructive pulmonary disease. While a minimum PIF for dry powder inhalers (DPIs) is established, acute bronchodilator (BD) effects on PIF remain unknown. Materials and Methods: An inspiratory flow meter (In-Check™ DIAL) was used to measure PIF in stable patients during a 24-week observational cross-sectional study. Additionally, bronchodilator responsiveness (BDR) was determined using the In-Check DIAL device and spirometry. Patients received four puffs of albuterol, and pre- and post-BD PIF, forced expiratory volume in one second (FEV1), and forced vital capacity were measured. Sixty-three patients completed acute BDR data collection from July 31, 2019, to November 9, 2021. Primary endpoints were pre- and post-BD spirometry and PIF. Statistical analyses included PIF correlations with FEV1. BD change was assessed according to inhaler resistance and sex (subgroup analysis). Results: Median patient age was 64.8 years, 85.7% were non-Hispanic White, and 57.1% were female. The median increase in absolute PIF (In-Check DIAL) was 5.0 L/min, and the % PIF change was 8.9%. With albuterol, 57.1% experienced a PIF BD change >5.0%, whereas 49.2% experienced a change >10.0%. Similarly, 55.6% experienced an FEV1 BD change >5.0% and 28.6% had a >10.0% FEV1 BD change with albuterol. PIF was weakly correlated with FEV1 BD change (absolute; % PIF; r = 0.28 [p = 0.02]; r = 0.21 [p = 0.11]). Pre- and post-BD median PIF were 75.5 and 83.5 L/min for low-to-medium-resistance DPI and 45.0 and 52.0 L/min for high-resistance, respectively. The median increases in pre- and post-BD PIF were 9.0 L/min in males and 4.5 L/min in females. In contrast to when using the In-Check DIAL device, we observed no consistent bronchodilatory effects on PIF measured by spirometry. Conclusions: Using the In-Check DIAL device, ∼50% of patients experienced >10% PIF increase after acute BD, potentially enhancing medication lung deposition. Further research is required to understand PIF's impact on medication delivery. ClinicalTrials.gov Identifier: NCT04168775.
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Affiliation(s)
- Roy A Pleasants
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Asif Shaikh
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut, USA
| | - Ashley G Henderson
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Valentina Bayer
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut, USA
| | - M Bradley Drummond
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Bhakare M, Nikalje R, Patil R, Shukla U, Bokade R, Sakhare G, Joshi S, Pais A. View Score: An early warning score to detect possible complications among COVID-19 patients. J Family Med Prim Care 2023; 12:3160-3166. [PMID: 38361864 PMCID: PMC10866265 DOI: 10.4103/jfmpc.jfmpc_221_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 02/17/2024] Open
Abstract
Introduction Understanding pulmonary function at various phases after coronavirus disease 2019 (COVID-19) infection is critical for determining the exact pathophysiological mechanism of COVID-19. Research Question What is the correlation between spirometry indices and clinical indicators in COVID-19 patients over a 6-week follow-up? Objectives 1) To assess deterioration or improvement in spirometry parameters including forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and ratio FEV1/FVC in COVID-19 patients. 2) To study the correlation between FVC, FEV1, and FEV1/FVC with oxygen saturation and clinical findings. Materials and Methods A prospective observational study was conducted for a 6-week period among 25, COVID-19 patients who were either asymptomatic or mildly symptomatic. Each patient received a home-use-connected spirometer-SpiroPRO®, a pulse oximeter, and a thermometer from Briota Technologies Pvt Ltd. (BRIOTA). Patients and healthcare professionals were given training for performing spirometry twice a day as well as access to mobile apps was provided. Spirometry indices, patient symptoms, and vital statistics were used to calculate the VIEW™ score using machine learning algorithms. Result The Bland-Altman plots showed that FEV1 reduced slightly up to 21-28 days and comes back to normal around 42 days. VIEW™ score increased up to day 21 and then decreased toward day 42. An increase in VIEW™ score increases the risk of COVID-19 complications. VIEW™ score and FEV1 showed a significant correlation. Conclusion Home-based spirometry acts as an effective tool for COVID-19 patients to predict lung complications and also promote self-monitoring thereby reducing the burden on the health system.
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Affiliation(s)
- Meenakshi Bhakare
- Department of Respiratory Medicine, Symbiosis Medical College for Women and Symbiosis University Hospital and Research Centre, Symbiosis International (Deemed University), Pune, Maharashtra, India
| | - Rajkumar Nikalje
- Symbiosis University Hospital and Research Centre, Symbiosis International (Deemed University), Pune, Maharashtra, India
| | - Reshma Patil
- Department of Community Medicine, Symbiosis Medical College for Women, Symbiosis International (Deemed University), Pune, Maharashtra, India
| | - Urvi Shukla
- Intensive Care Unit, Symbiosis University Hospital And Research Centre, Symbiosis International (Deemed University), Pune, Maharashtra, India
| | - Rupesh Bokade
- Department of Emergency Medicine, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, Maharashtra, India
| | - Gajanan Sakhare
- BRIOTA Technologies Private Limited Pune, Maharashtra, India
| | - Shardul Joshi
- BRIOTA Technologies Private Limited Pune, Maharashtra, India
| | - Aditi Pais
- BRIOTA Technologies Private Limited Pune, Maharashtra, India
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Huang WC, Chen CY, Liao WC, Wu BR, Chen WC, Tu CY, Chen CH, Cheng WC. Differences in Pulmonary Function Improvement after Once-Daily LABA/LAMA Fixed-Dose Combinations in Patients with COPD. J Clin Med 2022; 11:jcm11237165. [PMID: 36498738 PMCID: PMC9739795 DOI: 10.3390/jcm11237165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022] Open
Abstract
This real-world study evaluated the efficacy of once-daily long-acting β2-agonist (LABA)/long-acting muscarinic antagonist (LAMA) fixed-dose combinations (FDCs) for improving lung function in patients with chronic obstructive pulmonary disease (COPD). Patients with COPD who were treated with once-daily LABA/LAMA FDCs for 12 months were included. We evaluated their lung function improvement after 12 months of treatment with different LABA/LAMA FDCs. A total of 198 patients with COPD who were treated with once-daily LABA/LAMA FDCs were analyzed. A total of 114 patients were treated with umeclidinium/vilanterol (UMEC/VIL); 34 patients were treated with indacaterol/glycopyrronium (IND/GLY); and 50 patients were treated with tiotropium/olodaterol (TIO/OLO). The forced expiratory volume in 1 s (FEV1) was significantly increased in the patients treated with all three once-daily FDCs (55.2% to 60.9%, p = 0.012 for UMEC/VIL, 58.2% to 63.6%, p = 0.023 for IND/GLY, and 54.1% to 57.7%, p = 0.009 for TIO/OLO). The treatment of COPD patients with TIO/OLO resulted in a significant improvement in both forced vital capacity (FVC%) (71.7% to 77.9%, p = 0.009) and residual volume (RV%) (180.1% to 152.5%, p < 0.01) compared with those treated with UMEC/VIL (FVC%: 75.1% to 81.5%, p < 0.001; RV%:173.8% to 165.2%, p = 0.231) or IND/GLY (FVC%: 73.9% to 79.3%, p = 0.08; RV%:176.8% to 168.3%, p = 0.589). Patients treated with UMEC/VIL or TIO/OLO showed significant improvement in FVC. In addition, those receiving TIO/OLO also showed significant improvement in RV reduction.
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Affiliation(s)
- Wei-Chun Huang
- Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung 40402, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 406, Taiwan
| | - Chih-Yu Chen
- Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung 40402, Taiwan
| | - Wei-Chih Liao
- Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung 40402, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 406, Taiwan
| | - Biing-Ru Wu
- Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung 40402, Taiwan
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan
- Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan
| | - Wei-Chun Chen
- Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung 40402, Taiwan
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan
- Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan
| | - Chih-Yen Tu
- Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung 40402, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 406, Taiwan
| | - Chia-Hung Chen
- Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung 40402, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 406, Taiwan
- Correspondence: (C.-H.C.); (W.-C.C.)
| | - Wen-Chien Cheng
- Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung 40402, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 406, Taiwan
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan
- Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan
- Correspondence: (C.-H.C.); (W.-C.C.)
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Heraganahally SS, Howarth TP, Lloyd A, White E, Veale A, Ben Saad H. The Prevalence of Bronchodilator Responsiveness "Asthma" Among Adult Indigenous Australians Referred for Lung Function Testing in the Top End Northern Territory of Australia. J Asthma Allergy 2022; 15:1305-1319. [PMID: 36132978 PMCID: PMC9484079 DOI: 10.2147/jaa.s376213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background Among Indigenous Australians, studies examining the clinical significance of airway bronchodilator responsiveness (BDR) are limited. In this retrospective study, we examined the nature of underlying lung disease in adult Indigenous patients with BDR referred for lung function testing (LFT) in the Top End Health Service region of the Northern Territory of Australia. Methods Presence or absence of BDR as per usual (FVC or FEV1 change pre to post ≥12% and ≥0.2L) and updated (2021 ">10% predicted) ATS/ERS criteria among Indigenous and non-Indigenous Australians was determined. The radiological findings in the Indigenous study participants with and without BDR were next assessed for the presence of underlying chronic airway/lung disease. Results We found that 123/742 (17%) Indigenous and 578/4579 (13%) non-Indigenous patients had a significant BDR. Indigenous patients with BDR were younger (mean difference 7 years), with a greater proportion of females (52 vs 32%), underweight (15 vs 4%) and current smokers (52 vs 25%). Indigenous patients with BDR displayed lower LFT values, and a higher proportion exhibited FVC BDR compared to non-Indigenous (34 vs 20%). Almost half (46%) of Indigenous patients with BDR had evidence of COPD and/or bronchiectasis on radiology. Adjusting for the presence of radiologic or spirometric evidence of COPD, the presence of BDR was similar between Indigenous and non-Indigenous patients (5-8 vs 7-11%), irrespective of which BDR criteria was used. Conclusion BDR was higher overall among Indigenous in comparison to non-Indigenous patients; however, a significant proportion of Indigenous patients demonstrating BDR had evidence of underlying COPD/bronchiectasis. This study highlights that although presence of BDR among Indigenous people may indicate asthma, it may also be observed among patients with COPD/bronchiectasis or could represent asthma/COPD/bronchiectasis overlap. Hence, a combination of clinical history, LFT and radiology should be considered for precise diagnosis of lung disease in this population.
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Affiliation(s)
- Subash S Heraganahally
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia
| | - Timothy P Howarth
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia.,College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Angus Lloyd
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Elisha White
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia
| | - Antony Veale
- Department of Respiratory and Sleep Medicine, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Helmi Ben Saad
- Faculty of Medicine of Sousse, Hospital Farhat HACHED of Sousse, Research Laboratory "Heart Failure, LR12SP09", University of Sousse, Sousse, Tunisia
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Ketfi A, Ben Saad H. The global lung function initiative 2021 (GLI-2021) norms provide mixed results for static lung volumes (SLVs) in Algerian adults. Libyan J Med 2022; 17:2059893. [PMID: 35379081 PMCID: PMC8986198 DOI: 10.1080/19932820.2022.2059893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The validity of the GLI-2021 norms for SLVs in healthy Algerian adults has not been assessed. To ascertain how well do the GLI-2021 norms fit to contemporary SLVs data in Algerian adults. This was a cross-sectional study involving 481 (n = 242 females) healthy non-smoking adults recruited from the Algiers general population. All participants underwent a clinical examination and a plethysmography. Z-scores for slow vital capacity (SVC), functional residual capacity (FRC), residual volume (RV), total lung capacity (TLC), expiratory reserve volume (ERV), inspiratory capacity (IC), and RV/TLC were calculated. The mean difference between the determined and the predicted values (∆value) of SLVs were calculated. The GLI-2021 norms would be considered as reflective of contemporary Algerian SLVs if the total sample mean z-scores were in the normal range (ie; −0.5 to +0.5). The participants’ means ± SDs of age and height were 46.4 ± 16.4 years and 166 ± 10 cm, respectively. The determined SLVs were significantly different from those predicted (∆values means ± SDs were −170 ± 470 ml for IC, −100 ± 490 ml for SVC, 170 ± 400 ml for ERV, 240 ± 620 ml for TLC, 370 ± 340 ml for RV, 480 ± 480 ml for FRC, and 5.28 ± 4.38% for RV/TLC). The means ± SDs z-scores for IC, SVC, ERV, and TLC were in the normal range (−0.29 ± 0.88, −0.17 ± 0.94, 0.29 ± 0.77, and 0.35 ± 0.86, respectively), but those of RV, FRC, and RV/TLC were out of the normal range (0.74 ± 0.66, 0.75 ± 0.72, and 0.83 ± 0.75, respectively). In healthy Algerian adults, the GLI-2021 norms fit well to SVC, TLC, ERV, and IC, but they do not fit to FRC, RV, and RV/TLC.
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Affiliation(s)
- Abdelbassat Ketfi
- Department of Pneumology, Phthisiology and Allergology; Faculty of Medicine, Rouiba Hospital; University of Algiers 1, Algiers, Algeria
| | - Helmi Ben Saad
- Research laboratory “Heart failure, LR12SP09”, Hospital Farhat HACHED, Sousse, Tunisia
- Faculté de Médecine de Sousse, Laboratoire de Physiologie, Université de Sousse, Tunisie
- Université de Sousse, Hôpital Farhat HACHED, Service de Physiologie et Explorations Fonctionnelles, Sousse, Tunisie
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Altintas Dogan AD, Hilberg O, Hess S, Jensen TT, Bladbjerg EM, Juhl CB. Respiratory Effects of Treatment with a Glucagon-Like Peptide-1 Receptor Agonist in Patients Suffering from Obesity and Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2022; 17:405-414. [PMID: 35237033 PMCID: PMC8882670 DOI: 10.2147/copd.s350133] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 02/03/2022] [Indexed: 01/14/2023] Open
Abstract
Purpose Chronic obstructive pulmonary disease (COPD) affects millions of people worldwide. Obesity is commonly seen concomitantly with COPD. People with COPD have reduced quality of life, reduced physical activity, chronic respiratory symptoms, and may suffer from frequent clinical exacerbations. Liraglutide is a glucagon-like peptide-1 receptor agonist (GLP-1RA) approved for weight loss and treatment of type-2 diabetes mellitus. In addition, liraglutide exerts anti-inflammatory actions by reducing IL-6 and MCP-1 levels. We investigated the effect of liraglutide on pulmonary function in people suffering from obesity and COPD. Patients and Methods In this controlled, double-blind trial, 40 people with obesity and COPD from two outpatient clinics were allocated randomly to receive liraglutide (3.0 mg, s.c.) or placebo (s.c.) for 40 weeks. At baseline and after 4, 20, 40, and 44 weeks, participants underwent pulmonary-function tests, 6-min walking test, and replied to a questionnaire regarding the clinical impact of COPD (COPD assessment test (CAT)-score). Results Compared with placebo, liraglutide use resulted in significant weight loss, increased forced vital capacity (FVC) and carbon monoxide diffusion capacity, and improved CAT-score. We found no significant changes in forced expiratory volume in one second (FEV1), FEV1/FVC, or 6-min walking distance. Conclusion In patients suffering from obesity and COPD, 40 weeks of treatment with liraglutide improved some measures of pulmonary function. Our study suggests that liraglutide at 3.0 mg may be appropriate treatment in patients with obesity and COPD.
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Affiliation(s)
- Ayse Dudu Altintas Dogan
- Department of Medicine, Hospital South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Correspondence: Ayse Dudu Altintas Dogan, Department of Medicine, Hospital South West Jutland, University Hospital of Southern Denmark, Finsensgade 35, Esbjerg, 6700, Denmark, Tel +45 22 71 50 90, Email
| | - Ole Hilberg
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Søren Hess
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Radiology and Nuclear Medicine, Hospital South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Torben Tranborg Jensen
- Department of Medicine, Hospital South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Else-Marie Bladbjerg
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Unit for Thrombosis Research, Department of Clinical Biochemistry, Hospital South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Claus Bogh Juhl
- Department of Medicine, Hospital South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center, Odense, Denmark
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Diagnostic performance of lung volumes in assessment of reversibility in chronic obstructive pulmonary disease. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2021. [DOI: 10.1186/s43168-021-00066-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
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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Combined Forced Expiratory Volume in 1 Second and Forced Vital Capacity Bronchodilator Response, Exacerbations, and Mortality in Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2020; 16:826-835. [PMID: 30908927 DOI: 10.1513/annalsats.201809-601oc] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Rationale: The American Thoracic Society (ATS)/European Respiratory Society defines a positive bronchodilator response (BDR) by a composite of BDR in either forced expiratory volume in 1 second (FEV1) and/or forced vital capacity (FVC) greater than or equal to 12% and 200 ml (ATS-BDR). We hypothesized that ATS-BDR components would be differentially associated with important chronic obstructive pulmonary disease (COPD) outcomes. Objectives: To examine whether ATS-BDR components are differentially associated with clinical, functional, and radiographic features in COPD. Methods: We included subjects with COPD enrolled in the COPDGene study. In the main analysis, we excluded subjects with self-reported asthma. We categorized BDR into the following: 1) No-BDR, no BDR in either FEV1 or FVC; 2) FEV1-BDR, BDR in FEV1 but no BDR in FVC; 3) FVC-BDR, BDR in FVC but no BDR in FEV1; and 4) Combined-BDR, BDR in both FEV1 and FVC. We constructed multivariable logistic, linear, zero-inflated negative binomial, and Cox hazards models to examine the association of BDR categories with symptoms, computed tomography findings, change in FEV1 over time, respiratory exacerbations, and mortality. We also created models using the ATS BDR definition (ATS-BDR) as the main independent variable. Results: Of 3,340 COPD subjects included in the analysis, 1,083 (32.43%) had ATS-BDR, 182 (5.45%) had FEV1-BDR, 522 (15.63%) had FVC-BDR, and 379 (11.34%) had Combined-BDR. All BDR categories were associated with FEV1 decline compared with No-BDR. Compared with No-BDR, both ATS-BDR and Combined-BDR were associated with higher functional residual capacity %predicted, greater internal perimeter of 10 mm, and greater 6-minute-walk distance. In contrast to ATS-BDR, Combined-BDR was independently associated with less emphysema (adjusted beta regression coefficient, -1.67; 95% confidence interval [CI], -2.68 to -0.65; P = 0.001), more frequent respiratory exacerbations (incidence rate ratio, 1.25; 95% CI, 1.03-1.50; P = 0.02) and severe exacerbations (incidence rate ratio, 1.34; 95% CI, 1.05-1.71; P = 0.02), and lower mortality (adjusted hazards ratio, 0.76; 95% CI, 0.58-0.99; P = 0.046). Sensitivity analysis that included subjects with self-reported history of asthma showed similar findings. Conclusions: BDR in both FEV1 and FVC indicates a COPD phenotype with asthma-like characteristics, and provides clinically more meaningful information than current definitions of BDR.
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Anane I, Guezguez F, Knaz H, Ben Saad H. How to Stage Airflow Limitation in Stable Chronic Obstructive Pulmonary Disease Male Patients? Am J Mens Health 2020; 14:1557988320922630. [PMID: 32475199 PMCID: PMC7263160 DOI: 10.1177/1557988320922630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
No study has evaluated the utility of different classifications of chronic obstructive pulmonary disease (COPD) airflow limitation (AFL) in terms of the refined “ABCD” classification of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) or in terms of the impacts on quality of life. This study aimed to compare some relevant health outcomes (i.e., GOLD classification and quality-of-life scores) between COPD patients having “light” and “severe” AFL according to five COPD AFL classifications. It was a cross-sectional prospective study including 55 stable COPD male patients. The COPD assessment test (CAT), the VQ11 quality-of-life questionnaire, a spirometry, and a bronchodilator test were performed. The patients were divided into GOLD “A/B” and “C/D.” The following five classifications of AFL severity, based on different post-bronchodilator forced expiratory volume in 1 s (FEV1) expressions, were applied: FEV1%pred: “light” (≥50), “severe” (<50); FEV1z-score: “light” (≥−3), “severe” (<−3); FEV1/height2: “light” (≥0.40), “severe” (<0.40); FEV1/height3: “light” (≥0.29), “severe” (<0.29); and FEV1Quotient: “light” (≥2.50), “severe” (<2.50). The percentages of the patients with “severe” AFL were significantly influenced by the applied classification of the AFL severity (89.1 [FEV1z-score], 63.6 [FEV1%pred], 41.8 [FEV1/height3], 40.0 [FEV1Quotient], and 25.4 [FEV1/height2]; Cochrane test = 91.49, df = 4). The CAT and VQ11 scores were significantly different between the patients having “light” and “severe” AFL. In GOLD “C/D” patients, only the FEV1Quotient was able to distinguish between the two AFL severities. To conclude, the five classifications of COPD AFL were not similar when compared with regard to some relevant health outcomes.
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Affiliation(s)
- Ichraf Anane
- Laboratory of Physiology and Functional Explorations, Farhat HACHED Hospital, Sousse, Tunisia.,Heart Failure (LR12SP09) Research Laboratory, Farhat HACHED Hospital, Sousse, Tunisia
| | - Fatma Guezguez
- Laboratory of Physiology and Functional Explorations, Farhat HACHED Hospital, Sousse, Tunisia.,Heart Failure (LR12SP09) Research Laboratory, Farhat HACHED Hospital, Sousse, Tunisia
| | - Hend Knaz
- Laboratory of Physiology and Functional Explorations, Farhat HACHED Hospital, Sousse, Tunisia
| | - Helmi Ben Saad
- Laboratory of Physiology and Functional Explorations, Farhat HACHED Hospital, Sousse, Tunisia.,Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, Tunisia
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10
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Barjaktarevic IZ, Buhr RG, Wang X, Hu S, Couper D, Anderson W, Kanner RE, Paine Iii R, Bhatt SP, Bhakta NR, Arjomandi M, Kaner RJ, Pirozzi CS, Curtis JL, O'Neal WK, Woodruff PG, Han MK, Martinez FJ, Hansel N, Wells JM, Ortega VE, Hoffman EA, Doerschuk CM, Kim V, Dransfield MT, Drummond MB, Bowler R, Criner G, Christenson SA, Ronish B, Peters SP, Krishnan JA, Tashkin DP, Cooper CB. Clinical Significance of Bronchodilator Responsiveness Evaluated by Forced Vital Capacity in COPD: SPIROMICS Cohort Analysis. Int J Chron Obstruct Pulmon Dis 2019; 14:2927-2938. [PMID: 31908441 PMCID: PMC6930016 DOI: 10.2147/copd.s220164] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 10/31/2019] [Indexed: 12/26/2022] Open
Abstract
Objective Bronchodilator responsiveness (BDR) is prevalent in COPD, but its clinical implications remain unclear. We explored the significance of BDR, defined by post-bronchodilator change in FEV1 (BDRFEV1) as a measure reflecting the change in flow and in FVC (BDRFVC) reflecting the change in volume. Methods We analyzed 2974 participants from a multicenter observational study designed to identify varying COPD phenotypes (SPIROMICS). We evaluated the association of BDR with baseline clinical characteristics, rate of prospective exacerbations and mortality using negative binomial regression and Cox proportional hazards models. Results A majority of COPD participants exhibited BDR (52.7%). BDRFEV1 occurred more often in earlier stages of COPD, while BDRFVC occurred more frequently in more advanced disease. When defined by increases in either FEV1 or FVC, BDR was associated with a self-reported history of asthma, but not with blood eosinophil counts. BDRFVC was more prevalent in subjects with greater emphysema and small airway disease on CT. In a univariate analysis, BDRFVC was associated with increased exacerbations and mortality, although no significance was found in a model adjusted for post-bronchodilator FEV1. Conclusion With advanced airflow obstruction in COPD, BDRFVC is more prevalent in comparison to BDRFEV1 and correlates with the extent of emphysema and degree of small airway disease. Since these associations appear to be related to the impairment of FEV1, BDRFVC itself does not define a distinct phenotype nor can it be more predictive of outcomes, but it can offer additional insights into the pathophysiologic mechanism in advanced COPD. Clinical trials registration ClinicalTrials.gov: NCT01969344T4.
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Affiliation(s)
- Igor Z Barjaktarevic
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Russell G Buhr
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.,Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Xiaoyan Wang
- Department of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, CA, USA
| | - Scott Hu
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - David Couper
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Wayne Anderson
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Richard E Kanner
- Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Robert Paine Iii
- Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nirav R Bhakta
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Mehrdad Arjomandi
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Robert J Kaner
- Department of Medicine, Weill Cornell Weill Cornell Medical Center, New York, NY, USA
| | - Cheryl S Pirozzi
- Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jeffrey L Curtis
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA.,Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Wanda K O'Neal
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Prescott G Woodruff
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - MeiLan K Han
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Fernando J Martinez
- Department of Medicine, Weill Cornell Weill Cornell Medical Center, New York, NY, USA
| | - Nadia Hansel
- Department of Medicine, John Hopkins University, Baltimore, MD, USA
| | - James Michael Wells
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Victor E Ortega
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Eric A Hoffman
- Department of Medicine, University of Iowa, Iowa City, IA, USA
| | - Claire M Doerschuk
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Victor Kim
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M Bradley Drummond
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Russell Bowler
- Department of Medicine, National Jewish Health Systems, Denver, CO, USA
| | - Gerard Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | | | - Bonnie Ronish
- Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Stephen P Peters
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jerry A Krishnan
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Donald P Tashkin
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Christopher B Cooper
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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11
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Hansen JE, Dilektasli AG, Porszasz J, Stringer WW, Pak Y, Rossiter HB, Casaburi R. A New Bronchodilator Response Grading Strategy Identifies Distinct Patient Populations. Ann Am Thorac Soc 2019; 16:1504-1517. [PMID: 31404502 PMCID: PMC6956832 DOI: 10.1513/annalsats.201901-030oc] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 08/08/2019] [Indexed: 01/06/2023] Open
Abstract
Rationale: A positive bronchodilator response (BDR) according to American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines require both 200 ml and 12% increase in forced expiratory volume in 1 second (FEV1) or forced vital capacity (FVC) after bronchodilator inhalation. This dual criterion is insensitive in those with high or low FEV1.Objectives: To establish BDR criteria with volume or percentage FEV1 change.Methods: The largest FEV1 and FVC were identified from three pre- and three post-bronchodilator maneuvers in COPDGene (Genetic Epidemiology of COPD) participants. A total of 7,741 individuals with coefficient of variation less than 15% for both FEV1 and FVC formed bronchodilator categories of FEV1 response: negative (≤0.00% or ≤0.00 L), minimal (>0.00% to ≤9.00% or >0.00 L to ≤0.09 L), mild (>9.00% to ≤16.00% or >0.09 L to ≤0.16 L), moderate (>16.00% to ≤26.00% or >0.16 L to ≤0.26 L), and marked (>26.00% or >0.26 L). These response size categories are based on empirical limits considering average FEV1 increase of approximately 160 ml and the clinically important difference for FEV1. To compare flow and volume response characteristics, BDR-FEV1 category assignments were applied for the BDR-FVC response.Results: Twenty percent met mild and 31% met moderate or marked BDR-FEV1 criteria, whereas 12% met mild and 33% met moderate or marked BDR-FVC criteria. In contrast, only 20.6% met ATS/ERS positive criteria. Compared with the negative BDR-FEV1 category, the minimal, mild, moderate, and marked BDR-FEV1 categories were associated with greater 6-minute-walk distance and lower St. George's Respiratory Questionnaire and modified Medical Research Council dyspnea scale scores. Compared with negative BDR, moderate and marked BDR-FEV1 categories were associated with fewer exacerbations, and minimal BDR was associated with lower computed tomography airway wall thickness. Compared with the negative category, all BDR-FVC categories were associated with increasing emphysema percentage and gas trapping percentage. Moderate and marked BDR-FVC categories were associated with higher St. George's Respiratory Questionnaire scores but fewer exacerbations and lower dyspnea scores.Conclusions: BDR grading by FEV1 volume or percentage response identified subjects otherwise missed by ATS/ERS criteria. BDR grades were associated with functional exercise performance, quality of life, exacerbation frequency, dyspnea, and radiological airway measures. BDR grades in FEV1 and FVC indicate different clinical and radiological characteristics.
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Affiliation(s)
| | - Asli G Dilektasli
- Rehabilitation Clinical Trials Center and
- Department of Pulmonary Medicine, Faculty of Medicine, Uludağ University, Bursa, Turkey; and
| | | | | | - Youngju Pak
- UCLA Clinical and Translational Science Institute, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Harry B Rossiter
- Rehabilitation Clinical Trials Center and
- Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
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12
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Rejeb H, Ben Khelifa M, Ben Abdallah J, Mrad S, Ben Rejeb M, Hayouni A, Benzarti M, Limem K, Kortas M, Rouatbi S, Ben Saad H. The Effects of Ramadan-Fasting (RF) on Inflammatory and Hematological Indices of Stable Chronic Obstructive Pulmonary Disease (COPD) Male Patients: A Pilot Study. Am J Mens Health 2018; 12:2089-2103. [PMID: 30117367 PMCID: PMC6199458 DOI: 10.1177/1557988318794304] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
No previous study has evaluated the effects of RF on inflammatory and hematological indices of COPD patients. The main objective of the present pilot study was to assess the effects of RF on some inflammatory and hematological indices measured in male patients with stable COPD. Fifteen COPD patients (mean ± SD of age: 71 ± 6 years) who fasted during Ramadan 2017 volunteered for the study. Three sessions (Before-Ramadan, End-Ramadan and After-Ramadan) were selected. Spirometry tests and blood samples were consistently performed 2.5-4.5 hr before the interruption of the fasting. Assessment sessions comprised: spirometry, inflammatory [erythrocyte sedimentation rate (ESR); C-reactive protein (CRP)] and hematological [red and white blood cells (RBC, WBC); hemoglobin; hematocrit; mean corpuscular volume; mean corpuscular hemoglobin; platelets] indices. Findings were analyzed by applying Friedman ANOVA. The median (lower-upper quartiles) of ESR (Before-Ramadan: 3 (2-9), End-Ramadan: 7 (0-13), After-Ramadan: 9 (5-15) mm/h) and CRP (Before-Ramadan: 20 (11-38), End-Ramadan: 15 (9-34), After-Ramadan: 20 (12-46) mg/L) were not significantly affected by RF. Among all the hematological indices, RF influenced only hemoglobin (Before-Ramadan: 14.4 ± 2.2, End-Ramadan: 13.4 ± 1.3, After-Ramadan: 12.2 ± 0.9 g/dL), hematocrit (Before-Ramadan: 45 ± 7, End-Ramadan: 40 ± 4, After-Ramadan: 39 ± 4%), RBC (Before-Ramadan: 5.1 ± 1.0, End-Ramadan: 4.6 ± 0.7, After-Ramadan: 4.4 ± 0.5 106/mm3) and WBC (Before-Ramadan: 8,673 ± 1,911, End-Ramadan: 7,840 ± 1,526, After-Ramadan: 9,507 ± 2,190/mm3). Compared to the Before-Ramadan session, the End-Ramadan session values for hemoglobin, hematocrit, RBC and WBC were lower. Compared to the After-Ramadan session, the End-Ramadan session values for hemoglobin and WBC were higher and lower, respectively. In conclusion, RF caused significant reduction in hemoglobin, hematocrit, RBC and WBC. However, it did not induce any significant changes in the CRP and ESR indices.
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Affiliation(s)
- Hadhemi Rejeb
- Pulmonary Department, Farhat HACHED
Hospital, Sousse, Tunisia
| | | | | | - Sawssan Mrad
- Laboratory of Biochemistry, Farhat
HACHED Hospital, Sousse, Tunisia
| | - Mohamed Ben Rejeb
- Department of Prevention and Care
Safety, Sahloul Hospital, Sousse, Tunisia
| | | | | | - Khelifa Limem
- Laboratory of Biochemistry, Farhat
HACHED Hospital, Sousse, Tunisia
| | - Mondher Kortas
- Laboratory of Hematology, Farhat HACHED
Hospital, Sousse, Tunisia
| | - Sonia Rouatbi
- Laboratory of Physiology and Functional
Explorations, Farhat HACHED Hospital, Sousse, Tunisia
| | - Helmi Ben Saad
- Laboratory of Physiology and Functional
Explorations, Farhat HACHED Hospital, Sousse, Tunisia,Heart Failure (LR12SP09) Research
Laboratory, Farhat HACHED Hospital, Sousse, Tunisia,Laboratory of Physiology. Faculty of
Medicine of Sousse, University of Sousse. Sousse, Tunisia,Helmi Ben Saad, Laboratory of Physiology,
Faculty of Medicine of Sousse, Street Mohamed KAROUI, Sousse, 4000, Tunisia.
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13
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Ketfi A, Gharnaout M, Bougrida M, Ben Saad H. The multi-ethnic global lung initiative 2012 (GLI-2012) norms reflect contemporary adult's Algerian spirometry. PLoS One 2018; 13:e0203023. [PMID: 30180191 PMCID: PMC6122801 DOI: 10.1371/journal.pone.0203023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 08/14/2018] [Indexed: 01/01/2023] Open
Abstract
Background The validation of the multi-ethnic GLI-2012 spirometric norms has been debated in several countries. However, its applicability in Algeria has not been verified. Aim To ascertain how well the GLI-2012 norms fit contemporary adult Algerian spirometric data. Methods This was a cross-sectional study of a convenience sample of 300 healthy non-smoker adults (50% men, age range: 18–85 years) recruited from the Algiers region general population. All participants underwent a clinical examination and a plethysmography measurement. Z-scores for some spirometric data [FEV1, FVC, FEV1/FVC and forced expiratory flow at 25–75% of FVC (FEF25-75%)] were calculated. If the average Z-score deviated by “< ± 0.5” from the overall mean, the GLI-2012 norms would be considered as reflective of contemporary Algerian spirometry. Results The means±SDs of age, height, weight, FVC, FEV1, FEV1/FVC and FEF25-75% of the participants were, respectively, 48±17 years, 1.65±0.10 m, 73±14 kg, 4.04±1.04 L, 3.18±0.82 L, 0.79±0.05 and 4.09±1.09 L/s. Almost the quarter of participants were obese. The total sample means±SDs Z-scores were 0.22±0.87 for FVC, 0.04±0.88 for FEV1, -0.34±0.67 for FEV1/FVC and 0.93±0.79 for FEF25-75%. For men and women, only the means±SDs of the FEF25-75% Z-scores exceeded the threshold of “± 0.5”, respectively, 1.13±0.77 and 0.73±0.76. Conclusion Results of the present study, performed in an Algerian population of healthy non-smoking adults, supported the applicability of the GLI-2012 norms to interpret FEV1, FVC and FEV1/FVC but not the FEF25-75%.
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Affiliation(s)
- Abdelbassat Ketfi
- Department of Pneumology, Phthisiology and Allergology, Rouiba Hospital, Algiers, University of Algiers, Faculty of Medicine, Algiers, Algeria
| | - Merzak Gharnaout
- Department of Pneumology, Phthisiology and Allergology, Rouiba Hospital, Algiers, University of Algiers, Faculty of Medicine, Algiers, Algeria
| | - Mohamed Bougrida
- Metabolic Diseases Research Laboratory, Faculty of Medicine, Constantine University, Constantine, Algeria
- Department of Clinical Physiology and Functional Explorations, BENBADIS Hospital, Constantine, Algeria
| | - Helmi Ben Saad
- Department of Physiology and Functional Explorations, Farhat HACHED Hospital, Sousse, Tunisia
- Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
- Heart Failure Research Laboratory (LR12SP09), Farhat HACHED Hospital, Sousse, Tunisia
- * E-mail:
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14
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Zouari H, Latiri I, Mahjoub M, Boussarsar M, Benzarti M, Abdelghani A, Ben Saad H. The Effects of Ramadan Intermittent Fasting (RIF) on Spirometric Data of Stable COPD Patients: A Pilot Study. Am J Mens Health 2018; 12:359-369. [PMID: 29072125 PMCID: PMC5818112 DOI: 10.1177/1557988317734131] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
No previous study has raised the effects of RIF on lung function data of chronic obstructive pulmonary disease (COPD) patients. The objective of the present study was to assess the effects of RIF on spirometric data measured in male patients with a stable COPD. Sixteen patients with stable COPD (mean ± SD of age: 64 ± 7 years) who fasted during Ramadan volunteered to the study. Three sessions (Before-R, End-R, and After-R) were selected for spirometry tests that were consistently performed 2.5-4.5 hr before fasting break. Assessment sessions comprised: forced vital capacity (FVC), 1st s forced expiratory volume (FEV1), FEV1/FVC, peak expiratory flow (PEF), maximal mid-expiratory flow (MMEF), and forced expiratory flow rate at the x% of FVC to be exhaled (FEFx%). A reversibility test was performed only during the Before-Ramadan session. Spirometric data were expressed in percentages of local reference values. Findings were analyzed by applying repeated measures analysis of variance. The mean ± SD of the postbronchodilator FEV1/FVC ratio and the FEV1 were, respectively, 0.52 ± 0.14 and 48 ± 19%. The mean ± SD of FEV1 (Before-R: 47 ± 19, End-R: 45 ± 18, After-R: 44 ± 19%), FVC (Before-R: 73 ± 18, End-R: 71 ± 16, After-R: 69 ± 17%), FEV1/FVC (Before-R: 67 ± 16, End-R: 66 ± 16, After-R: 65 ± 16%), PEF (Before-R: 46 ± 19, End-R: 47 ± 22, After-R: 45 ± 21%), MMEF (Before-R: 19 ± 10, End-R: 18 ± 8, After-R: 18 ± 9%), FEF25% (Before-R: 16 ± 6, End-R: 16 ± 5, After-R: 15 ± 5%), FEF50% (Before-R: 21 ± 14, End-R: 20 ± 12, After-R: 20 ± 12%) and FEF75% (Before-R: 27 ± 19, End-R: 27 ± 19, After-R: 27 ± 19%) were not significantly influenced by RIF. RIF did not bring about any significant changes in the spirometric data of stable COPD male patients fasting the 2016 holy month of Ramadan.
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Affiliation(s)
- Hajer Zouari
- Physiology Laboratory, Faculty of Medicine of Sousse, University of Sousse, Tunisia
| | - Imed Latiri
- Physiology Laboratory, Faculty of Medicine of Sousse, University of Sousse, Tunisia
| | - Mohamed Mahjoub
- Department of Hospital Hygiene, Farhat HACHED University Hospital in Sousse, Tunisia
| | - Mohamed Boussarsar
- Medical Intensive Care Unit, Farhat HACHED University Hospital in Sousse, Tunisia,Research Laboratory LR14ES05: interaction of the cardiorespiratory system, Faculty of Medicine of Sousse, University of Sousse, Tunisia
| | - Mohamed Benzarti
- Pulmonary Department, Farhat HACHED University Hospital in Sousse, Tunisia
| | - Ahmed Abdelghani
- Research Laboratory LR14ES05: interaction of the cardiorespiratory system, Faculty of Medicine of Sousse, University of Sousse, Tunisia,Pulmonary Department, Farhat HACHED University Hospital in Sousse, Tunisia
| | - Helmi Ben Saad
- Physiology Laboratory, Faculty of Medicine of Sousse, University of Sousse, Tunisia,Research Laboratory LR14ES05: interaction of the cardiorespiratory system, Faculty of Medicine of Sousse, University of Sousse, Tunisia,Physiology Department and Functional Exploration, Farhat HACHED University Hospital in Sousse, Tunisia,Helmi Ben Saad, Laboratory of Physiology, Faculty of Medicine of Sousse, Rue Mohamed KAROUI, Sousse, Tunisia.
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15
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Saad HB. COPD in exclusive narghile smokers: Some points to verify. Chron Respir Dis 2017; 14:420-421. [PMID: 29081266 PMCID: PMC5729735 DOI: 10.1177/1479972317733863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Helmi Ben Saad
- Helmi Ben Saad, Research Laboratory N° LR14ES05: Interactions of the Cardiopulmonary System, Faculty of Medicine of Sousse, University of Sousse, Sousse 4000, Tunisia.
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16
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Khalladi R, Gargouri I, Mahjoub M, Belhareth S, Ben Saad H. [Evaluation of quality of life (QOL) of Tunisians patients with COPD]. REVUE DE PNEUMOLOGIE CLINIQUE 2017; 73:231-239. [PMID: 29054717 DOI: 10.1016/j.pneumo.2017.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 07/26/2017] [Accepted: 08/16/2017] [Indexed: 06/07/2023]
Abstract
AIM To test the Arabic version of the St. George's Hospital Respiratory Questionnaire (SGRQ) in stable Tunisian COPD patients. HYPOTHESES A correlation coefficient between the post-bronchodilator FEV1 and the "Total" score of SGRQ higher than "-0.40", and QOL scores lower in COPD with "mild to moderate airway obstruction" than in those with "severe to very severe airway obstruction" will be in favor of a possible application of the Arabic version of the SGRQ in Tunisians COPD patients. METHODS This is a prospective cross-sectional study including 50 clinically stable COPD patients. The Arabic version of the SGRQ was used. Four scores were calculated for the "Symptoms", "Activities", "Impacts" and "Total" components. Patients were divided into two groups according to the severity of their airway obstruction: "mild to moderate, n=30" and "severe to very severe, n=20". The correlation between the QOL "Total" score and postBD FEV1 was evaluated. RESULTS The mean±SD of age, cigarette smoking and post-bronchodilator FEV1 were, respectively, 60±10, 61±36 pack-years and 55±20 %. The correlation between the post-bronchodilator FEV1 and QOL "Total" score was significant at "-0.65". "Symptoms", "Activities", "Impacts" and "Total" scores were significantly less altered in patients with "mild to moderate airway obstruction" than among those with "severe to very severe airway obstruction" (respectively, 52±24 vs. 77±17, 66±28 vs. 87±18, 48±25 vs. 70±23 and 54±22 vs. 76±17). CONCLUSION The application of the Arabic version of the SGRQ in stable COPD patients gives reliable results.
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Affiliation(s)
- R Khalladi
- Institut supérieur des sciences infirmières de Sousse, université de Sousse, Sousse, Tunisie
| | - I Gargouri
- Service de pneumologie, EPS Farhat Hached, Sousse, Tunisie
| | - M Mahjoub
- Service d'hygiène hospitalière, EPS Farhat Hached, Sousse, Tunisie
| | - S Belhareth
- Institut supérieur des sciences infirmières de Sousse, université de Sousse, Sousse, Tunisie; Service de pneumologie, EPS Farhat Hached, Sousse, Tunisie
| | - H Ben Saad
- Service de physiologie et explorations fonctionnelles, EPS Farhat Hached, Sousse, Tunisie; Laboratoire de physiologie, faculté de médecine « Ibn Eljazzar » de Sousse, université de Sousse, avenue Karoui-Mohamed, 4000 Sousse, Tunisie.
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17
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Ben Saad H. Promoting the inclusion of vital-capacity data in the bronchodilator response. Int J Chron Obstruct Pulmon Dis 2017; 12:1243-1245. [PMID: 28490867 PMCID: PMC5413481 DOI: 10.2147/copd.s138452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Helmi Ben Saad
- Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, Tunisia
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18
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Affes Z, Rekik S, Ben Saad H. Defining obstructive ventilatory defect in 2015. Libyan J Med 2015; 10:28946. [PMID: 26452407 PMCID: PMC4600093 DOI: 10.3402/ljm.v10.28946] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/16/2015] [Accepted: 09/17/2015] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION There is no clear consensus as to what constitutes an obstructive ventilatory defect (OVD): Is it FEV1/FVC AIM To determine, according to the two definitions, the percentage of subjects having an OVD among them explored in a lung function exploration laboratory. POPULATION AND METHODS This is a retrospective study including 4,730 subjects aged 17-85 years. Subjects were divided according to the presence [physio (+) or operat (+)] or absence [physio (-) or operat (-)] of an OVD, and into younger (<45 years, n=2,076), older (≥45 years, n=2,654), smokers (n=1,208), and non-smokers (n=3,522) groups. RESULTS For the total sample, the younger and older groups [mean±SD of age (years), respectively, 46.7±14.1; 33.9±7.4, and 56.8±9.1], the 'physiological definition' detected, respectively, 13.46, 43.22, and 5.09% more OVD than the 'operational one' (p<0.05). In addition, the operational definition, compared with the physiological one, overdiagnosed OVD in 2.33 and 0.44% of smokers and non-smokers, respectively, and underdiagnosed it in 4.46% and 29.72% of smokers and non-smokers, respectively (p<0.05). Compared with the group 'physio (-), operat (+)', the 'physio (+), operat (-)' one was younger (74.2±4.7 years vs. 40.9±10.3 years) and had significantly higher FEV1 (62±13% vs. 78±17%) and FVC (71±15% vs. 93±19%). CONCLUSION The frequency of OVD much depends on the criteria used for its definition.
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Affiliation(s)
- Zied Affes
- Department of Physiology and Functional Exploration, Farhat HACHED University Hospital of Sousse, Sousse, Tunisia
| | - Salaheddine Rekik
- Department of Physiology and Functional Exploration, Farhat HACHED University Hospital of Sousse, Sousse, Tunisia
| | - Helmi Ben Saad
- Department of Physiology and Functional Exploration, Farhat HACHED University Hospital of Sousse, Sousse, Tunisia
- Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
- Research Laboratory N° LR14ES05: Interactions of the Cardiopulmonary System, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia;
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Pisi R, Aiello M, Zanini A, Tzani P, Paleari D, Marangio E, Spanevello A, Nicolini G, Chetta A. Small airway dysfunction and flow and volume bronchodilator responsiveness in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2015; 10:1191-7. [PMID: 26150710 PMCID: PMC4480584 DOI: 10.2147/copd.s82509] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background We investigated whether a relationship between small airways dysfunction and bronchodilator responsiveness exists in patients with chronic obstructive pulmonary disease (COPD). Methods We studied 100 (20 female; mean age: 68±10 years) patients with COPD (forced expiratory volume in 1 second [FEV1]: 55% pred ±21%; FEV1/forced vital capacity [FVC]: 53%±10%) by impulse oscillometry system. Resistance at 5 Hz and 20 Hz (R5 and R20, in kPa·s·L−1) and the fall in resistance from 5 Hz to 20 Hz (R5 – R20) were used as indices of total, proximal, and peripheral airway resistance; reactance at 5 Hz (X5, in kPa·s·L−1) was also measured. Significant response to bronchodilator (salbutamol 400 μg) was expressed as absolute (≥0.2 L) and percentage (≥12%) change relative to the prebronchodilator value of FEV1 (flow responders, FRs) and FVC (volume responders, VRs). Results Eighty out of 100 participants had R5 – R20 >0.03 kPa·s·L−1 (> upper normal limit) and, compared to patients with R5 – R20 ≤0.030 kPa·s·L−1, showed a poorer health status, lower values of FEV1, FVC, FEV1/FVC, and X5, along with higher values of residual volume/total lung capacity and R5 (P<0.05 for all comparisons). Compared to the 69 nonresponders and the 8 FRs, the 16 VRs had significantly higher R5 and R5 – R20 values (P<0.05), lower X5 values (P<0.05), and greater airflow obstruction and lung hyperinflation. Conclusion This study shows that peripheral airway resistance is increased in the vast majority of patients with COPD, who showed worse respiratory reactance, worse spirometry results, more severe lung hyperinflation, and poorer health status. Small airway dysfunction was also associated with the bronchodilator responsiveness in terms of FVC, but not in terms of FEV1.
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Affiliation(s)
- Roberta Pisi
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Marina Aiello
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Andrea Zanini
- Division of Pneumology, IRCCS Rehabilitation Institute of Tradate, Salvatore Maugeri Foundation, Tradate, Italy
| | - Panagiota Tzani
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Davide Paleari
- Medical Department, Chiesi Farmaceutici SpA, Parma, Italy
| | - Emilio Marangio
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Antonio Spanevello
- Division of Pneumology, IRCCS Rehabilitation Institute of Tradate, Salvatore Maugeri Foundation, Tradate, Italy ; Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - Gabriele Nicolini
- Corporate Clinical Development, Chiesi Farmaceutici SpA, Parma, Italy
| | - Alfredo Chetta
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
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Ben Moussa S, Sfaxi I, Tabka Z, Ben Saad H, Rouatbi S. Oxidative stress and lung function profiles of male smokers free from COPD compared to those with COPD: a case-control study. Libyan J Med 2014; 9:23873. [PMID: 24929061 PMCID: PMC4057786 DOI: 10.3402/ljm.v9.23873] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 05/14/2014] [Accepted: 05/15/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The mechanisms of smoking tobacco leading to chronic obstructive pulmonary disease (COPD) are beginning to be understood. However, conclusions about the role of blood or lung oxidative stress markers were disparate. AIMS To investigate the oxidative stress in blood or lung associated with tobacco smoke and to evaluate its effect on pulmonary function data and its relation with physical activity. METHODS It is a case-control study. Fifty-four male-smokers of more than five pack-years (PY) and aged 40-60 years were included (29 Non-COPD, 16 COPD). Physical activity score was determined. Blood sample levels of malondialdehyde (MDA), protein-cys-SH (PSH), and Glutathione (GSH) were measured. Fractional exhaled nitric oxide (FeNO) and plethysmographic measurements were performed. Correlation coefficients (r) evaluated the association between oxidative stress markers and independent variables (plethysmographic data and physical activity score). RESULTS Non-COPD (48 ± 6 years) and COPD (49 ± 5 years) groups had similar tobacco consumption patterns, that is, 27 ± 14 PY versus 30 ± 19 PY, respectively. Compared to the Non-COPD group, the COPD group had significantly lower levels of GSH and PSH, that is, mean ± SE were 40 ± 6 versus 25 ± 5 µg/mL and 54 ± 10 versus 26 ± 5 µg/g of hemoglobin, respectively. However, MDA level and FeNO values were similar. In the COPD group, none of the oxidative stress markers was significantly correlated with plethysmographic data or physical activity score. In the Non-COPD group, GSH was significantly correlated with physical activity score (r = 0.47) and PSH was significantly correlated with total lung capacity (TLC) (r = -0.50), residual volume (r = 0.41), and physical activity score (r = 0.62). FeNO was significantly correlated with TLC of the COPD group (r = -0.48). CONCLUSION Compared to the Non-COPD group, the COPD group had a marked decrease in blood antioxidant markers (GSH and PSH) but similar blood oxidant (MDA) or lung (FeNO) burden.
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Affiliation(s)
- Syrine Ben Moussa
- Service of Physiology and Functional Explorations, Farhat HACHED Hospital, Sousse, Tunisia;
| | - Ines Sfaxi
- Service of Physiology and Functional Explorations, Farhat HACHED Hospital, Sousse, Tunisia
| | - Zouhair Tabka
- Service of Physiology and Functional Explorations, Farhat HACHED Hospital, Sousse, Tunisia; Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Helmi Ben Saad
- Service of Physiology and Functional Explorations, Farhat HACHED Hospital, Sousse, Tunisia; Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia; Research Unit: Secondary Prevention after Myocardial Infarction, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Sonia Rouatbi
- Service of Physiology and Functional Explorations, Farhat HACHED Hospital, Sousse, Tunisia; Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
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Ben Saad H, Selmi H, Hadj Mabrouk K, Gargouri I, Nouira A, Said Latiri H, Maatoug C, Bouslah H, Chatti S, Rouatbi S. Spirometric “Lung Age” estimation for North African population. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2014. [DOI: 10.1016/j.ejcdt.2014.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Perez T, Garcia G, Roche N, Bautin N, Chambellan A, Chaouat A, Court-Fortune I, Delclaux B, Guenard H, Jebrak G, Orvoen-Frija E, Terrioux P. Société de pneumologie de langue française. Recommandation pour la pratique clinique. Prise en charge de la BPCO. Mise à jour 2012. Exploration fonctionnelle respiratoire. Texte long. Rev Mal Respir 2014; 31:263-94. [DOI: 10.1016/j.rmr.2013.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Ben Saad H, Ben Amor L, Ben Mdalla S, Ghannouchi I, Ben Essghair M, Sfaxi R, Garrouche A, Rouatbi N, Rouatbi S. Place de la distension pulmonaire dans l’exploration des gros fumeurs de cigarettes. Rev Mal Respir 2014; 31:29-40. [DOI: 10.1016/j.rmr.2013.05.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 04/16/2013] [Indexed: 12/20/2022]
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Jian W, Zheng J, Hu Y, Li Y, Gao Y, An J. What is the difference between FEV1 change in percentage predicted value and change over baseline in the assessment of bronchodilator responsiveness in patients with COPD? J Thorac Dis 2013; 5:393-9. [PMID: 23991293 DOI: 10.3978/j.issn.2072-1439.2013.08.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 08/09/2013] [Indexed: 11/14/2022]
Abstract
BACKGROUND Several criteria are clinically applied in the assessment of significant bronchodilator responsiveness in chronic obstructive pulmonary disease (COPD). The present study aimed to investigate the differences in various degree of severity of COPD among these criteria. METHODS After 400 micrograms of salbutamol administered via spacer by metered dose inhaler (MDI), forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) changes (including percentage change, absolute change and absolute change in percentage predicted value) were retrospectively analysed in 933 stable patients with mild-to-very-severe COPD. Significant bronchodilator responsiveness was assessed using American Thoracic Society and European Respiratory Society (ATS-ERS) criterion based on FEV1 or/and FVC (both ≥12% increase over baseline and ≥200 mL) and FEV1 percentage predicted criterion (≥10% absolute increase in percentage predicted FEV1) in different grades of COPD. RESULTS Of the patients [age 66.8 years, baseline FEV1 974 mL (39.3% predicted) and FVC 2,242 mL], mean improvements were 126 mL in FEV1 and 265 mL in FVC; 21.4% and 45.3% met ATS-ERS criterion based on FEV1 and FVC, respectively; and 13.5% met FEV1 percentage predicted criterion. The responsive ratios of ATS-ERS criterion based on FEV1 to FEV1 percentage predicted criterion in grade I, II, III and IV of COPD were 0.95(:)1.26(:)2.53(:)6.00, respectively (P<0.01 in grade II and P<0.001 in grade III). As the degree of severity increased, the mean improvement of FEV1 was reduced; on the contrary, that of FVC was increased. CONCLUSIONS Compared with FEV1 percentage predicted criterion, ATS-ERS criterion based on FEV1 as well as FVC, the later in particular, detected a larger percentage of patients with significant responsiveness. The increasing difference was relevant as a function of the severity of airflow obstruction.
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Affiliation(s)
- Wenhua Jian
- State Key Lab of Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
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Bronchodilator responsiveness and reported respiratory symptoms in an adult population. PLoS One 2013; 8:e58932. [PMID: 23554960 PMCID: PMC3598856 DOI: 10.1371/journal.pone.0058932] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 02/08/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The relationship between patient-reported symptoms and objective measures of lung function is poorly understood. AIM To determine the association between responsiveness to bronchodilator and respiratory symptoms in random population samples. METHODS 4669 people aged 40 years and older from 8 sites in Canada completed interviewer-administered respiratory questionnaires and performed spirometry before and after administration of 200 ug of inhaled salbutamol. The effect of anthropometric variables, smoking exposure and doctor-diagnosed asthma (DDA) on bronchodilator responsiveness in forced expiratory volume in 1 second (FEV1) and in forced vital capacity (FVC) were evaluated. Multiple logistic regression was used to test for association between quintiles of increasing changes in FEV1 and in FVC after bronchodilator and several respiratory symptoms. RESULTS Determinants of bronchodilator change in FEV1 and FVC included age, DDA, smoking, respiratory drug use and female gender [p<0.005 to p<0.0001 ]. In subjects without doctor-diagnosed asthma or COPD, bronchodilator response in FEV1 was associated with wheezing [p for trend<0.0001], while bronchodilator response for FVC was associated with breathlessness. [p for trend <0.0001]. CONCLUSIONS Bronchodilator responsiveness in FEV1 or FVC are associated with different respiratory symptoms in the community. Both flow and volume bronchodilator responses are useful parameters which together can be predictive of both wheezing and breathlessness in the general population.
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Hanania NA, Celli BR, Donohue JF, Martin UJ. Bronchodilator reversibility in COPD. Chest 2011; 140:1055-1063. [PMID: 21972384 DOI: 10.1378/chest.10-2974] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
COPD is a preventable and treatable disease characterized by airflow limitation that is not fully reversible. The diagnosis of COPD is based on spirometric evidence of airways obstruction following bronchodilator administration. Although it used to be commonly believed that patients with COPD have largely irreversible airflow obstruction, evidence now suggests that a considerable proportion of patients exhibit clinically significant bronchodilator reversibility. The complexity and inherent variability of a patient's acute response to a bronchodilator and the lack of a standardized procedure for assessing bronchodilator reversibility have led to significant confusion surrounding this concept. Although bronchodilator reversibility commonly is defined based on thresholds for improvement in FEV(1), lung volume-based measures of pulmonary function may be of particular importance in patients with severe COPD. The usefulness of acute reversibility to short-acting bronchodilators in predicting a patient's long-term response to bronchodilator maintenance therapy is also unclear, although most studies suggest that a lack of acute response to short-acting bronchodilators does not preclude a beneficial long-term response to maintenance bronchodilator treatment. This review outlines recent findings about the prevalence and usefulness of bronchodilator reversibility in patients with COPD based on the available literature and proposes areas of future research.
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Affiliation(s)
- Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Asthma Clinical Research Center, Baylor College of Medicine, Houston, TX.
| | - Bartolome R Celli
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard University, Boston, MA
| | - James F Donohue
- Division of Pulmonary Disease and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ubaldo J Martin
- Clinical Research, Respiratory and Inflammation Therapeutic Area, AstraZeneca LP, Wilmington, DE
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De Backer LA, Vos WG, Salgado R, De Backer JW, Devolder A, Verhulst SL, Claes R, Germonpré PR, De Backer WA. Functional imaging using computer methods to compare the effect of salbutamol and ipratropium bromide in patient-specific airway models of COPD. Int J Chron Obstruct Pulmon Dis 2011; 6:637-46. [PMID: 22162649 PMCID: PMC3232170 DOI: 10.2147/copd.s21917] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Salbutamol and ipratropium bromide improve lung function in patients with chronic obstructive pulmonary disease (COPD). However, their bronchodilating effect has not yet been compared in the central and distal airways. Functional imaging using computational fluid dynamics offers the possibility of making such a comparison. The objective of this study was to assess the effects of salbutamol and ipratropium bromide on the geometry and computational fluid dynamics-based resistance of the central and distal airways. METHODS Five patients with Global Initiative for Chronic Obstructive Lung Disease Stage III COPD were randomized to a single dose of salbutamol or ipratropium bromide in a crossover manner with a 1-week interval between treatments. Patients underwent lung function testing and a multislice computed tomography scan of the thorax that was used for functional imaging. Two hours after dosing, the patients again underwent lung function tests and repeat computed tomography. RESULTS Lung function parameters, including forced expiratory volume in 1 second, vital capacity, overall airway resistance, and specific airway resistance, changed significantly after administration of each product. On functional imaging, the bronchodilating effect was greater in the distal airways, with a corresponding drop in airway resistance, compared with the central airways. Salbutamol and ipratropium bromide were equally effective at first glance when looking at lung function tests, but when viewed in more detail with functional imaging, hyporesponsiveness could be shown for salbutamol in one patient. Salbutamol was more effective in the other patients. CONCLUSION This pilot study gives an innovative insight into the modes of action of salbutamol and ipratropium bromide in patients with COPD, using the new techniques of functional imaging and computational fluid dynamics.
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Affiliation(s)
- L A De Backer
- Department of Respiratory Medicine, Antwerp University Hospital, Antwerp, Belgium.
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Celli BR, Tashkin DP, Rennard SI, McElhattan J, Martin UJ. Bronchodilator responsiveness and onset of effect with budesonide/formoterol pMDI in COPD. Respir Med 2011; 105:1176-88. [PMID: 21531124 DOI: 10.1016/j.rmed.2011.02.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 02/25/2011] [Accepted: 02/28/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) patients are thought to have limited bronchodilator response, determined by changes in forced expiratory volume in 1s (FEV(1)). In this study, we assessed bronchodilator response in patients with COPD using not only FEV(1) but also changes in lung volume expressed as forced vital capacity (FVC) and inspiratory capacity (IC). We also evaluated the speed of onset of bronchodilation. METHODS Data were from 2 randomized, double-blind, placebo-controlled studies (6-months [NCT00206154]; 12-months [NCT00206167]) in patients with moderate to very severe COPD. TREATMENTS twice daily budesonide/formoterol pressurized metered-dose inhaler (pMDI) 320/9μg, budesonide/formoterol pMDI 160/9μg, formoterol dry powder inhaler (DPI) 9μg, placebo. RESULTS The percentage of patients with FEV(1) improvement (≥12% and ≥200mL; American Thoracic Society [ATS] criterion) was 34-39% post-albuterol (screening). On day of randomization (DOR), a larger proportion receiving formoterol-containing treatment exhibited reversibility within 60min: FEV(1) (57-59%). Similar results were seen for IC (50-61%) and FVC (57-67%) using the same improvement criteria. The time to ≥15% FEV(1) improvement on DOR was 5.0, 4.8, and 7.3min for budesonide/formoterol 320/9, budesonide/formoterol 160/9, and formoterol, respectively. Time to ≥15% FEV(1) improvement was better maintained with budesonide/formoterol than formoterol at treatment end (6 and 12 months). CONCLUSIONS Most patients with moderate to very severe COPD exhibit ATS-defined bronchodilator reversibility based on flow and lung volume measures after budesonide/formoterol pMDI or formoterol treatment. Budesonide/formoterol pMDI also has a rapid (within 5min) onset of bronchodilation that is maintained over time compared with formoterol alone.
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Affiliation(s)
- Bartolome R Celli
- Harvard University, Brigham and Women's Hospital, Pulmonary and Critical Care Medicine, Boston, MA 02115, USA.
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Abdelghani A, Ben Saad H, Ben Hassen I, Ghannouchi I, Ghrairi H, Bougmiza I, Slama R, Tabka Z, Benzarti M. [Evaluation of the deficiency and the submaximal exercise capacity in obstructive sleep apnoea patients]. Rev Mal Respir 2010; 27:266-74. [PMID: 20359621 DOI: 10.1016/j.rmr.2010.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 09/28/2009] [Indexed: 11/16/2022]
Abstract
BACKGROUND In addition to excessive daytime somnolence, exercise limitation is a likely consequence of the cardiorespiratory problems that occur in patients who have obstructive sleep apnoea (OSA). However, few studies have evaluated the aerobic capacity of this patient group. AIMS To evaluate submaximal exercise capacity over the 6-minute walking test (6-MWT). To determine the factors that influence 6-minutes walking distance (6-MWD). METHODS INCLUSION CRITERIA 120 consecutive patients with severe OSA treated by continuous positive airway pressure who were medically stable will be included. EXCLUSION CRITERIA 6-MWT contraindications, orthopaedic or rheumatologic diseases likely to influence walking capacity and corticosteroid therapy. INVESTIGATIONS polysomnography, electrocardiogram, plethysmography, and two 6-MWT's. Indicators of impaired exercise capacity: stops during the walk, 6-MWD less than or equal to predicted lower limit of normal, end walking dyspnoea greater than or equal to 5/10, oxygen saturation fall greater than or equal to five points, end walking heart rate less than or equal to 60 % maximal predicted. Data from our obese patients aged 40-60 years old will be compared with data from 45 age-matched obese subjects free from OSA. EXPECTED RESULTS OSA will significantly affect the submaximal exercise capacity and will accelerate the ageing of the cardiorespiratory-muscle chain. Submaximal exercise capacity of obese subjects having OSA, compared to subjects free from OSA, will be significantly deteriorated. 6-MWD of OSA patients will be significantly influenced by: resting plethysmographic data, apnoea hypopnoea index, arterial hypertension, obesity or smoking histories.
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Affiliation(s)
- A Abdelghani
- Service de pneumologie, EPS Farhat Hached, Sousse, Tunisie
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Montes de Oca M, Perez-Padilla R, Tálamo C, Halbert RJ, Moreno D, Lopez MV, Muiño A, José Roberto BJ, Valdivia G, Pertuzé J, Ana Maria BM. Acute bronchodilator responsiveness in subjects with and without airflow obstruction in five Latin American cities: The PLATINO study. Pulm Pharmacol Ther 2010; 23:29-35. [DOI: 10.1016/j.pupt.2009.09.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2009] [Revised: 09/21/2009] [Accepted: 09/27/2009] [Indexed: 11/26/2022]
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