The prevalence of bronchodilator responsiveness of the small airway (using mid-maximal expiratory flow) in COPD - a retrospective study

BMC Pulmonary Medicine

Research

Elizabeth Sapey¹  Mohammed A. Almeshari²  Nowaf Y. Alobaidi³  Robert A. Stockley⁴  James A. Stockley⁵ 

[1] Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, B15 2TT, Birmingham, UK;Acute Medicine, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, B15 2GW, Birmingham, UK;Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, B15 2TT, Birmingham, UK;Rehabilitation Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia;Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, B15 2TT, Birmingham, UK;Respiratory Therapy Department, King Saud Bin Abdulaziz University for Health Sciences, Alahsa, Saudi Arabia;Department of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK;Lung Function & Sleep Department, Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK;

关键词: COPD;    Spirometry;    Bronchodilator responsiveness;    MMEF;    FEV;   

DOI  :  10.1186/s12890-022-02235-0

 received in 2022-07-13, accepted in 2022-11-10,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundBronchodilator responsiveness (BDR) using FEV1 is often utilised to separate COPD patients from asthmatics, although it can be present in some COPD patients. With the advent of treatments with distal airway deposition, BDR in the small airways (SA) may be of value in the management of COPD. We aimed to identify the prevalence of BDR in the SA, utilizing maximal mid-expiratory flow (MMEF) as a measure of SA. We further evaluated the prevalence of BDR in MMEF with and without BDR in FEV1 and its association with baseline demographics, including conventional airflow obstruction severity and smoking history.MethodsLung function data of ever-smoking COPD patients were retrospectively analysed. BDR was evaluated 20 min after administering 2.5 mg of salbutamol via jet nebulizer. Increase in percent change of ≥ 12% and absolute change of ≥ 200 ml was used to define a BDR in FEV1, whereas an increase percent change of MMEF ≥ 30% was used to define a BDR in MMEF. Patients were classified as one of three groups according to BDR levels: group 1 (BDR in MMEF and FEV1), group 2 (BDR in MMEF alone) and group 3 (no BDR in either measure).ResultBDR in MMEF was present in 59.2% of the patients. Of note, BDR in MMEF was present in all patients with BDR in FEV1 (group 1) but also in 37.9% of the patients without BDR in FEV1 (group 2). Patients in group 1 were younger than in groups 2 and 3. BMI was higher in group 1 than in group 3. Baseline FEV1% predicted and FVC % predicted were also higher in groups 1 and 2 than in group 3.ConclusionBDR in the SA (evaluated by MMEF) is common in COPD, and it is also feature seen in all patients with BDR in FEV1. Even in the absence of BDR in FEV1, BDR in MMEF is detected in some patients with COPD, potentially identifying a subgroup of patients who may benefit from different treatment strategies.

【 授权许可】

CC BY   
© The Author(s) 2022

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