•  
  •  
 

Abstract

Introduction: Chronic obstructive pulmonary disease (COPD) is characterized as expiratory airflow limitation in individuals with significant smoking history. Bronchodilator responsiveness (BDR) might be shown in some COPD patients and might be associated with clinical outcomes.

Objectives: To determine the BDR prevalence and the correlation between BDR and clinical outcomes in COPD patients.

Methods: A cross-sectional study was conducted on stable COPD patients at Thammasat University Hospital between March 2019 and January 2022. Demographics, respiratory symptoms and functional capacity assessed by modified Medical Research Council, COPD Assessment Test, 6-minute walking distance, clinical outcomes (exacerbation, hospitalization, rescue medication use), and pulmonary functions were recorded. BDR criteria were defined according to the following established guidelines: the American College of Chest Physicians (ACCP), the European Respiratory Society (ERS), and the American Thoracic Society/European Respiratory Society (ATS/ERS).

Results: A total of 150 patients were included. Mean age was 75.2 ± 8.5 years. Post-BD FEV1 was 65.6 ± 24.0%. Prevalence of BDR was 30.7% (ERS), 25.3% (ATS/ERS), and 16.0% (ACCP). BDR did not significantly correlate with respiratory symptoms, functional capacity, or clinical outcomes. Nevertheless, the pulmonary function data showed the BDR group had less severe airway obstruction than the non-BDR group (pre-BD FEV1 in 72.4 ± 25.0% vs 63.3 ± 23.3%, P = 0.045).

Conclusions: Bronchodilator responsiveness in COPD was a common condition. However, there was no correlation between BDR and clinical outcomes. A large prospective cohort study is needed to investigate this relationship and demonstrate the mortality outcome.

References

1. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease 2020 report. 2020 [cited 2019 November 8,]. Available from: http://goldcopd.org.

2. Adeloye D, Chua S, Lee C, et al. Global and regional estimates of COPD prevalence: Systematic review and meta-analysis. J Glob Health. 2015;5:020415.

3. Maranetra KN, Chuaychoo B, Dejsomritrutai W, et al. The prevalence and incidence of COPD among urban older persons of Bangkok Metropolis. J Med Assoc Thai. 2002;85:1147-55.

4. Pothirat C, Chaiwong W, Phetsuk N, Pisalthanapuna S, Chetsadaphan N, Inchai J. A comparative study of COPD burden between urban vs rural communities in northern Thailand. Int J Chron Obstruct Pulmon Dis. 2015;10:1035-42.

5. O'Donnell DE, Fluge T, Gerken F, et al. Effects of tiotropium on lung hyperinflation, dyspnoea and exercise tolerance in COPD. Eur Respir J. 2004;23:832-40.

6. O'Donnell DE, Sciurba F, Celli B, et al. Effect of fluticasone propionate/salmeterol on lung hyperinflation and exercise endurance in COPD. Chest. 2006;130:647-56.

7. Tashkin DP, Celli B, Decramer M, et al. Bronchodilator responsiveness in patients with COPD. Eur Respir J. 2008;31:742-50.

8. Dahl R, Greefhorst LA, Nowak D, et al. Inhaled formoterol dry powder versus ipratropium bromide in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001;164:778-84.

9. Jones PW, Bosh TK. Quality of life changes in COPD patients treated with salmeterol. Am J Respir Crit Care Med. 1997;155:1283-9.

10. Rennard SI, Anderson W, ZuWallack R, et al. Use of a long-acting inhaled beta2-adrenergic agonist, salmeterol xinafoate, in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001;163:1087-92.

11. Mahler DA. The effect of inhaled beta2-agonists on clinical outcomes in chronic obstructive pulmonary disease. J Allergy Clin Immunol. 2002;110:S298-303.

12. Kawakami Y, Kishi F, Dohsaka K, Nishiura Y, Suzuki A. Reversibility of airway obstruction in relation to prognosis in chronic obstructive pulmonary disease. Chest. 1988;93:49-53.

13. Miller MR, Crapo R, Hankinson J, et al. General considerations for lung function testing. Eur Respir J. 2005;26:153-61.

14. Miller MR, Hankinson J, Brusasco V, et al. Standardisation of spirometry. Eur Respir J. 2005;26:319-38.

15. Graham BL, Steenbruggen I, Miller MR, et al. Standardization of spirometry 2019 update. An official American Thoracic Society and European Respiratory Society technical statement. Am J Respir Crit Care Med. 2019;200:e70-e88.

16. Quanjer PH, Stanojevic S, Cole TJ, et al. Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations. Eur Respir J. 2012;40:1324-43.

17. Hanania NA, Celli BR, Donohue JF, Martin UJ. Bronchodilator reversibility in COPD. Chest. 2011;140:1055-63.

18. Report of the Committee on Emphysema American College of Chest Physicians. Criteria for the assessment of reversibility in airways obstruction. Chest. 1974;65:552-3.

19. Siafakas NM, Vermeire P, Pride NB, et al. Optimal assessment and management of chronic obstructive pulmonary disease (COPD). The European Respiratory Society Task Force. Eur Respir J. 1995;8:1398-420.

20. Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests. Eur Respir J. 2005;26:948-68.

21. Stanojevic S, Kaminsky DA, Miller M, et al. ERS/ATS technical standard on interpretive strategies for routine lung function tests. Eur Respir J. 2022;60:2101499.

22. Cavallazzi RS, Polivka BJ, Beatty BL, et al. Current bronchodilator responsiveness criteria underestimate asthma in older adults. Respir Care. 2020;65:1104-11.

23. Janson C, Malinovschi A, Amaral AFS, et al. Bronchodilator reversibility in asthma and COPD: findings from three large population studies. Eur Respir J. 2019;54:1900561.

24. Albert P, Agusti A, Edwards L, et al. Bronchodilator responsiveness as a phenotypic characteristic of established chronic obstructive pulmonary disease. Thorax. 2012;67:701-8.

25. Vestbo J, Anderson W, Coxson HO, et al. Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE). Eur Respir J. 2008;31:869-73.

26. Maltais F, Bjermer L, Kerwin EM, et al. Efficacy of umeclidinium/vilanterol versus umeclidinium and salmeterol monotherapies in symptomatic patients with COPD not receiving inhaled corticosteroids: the EMAX randomised trial. Respir Res. 2019;20:238.

27. Saiphoklang N, Chomchoey C. Eosinophilia and parasitic infestations in patients with chronic obstructive pulmonary disease. Sci Rep. 2020;10:12490.

Download

Share

COinS