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Acute bronchodilator responsiveness to tiotropium in postinfectious bronchiolitis obliterans in children.
Chest 2013; 144(3):974-980Chest

Abstract

BACKGROUND

Patients with postinfectious bronchiolitis obliterans (PIBO) usually have severe airflow obstruction and respond poorly to β-adrenergic drugs. However, the bronchodilator response to an anticholinergic agent such as tiotropium bromide is not known. We studied the acute bronchodilator response to tiotropium for up to 24 h in children with PIBO using spirometric and plethysmographic criteria.

METHODS

A randomized, double-blind, placebo-controlled, crossover, prospective study was performed in patients with stable PIBO, 6 to 16 years of age. Standard spirometry and plethysmography were performed before and at 30, 60, 120, and 180 min and 24 h after inhalation of 18 μg of tiotropium or a placebo. After 7 to 14 days, the drugs were inverted, and the procedures were repeated. The changes in lung function parameters at each time point were compared with the baseline by analysis of variance and Tukey posttest, and the differences in all time points assessments vs baseline in tiotropium vs placebo groups were compared using the Friedman test.

RESULTS

A total of 30 patients were enrolled in the study (23 boys, seven girls; aged 10.9 ± 2.8 years) with baseline lung function values (% predicted) of FVC, FEV1, FEV1/FVC, forced expiratory flow between 25% and 75% of FVC (FEF25%-75%), total lung capacity (TLC), residual volume (RV), RV/TLC, airway resistance (Raw), and specific airway conductance (sGaw) of 75 ± 15, 48 ± 14, 59 ± 11, 22 ± 11, 120 ± 19, 281 ± 101, 49 ± 13, 250 ± 65, and 23 ± 9, respectively. Statistically significant differences were observed after tiotropium inhalation in the following parameters compared with baseline: FVC at 60, 120, and 180 min and 24 h; FEV1 at 30, 60, 120, and 180 min; FEV1/FVC at 60, 120, and 180 min; FEF25%-75% at 60, 120, and 180 min; RV at 30, 60, 120, and 180 min; TLC at 30, 120, and 180 min; RV/TLC at 30, 60, 120, and 180 min; Raw at 30, 60, 120, and 180 min and 24 h; and sGaw at 30, 60, 120, and 180 min and 24 h. For the placebo group, no significant differences were observed in any lung function parameters at any time. The differences in the main functional measurements between the tiotropium and placebo groups were statistically significant.

CONCLUSIONS

Tiotropium acutely decreased airway obstruction and air trapping for up to 24 h in children with PIBO.

Authors+Show Affiliations

Pulmonology Division, College of Public Health, University of São Paulo, São Paulo, Brazil. Electronic address: mariangelacard@hotmail.com.Pulmonology Division, College of Public Health, University of São Paulo, São Paulo, Brazil.Instituto da Criança, Hospital das Clínicas, and Department of Maternal and Child Health, College of Public Health, University of São Paulo, São Paulo, Brazil.Pulmonology Division, College of Public Health, University of São Paulo, São Paulo, Brazil.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

23558666

Citation

Teixeira, Mariângela F C., et al. "Acute Bronchodilator Responsiveness to Tiotropium in Postinfectious Bronchiolitis Obliterans in Children." Chest, vol. 144, no. 3, 2013, pp. 974-980.
Teixeira MFC, Rodrigues JC, Leone C, et al. Acute bronchodilator responsiveness to tiotropium in postinfectious bronchiolitis obliterans in children. Chest. 2013;144(3):974-980.
Teixeira, M. F. C., Rodrigues, J. C., Leone, C., & Adde, F. V. (2013). Acute bronchodilator responsiveness to tiotropium in postinfectious bronchiolitis obliterans in children. Chest, 144(3), pp. 974-980. doi:10.1378/chest.12-2280.
Teixeira MFC, et al. Acute Bronchodilator Responsiveness to Tiotropium in Postinfectious Bronchiolitis Obliterans in Children. Chest. 2013;144(3):974-980. PubMed PMID: 23558666.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute bronchodilator responsiveness to tiotropium in postinfectious bronchiolitis obliterans in children. AU - Teixeira,Mariângela F C, AU - Rodrigues,Joaquim C, AU - Leone,Claudio, AU - Adde,Fabíola V, PY - 2013/4/6/entrez PY - 2013/4/6/pubmed PY - 2014/1/8/medline SP - 974 EP - 980 JF - Chest JO - Chest VL - 144 IS - 3 N2 - BACKGROUND: Patients with postinfectious bronchiolitis obliterans (PIBO) usually have severe airflow obstruction and respond poorly to β-adrenergic drugs. However, the bronchodilator response to an anticholinergic agent such as tiotropium bromide is not known. We studied the acute bronchodilator response to tiotropium for up to 24 h in children with PIBO using spirometric and plethysmographic criteria. METHODS: A randomized, double-blind, placebo-controlled, crossover, prospective study was performed in patients with stable PIBO, 6 to 16 years of age. Standard spirometry and plethysmography were performed before and at 30, 60, 120, and 180 min and 24 h after inhalation of 18 μg of tiotropium or a placebo. After 7 to 14 days, the drugs were inverted, and the procedures were repeated. The changes in lung function parameters at each time point were compared with the baseline by analysis of variance and Tukey posttest, and the differences in all time points assessments vs baseline in tiotropium vs placebo groups were compared using the Friedman test. RESULTS: A total of 30 patients were enrolled in the study (23 boys, seven girls; aged 10.9 ± 2.8 years) with baseline lung function values (% predicted) of FVC, FEV1, FEV1/FVC, forced expiratory flow between 25% and 75% of FVC (FEF25%-75%), total lung capacity (TLC), residual volume (RV), RV/TLC, airway resistance (Raw), and specific airway conductance (sGaw) of 75 ± 15, 48 ± 14, 59 ± 11, 22 ± 11, 120 ± 19, 281 ± 101, 49 ± 13, 250 ± 65, and 23 ± 9, respectively. Statistically significant differences were observed after tiotropium inhalation in the following parameters compared with baseline: FVC at 60, 120, and 180 min and 24 h; FEV1 at 30, 60, 120, and 180 min; FEV1/FVC at 60, 120, and 180 min; FEF25%-75% at 60, 120, and 180 min; RV at 30, 60, 120, and 180 min; TLC at 30, 120, and 180 min; RV/TLC at 30, 60, 120, and 180 min; Raw at 30, 60, 120, and 180 min and 24 h; and sGaw at 30, 60, 120, and 180 min and 24 h. For the placebo group, no significant differences were observed in any lung function parameters at any time. The differences in the main functional measurements between the tiotropium and placebo groups were statistically significant. CONCLUSIONS: Tiotropium acutely decreased airway obstruction and air trapping for up to 24 h in children with PIBO. SN - 1931-3543 UR - https://www.unboundmedicine.com/medline/citation/23558666/Acute_bronchodilator_responsiveness_to_tiotropium_in_postinfectious_bronchiolitis_obliterans_in_children_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0012-3692(13)60615-7 DB - PRIME DP - Unbound Medicine ER -