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Small airway dysfunction and flow and volume bronchodilator responsiveness in patients with chronic obstructive pulmonary disease.

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.

Authors+Show Affiliations

Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.Division of Pneumology, IRCCS Rehabilitation Institute of Tradate, Salvatore Maugeri Foundation, Tradate, Italy.Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.Medical Department, Chiesi Farmaceutici SpA, Parma, Italy.Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.Division of Pneumology, IRCCS Rehabilitation Institute of Tradate, Salvatore Maugeri Foundation, Tradate, Italy ; Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy.Corporate Clinical Development, Chiesi Farmaceutici SpA, Parma, Italy.Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

26150710

Citation

Pisi, Roberta, et al. "Small Airway Dysfunction and Flow and Volume Bronchodilator Responsiveness in Patients With Chronic Obstructive Pulmonary Disease." International Journal of Chronic Obstructive Pulmonary Disease, vol. 10, 2015, pp. 1191-7.
Pisi R, Aiello M, Zanini A, et al. 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.
Pisi, R., Aiello, M., Zanini, A., Tzani, P., Paleari, D., Marangio, E., Spanevello, A., Nicolini, G., & Chetta, A. (2015). Small airway dysfunction and flow and volume bronchodilator responsiveness in patients with chronic obstructive pulmonary disease. International Journal of Chronic Obstructive Pulmonary Disease, 10, 1191-7. https://doi.org/10.2147/COPD.S82509
Pisi R, et al. 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. PubMed PMID: 26150710.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Small airway dysfunction and flow and volume bronchodilator responsiveness in patients with chronic obstructive pulmonary disease. AU - Pisi,Roberta, AU - Aiello,Marina, AU - Zanini,Andrea, AU - Tzani,Panagiota, AU - Paleari,Davide, AU - Marangio,Emilio, AU - Spanevello,Antonio, AU - Nicolini,Gabriele, AU - Chetta,Alfredo, Y1 - 2015/06/19/ PY - 2015/7/8/entrez PY - 2015/7/8/pubmed PY - 2016/3/22/medline KW - COPD KW - bronchodilator responsiveness KW - small airways SP - 1191 EP - 7 JF - International journal of chronic obstructive pulmonary disease JO - Int J Chron Obstruct Pulmon Dis VL - 10 N2 - 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. SN - 1178-2005 UR - https://www.unboundmedicine.com/medline/citation/26150710/Small_airway_dysfunction_and_flow_and_volume_bronchodilator_responsiveness_in_patients_with_chronic_obstructive_pulmonary_disease_ L2 - https://dx.doi.org/10.2147/COPD.S82509 DB - PRIME DP - Unbound Medicine ER -