Bronchodilator Response Assessment of the Small Airways Obstructive Pattern.

Q3 Medicine

Open Respiratory Medicine Journal Pub Date : 2017-07-25 eCollection Date: 2017-01-01 DOI:10.2174/1874306401711010047

Plamen Bokov, Clémence Martin, Sémia Graba, Karine Gillet-Juvin, Mohamed Essalhi, Christophe Delclaux

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引用次数: 6

Abstract

Background: A concomitant decrease in FEV₁ and FVC with normal FEV₁/FVC ratio and TLC defines small airways obstructive pattern (SAOP) and constitutes a classic pitfall of pulmonary-function-tests interpretation.

Objective: To evaluate the prevalence of flow- (FEV₁ increase≥12% and 200 mL), volume- (FVC or inspiratory capacity [IC] increase≥12% and 200 mL), flow and volume-, and non-response to bronchodilation in patients with SAOP. An additional objective was to assess whether impulse oscillometry (IOS) parameters allow the diagnosis of SAOP and its reversibility.

Methods: Fifty consecutive adult patients with SAOP (FEV₁ and FVC < lower limit of normal, FEV₁/FVC and TLC > lower limit of normal) diagnosed on spirometry and plethysmography underwent the assessment of reversibility (400 µg salbutamol) on FEV₁, FVC, IC and IOS parameters.

Results: The diseases most frequently associated with SAOP were COPD and asthma (26 and 15 patients, respectively). Six patients were flow-responders, 20 were volume-responders, 9 were flow and volume-responders and 15 patients were non-responders. Overall, 26 patients had a significant improvement of IC, and 35 / 50 (70%, 95%CI: 57-83) exhibited a significant bronchodilator response. The difference between Rrs_5Hz and Rrs_20Hz was increased in 28/50 patients (56%, 95%CI: 42-70 with value higher than upper limit of normal) and its decrease after bronchodilator significantly correlated to FEV₁ increase only, suggesting proximal airway assessment.

Conclusion: A significant reversibility, mainly assessed on IC increase, is frequent in Small Airways Obstructive Pattern. Impulse oscillometry is of limited value in this context because of its low sensitivity.

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小气道梗阻型支气管扩张剂反应评价。

背景:在FEV1/FVC比值和TLC正常的情况下，FEV1和FVC同时下降定义了小气道阻塞性(SAOP)，构成了肺功能测试解释的一个经典缺陷。目的:评价SAOP患者血流- (FEV1增加≥12%，200 mL)、容积- (FVC或吸气量[IC]增加≥12%，200 mL)、血流和容积-及支气管扩张无反应的发生率。另一个目的是评估脉冲振荡(IOS)参数是否允许SAOP的诊断及其可逆性。方法:连续50例经肺活量和体积谱诊断为SAOP (FEV1和FVC <正常下限，FEV1/FVC和TLC >正常下限)的成人患者，对FEV1、FVC、IC和IOS参数进行可逆性评价(400µg沙丁胺醇)。结果:与SAOP相关最常见的疾病为COPD和哮喘(分别为26例和15例)。6例为流量反应者，20例为容量反应者，9例为流量和容量反应者，15例为无反应者。总体而言，26例患者的IC有显著改善，35 / 50 (70%，95%CI: 57-83)表现出显著的支气管扩张剂反应。28/50例患者Rrs5Hz与Rrs20Hz的差异增大(56%，95%CI: 42-70，值高于正常上限)，支气管扩张剂后Rrs5Hz与Rrs20Hz的差异减小仅与FEV1升高显著相关，提示近端气道评估。结论:明显的可逆性在小气道梗阻型中很常见，主要表现为IC升高。脉冲振荡法在这种情况下的价值有限，因为它的灵敏度低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Open Respiratory Medicine Journal Medicine-Pulmonary and Respiratory Medicine

CiteScore

1.70

自引率

0.00%

发文量

期刊介绍： The Open Respiratory Medicine Journal is an Open Access online journal, which publishes research articles, reviews/mini-reviews, letters and guest edited single topic issues in all important areas of experimental and clinical research in respiratory medicine. Topics covered include: -COPD- Occupational disorders, and the role of allergens and pollutants- Asthma- Allergy- Non-invasive ventilation- Therapeutic intervention- Lung cancer- Lung infections respiratory diseases- Therapeutic interventions- Adult and paediatric medicine- Cell biology. The Open Respiratory Medicine Journal, a peer reviewed journal, is an important and reliable source of current information on important recent developments in the field. The emphasis will be on publishing quality articles rapidly and making them freely available worldwide.