RESUMEN
A positive response in reversibility testing is widely used to diagnose patients with airway limitations. However, despite its simple procedure, it doesn't accurately reflect the exact airway irreversibility. This study aimed to investigate the efficacy of a bronchodilation reversibility test using salbutamol and fluticasone/salmeterol combination in obese non-smoker subjects.The study included patients without a history of obstructive lung disease or bronchodilators. A sub-classification of patients based on body mass index (BMI) was carried out into normal (< 24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (BMI ≥ 30). Spirometry measurements were performed before and after salbutamol or fluticasone/salmeterol administration.The study included 415 (49.9% male) patients with a mean age of 40.92 ± 10.86 years. Obese subjects showed a high prevalence of restrictive patterns (23.4%), with non-significantly lower spirometric values compared to normal and overweight subjects (p > 0.05). The magnitude of bronchodilation, as identified by spirometry, following fluticasone/salmeterol was higher in all participants, with a significant increase in obese subjects with a p-value of 0.013, 0.002, and 0.035 for FEV1, FEV1% predicted, and FEV1/FVC, respectively.Fluticasone/salmeterol combination increases FEV1, FEV1% of predicted, and FEV1/FVC ratio than the conventional test using salbutamol inhaler, and it can be a potential candidate for assessment of airway obstruction using reversibility test, especially among the obese population.
Asunto(s)
Broncodilatadores , Obesidad Mórbida , Humanos , Masculino , Adulto , Persona de Mediana Edad , Femenino , Broncodilatadores/uso terapéutico , Albuterol , No Fumadores , Obesidad Mórbida/tratamiento farmacológico , Sobrepeso , Volumen Espiratorio Forzado , Combinación Fluticasona-Salmeterol , Xinafoato de Salmeterol/uso terapéutico , Administración por Inhalación , Método Doble CiegoRESUMEN
INTRODUCTION: The usefulness of total specific resistance (sRtot) and interrupter resistance (Rint) as a bronchodilator reversibility test (BT) alternative to forced expiratory volume in 1 s (FEV1) in asthma diagnosis in children has not been established. AIM: To compare different applied definitions of airflow obstruction in children measuring response to the bronchodilator by spirometry, plethysmography and the interrupter technique in asthmatic children. MATERIAL AND METHODS: It was a prospective, real-life, non-interventional study. Children, aged 6-18 with newly diagnosed asthma, able to perform lung function tests were included into the study. Subjects underwent a history taking, physical examination, reversibility test in spirometry, plethysmography, and the interrupter technique. A standard cut-off of 12% from the initial value for reversibility in FEV1 was employed. Improvement in the pre-bronchodilator sRtot and Rint ≥ 25% and ≥ 35% was assessed after administration of salbutamol (400 µg) as well as allergen sensitization were measured. RESULTS: We included 135 children diagnosed with asthma into the analysis. All investigated parameters changed statistically significantly due to the bronchodilator administration in the examined patients. The FEV1 was not as useful in diagnostics of asthma as the sRtot and Rint, taking into consideration the fait accompli that all the study participants had aptly been diagnosed as having asthma (p < 0.001). The differences between the sRtot and Rint were not statistically significant (p = 0.215). CONCLUSIONS: Our results suggest that sRtot and Rint may be useful parameters in BT in clinical practice in the asthma diagnostic process in children.
RESUMEN
The aim of the study was to determine the prognostic value of hemodynamic parameters measured during initial diagnostic right heart catheterization (RHC) in standard conditions and using a nitric oxide reversibility test. A retrospective observational study of 62 patients with pulmonary arterial hypertension (PAH) was performed. Clinical, biochemical, echocardiographic, and hemodynamic data obtained at the time of the PAH diagnosis were precisely analyzed. Patients were followed for five years. Death or lung transplantation was considered as a primary endpoint. The mean follow-up period was 1090 ± 703 days and the median age was 46.84 years. In the studied group, 25 patients survived, 36 patients died, and one underwent a lung transplantation. From all the examined parameters, only stroke volume index during reversibility test with iNO (SVI(NO test)) (HR = 0.910; 95% confidence interval 0.878-0.944; p < 0.001) and initial arterial oxygen saturation (SaO2) (HR = 0.910; 95% confidence interval 0.843-0.982; p = 0.015) have been established as independent predictors of death or lung transplantation in the five-year follow-up. An SVI(NO test) value above 39.86 mL/m2 was associated with 100% five-year survival rate (AUC = 0.956; 95% confidence interval 0.899-1.000; p < 0.001; specificity/sensitivity: 100/84%). The results of the analysis suggest that the SVI(NO test) measured during the initial diagnostic RHC could be a very valuable prognostic factor in the PAH patients.
RESUMEN
Changes of maximum expiratory flow at 25% and 50% of vital capacity (MEF25 and MEF50, respectively), and predominant parameters indicating small airways function in asthmatics before and after bronchodilator (BD) reversibility test have been less interpreted. Our study aimed to investigate the clinical role of changes of MEF25 and MEF50 before and after BD reversibility test in diagnosing asthma. Forced expiratory volume in the first second (FEV1), MEF25, and MEF50 were measured before and after BD reversibility test in 207 asthmatic patients using standard process. Forty healthy individuals were enrolled as controls. Receiver operating characteristic (ROC) curve was used to assess the diagnostic accuracy of reversibility of MEF25 and MEF50 before and after BD reversibility test (ΔMEF25% and ΔMEF50%, respectively) in diagnosing asthma. Among these functional criteria, ΔMEF25% and ΔMEF50% ≥ 25% performed the best diagnostic performance. The sensitivity, specificity, and accuracy of ΔMEF25% ≥ 25% as an objective diagnostic test for asthma were 63.29%, 87.50%, and 67.21%, and of ΔMEF50% ≥ 25% were 79.23%, 85.00%, and 80.16%, respectively. The area under the ROC curve of the indicators was 0.8203 and 0.9104, respectively. By contrast, an increase in FEV1 ≥ 12% and 200 mL demonstrated a sensitivity of 62.32%, specificity of 82.50%, and accuracy of 65.59% in diagnosing asthma. The changes of MEF25 and MEF50 before and after BD reversibility test may be of additional value in the clinical diagnosis of asthma, with cutoff values of 25% being the most.
Asunto(s)
Asma/diagnóstico , Adulto , Asma/fisiopatología , Broncoespirometría , Estudios de Casos y Controles , Estudios Transversales , Femenino , Volumen Espiratorio Forzado , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Curva ROC , Sensibilidad y Especificidad , Capacidad Vital , Adulto JovenRESUMEN
Chronic obstructive pulmonary disease (COPD) is a systemic disease which may be associated with other comorbidities. The aim of the study was to estimate the incidence of metabolic syndrome (MS) in COPD patients and to assess its impact on systemic inflammation and lung function. MS was diagnosed in accordance with the recommendations of the Polish Forum for the Prevention of Cardiovascular Diseases. The study group consisted of 267 patients with stable COPD in all stages of severity. All patients underwent spirometry with bronchial reversibility testing and 6 min walk test (6MWT). The following blood tests were evaluated: lipid profile, glucose and C-reactive protein as well as serum concentration of IL-6, leptin, adiponectin, and endothelin. MS was diagnosed in 93 patients (35.8%). No differences were observed in the incidence of MS in relation to airflow limitation severity (mild; moderate; severe and very severe: 38.9; 36.3; 35.2 and 25.0%, respectively). FEV1 (% predicted), FVC (% predicted), 6MWT distance (6MWD), age, and the number of pack-years were similar in patients with and without MS. MS was more frequent in males than females (38.7 vs. 28.4%, p > 0.05). Serum concentrations of IL-6, endothelin, leptin, and CRP were higher in the MS group, contrary to adiponectin concentration which was lower (p < 0.01). MS was more frequent in male COPD patients, but there were no differences in its frequency between patients with different severity of airflow limitation. We conclude that MS, as a comorbidity, occurs in all COPD stages and affects systemic inflammation. MS incidence does not depend on COPD severity.
Asunto(s)
Inflamación/complicaciones , Síndrome Metabólico/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Femenino , Volumen Espiratorio Forzado , Humanos , Pulmón/fisiopatología , Masculino , EspirometríaRESUMEN
BACKGROUND: Asthma Control Test (ACT ™) validity relies on Global Initiative for Asthma (GINA) definition of control. It includes neither reversibility nor inflammation assessment despite their importance as hallmark of asthma, partially unrelated to symptoms. Furthermore though rhinitis may affect the patient's perception of asthma control, its impact on ACT accuracy has not been systematically evaluated. OBJECTIVE: To explore ACT validity according to a definition of control including: forced expiratory volume in 1 s (FEV1) ≥ 80%, negative reversibility test, exhaled nitric oxide at a flow rate of 50 ml/s (FeNO) < 50 ppb. RESULTS: 177 asthmatics referring to our Unit have been studied. ACT with cut-off score ≥20 showed a good positive predictive value (83.5%) but low sensitivity (47.8%), specificity (66.7%), and negative predictive value (26.5%). ROC curves analysis indicates that ACT in patients with mild intermittent rhinitis is more reliable (AUC: 0.714; p < 0.05) than in patients with nasal polyposis/chronic rhino-sinusitis (AUC: 0.176; p > 0.05). Considering asthma classification, the probability that ACT detects patients with uncontrolled asthma is significantly higher in moderate persistent asthma subgroup than in mild persistent asthma one (OR 5.464; IC 95%: 2.5-11,9; p < 0.05). CONCLUSIONS: As ACT mainly relies on patient's reported outcomes, it may not completely reflect the airways inflammation and airways obstruction. The presence and severity of rhinitis may affect ACT outcome. The awareness of the variables that could influence ACT evaluation is much more important in the primary care setting where ACT may often represent the only tool for asthma assessment.
Asunto(s)
Asma/diagnóstico , Adulto , Asma/epidemiología , Asma/metabolismo , Asma/fisiopatología , Pruebas Respiratorias , Comorbilidad , Espiración , Femenino , Volumen Espiratorio Forzado , Humanos , Masculino , Persona de Mediana Edad , Pólipos Nasales/epidemiología , Óxido Nítrico/metabolismo , Valor Predictivo de las Pruebas , Curva ROC , Rinitis/epidemiología , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Sinusitis/epidemiología , Adulto JovenRESUMEN
INTRODUCTION: The use of a combination inhaler containing budesonide and formoterol (BUD/FOR) to both maintenance and quick relief therapy has been recommended as an improved method of using inhaled corticosteroid/long-acting ß agonist therapy. The aim of this study was to investigate the acute effects of BUD/FOR and testing the availability of BUD/FOR for early reversibility test in patients with airway obstruction. PATIENTS AND METHODS: The study was conducted on patients who were admitted to the Department of Pulmonary Medicine, Samsun Medical Park Hospital, Samsun, Turkey. RESULTS: A total of 44 patients were included in the study. The mean age of patients was 48.5 ± 17.3 (range 10-75) years and the male-to-female ratio was 36:8. The pre-bronchodilator pulmonary function test results are as follows: the mean forced vital capacity, 3,025 ± 1,162 mL (76.3% ± 23.2%); mean forced expiratory volume in 1 second (FEV1), 1,898 ± 725 mL (59.2% ± 19.1%); mean FEV1/forced vital capacity, 62.8 ± 6.3% (range 42%-70%); mean peak expiratory flow, 3,859 ± 1,779 mL (48.0% ± 19.7%); and forced expiratory flow 25%-75%, 1,295 ± 486 mL (35.8% ± 12.3%). The reversibility was positive in 26 (59.1%) patients. The absolute change and percentage of change in FEV1 were 318 ± 228 mL and 17.7% ± 11.9%, respectively. The patients were divided into two groups according to reversibility (reversible and irreversible) and both groups were compared with changes according to spirometric results. FEV1 values were statistically different between the two groups. CONCLUSION: The fixed combination of BUD/FOR has rapid bronchodilator effect, and they can be used for early reversibility test.
Asunto(s)
Agonistas de Receptores Adrenérgicos beta 2/administración & dosificación , Obstrucción de las Vías Aéreas/tratamiento farmacológico , Asma/tratamiento farmacológico , Broncodilatadores/administración & dosificación , Combinación Budesonida y Fumarato de Formoterol/administración & dosificación , Glucocorticoides/administración & dosificación , Pulmón/efectos de los fármacos , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Administración por Inhalación , Adolescente , Agonistas de Receptores Adrenérgicos beta 2/efectos adversos , Adulto , Anciano , Obstrucción de las Vías Aéreas/diagnóstico , Obstrucción de las Vías Aéreas/fisiopatología , Asma/diagnóstico , Asma/fisiopatología , Broncoconstricción/efectos de los fármacos , Broncodilatadores/efectos adversos , Combinación Budesonida y Fumarato de Formoterol/efectos adversos , Niño , Femenino , Volumen Espiratorio Forzado , Glucocorticoides/efectos adversos , Humanos , Pulmón/fisiopatología , Masculino , Persona de Mediana Edad , Nebulizadores y Vaporizadores , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Espirometría , Factores de Tiempo , Resultado del Tratamiento , Turquía , Capacidad Vital , Adulto JovenRESUMEN
Maximal inspiratory pressure (MIP) is a marker for assessing the degree of respiratory muscle dysfunction. Muscle dysfunction represents a pathophysiological feature of chronic obstructive pulmonary disease. We aimed to determinate the MIP value in patients with airway obstruction, to evaluate the change in MIP with bronchodilator drug, and to show the relationship between the changes in MIP and disease characteristics. We evaluated 21 patients with airway obstruction at the Department of Pulmonary Medicine, Samsun Medicalpark Hospital, Samsun, Turkey. We performed pulmonary function tests, measurement of MIP values, and reversibility tests with salbutamol. The baseline spirometry results were: mean forced vital capacity (FVC), 3,017±1,020 mL and 75.8%±20.8%; mean forced expiratory volume in 1 second (FEV1), 1,892±701 mL and 59.2%±18.2%; FEV1/FVC, 62.9%±5.5%; peak expiratory flow, 53%±19%. The pre-bronchodilator MIP value was 62.1±36.9 cmH2O. The reversibility test was found to be positive in 61.9% of patients with salbutamol. The absolute change and percentage of change in FEV1 were 318±223 mL and 19.8%±16.7%, respectively. The MIP value was increased by 5.5 cmH2O (8.8%) and was 67.7±30.3 cmH2O after bronchodilation. There was no significant relationship between age, FEV1, reversibility, and change in MIP with bronchodilator. However, the increase in MIP with bronchodilator drug was higher in patients with low body mass index (<25 kg/m(2)). We noted a 13.1% increase in FVC, a 19.8% increase in FEV1, a 20.2% increase in peak expiratory flow, and an 8.8% increase in MIP with salbutamol. In conclusion; MIP increases with bronchodilator therapy, regardless of changes in lung function, in patients with airway obstruction. The reversibilty test can be used to evaluate change in MIP with salbutamol.
Asunto(s)
Obstrucción de las Vías Aéreas/diagnóstico , Albuterol , Broncodilatadores , Inhalación , Pulmón/fisiopatología , Pruebas de Función Respiratoria , Músculos Respiratorios/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Obstrucción de las Vías Aéreas/tratamiento farmacológico , Obstrucción de las Vías Aéreas/fisiopatología , Volumen Espiratorio Forzado , Humanos , Pulmón/efectos de los fármacos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Presión , Espirometría , Turquía , Capacidad VitalRESUMEN
BACKGROUND: In the measurement of bronchodilator reversibility, the forced expiratory volume in one second(FEV(1)) and the forced vital capacity(FVC) are commonly used parameters and recommended criteria for the reversibility requiring an increase of more than 200ml and 12% above the baseline, respectively. However, aged patients do not often meet the criteria of an increase in volume(>200ml) even though the medical history of that patient is adequate for asthma. This study investigated the role of the forced expiratory volume in six seconds(FEV(6)) in the bronchodilator reversibility test in elderly patients. METHODS: A total of 236 patients more than 65 years of age with a FEV(1)/FVC ratio or = 80% of the predicted value, Group II: 60%Asunto(s)
Anciano
, Humanos
, Asma
, Volumen Espiratorio Forzado
RESUMEN
Objective To analyze the clinical features of chronic obstructive pulmanory disease(COPD)with different results of bronchodilator reversibility test.Methods A total of 47 cases of COPD were selected and given bronchodilator reversibility test and lung fuction who were divided into two groups according to the bronchodilator reversibility test.We compared these two groups with sex,age,smoke history,body mass index,levels of IgE,eosinophil and lung function.Results The positive group had a shorter history of smoking and a higher level of IgE.The amelioration of FVC,FEV1,FRC,MEF 75% and MEF 50% was higher in the positive group than the negative(P