Pierachille Santus1, Dejan Radovanovic2, Sonia Henchi3, Fabiano Di Marco4, Stefano Centanni5, Edgardo D'Angelo6, Matteo Pecchiari7. 1. Dipartimento di Scienze della Salute, Università degli Studi di Milano, Pneumologia Riabilitativa Fondazione Salvatore Maugeri-IRCCS, Milan, Italy. Electronic address: pierachille.santus@unimi.it. 2. Dipartimento di Scienze della Salute, Università degli Studi di Milano, Pneumologia Riabilitativa Fondazione Salvatore Maugeri-IRCCS, Milan, Italy. Electronic address: danko86@hotmail.com. 3. Dipartimento di Scienze della Salute, Università degli Studi di Milano, Pneumologia Riabilitativa Fondazione Salvatore Maugeri-IRCCS, Milan, Italy. Electronic address: soniaponga85@yahoo.it. 4. Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy. Electronic address: fabiano.dimarco@unimi.it. 5. Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy. Electronic address: stefano.centanni@unimi.it. 6. Dipartimento di Fisiopatologia e dei Trapianti, Università degli Studi di Milano, Milan, Italy. Electronic address: edgardo.dangelo@unimi.it. 7. Dipartimento di Fisiopatologia e dei Trapianti, Università degli Studi di Milano, Milan, Italy. Electronic address: matteo.pecchiari@unimi.it.
Abstract
BACKGROUND: In COPD patients, reversibility is currently evaluated from the changes of forced expiratory volume at 1s (ΔFEV1) and forced vital capacity (ΔFVC). By lowering peripheral airway smooth muscle tone, bronchodilators should decrease dynamic hyperinflation, gas trapping, and possibly dyspnea at rest. Hence, we hypothesize that specific airway resistance changes (ΔsRAW) should better characterize the acute response to bronchodilators. METHODS: On two days, 60 COPD patients underwentdyspnea evaluation (VAS score) and pulmonary function testing at baseline and one hour after placebo or 300μg indacaterol administration. RESULTS: Spirographic and ΔsRAW-based criteria identified as responders 24 and 45 patients, respectively. ΔsRAW correlated with changes of intrathoracic gas volume (ΔITGV) (r=0.61; p<0.001), residual volume (ΔRV) (r=0.60; p<0.001), ΔFVC (r=0.44; p=0.001), and ΔVAS (r=0.73; p<0.001), while ΔFEV1 correlated only with ΔFVC (r=0.34; p=0.008). Significant differences in terms of ΔITGV (p=0.002), ΔRV (p=0.023), and ΔVAS (p<0.001) occurred only if patients were stratified according to ΔsRAW. CONCLUSIONS: In assessing the acute functional effect of bronchodilators, ΔsRAW-based criterion is preferable to FEV1-FVC-based criteria, being more closely related to bronchodilator-induced improvements of lung mechanics and dyspnea at rest.
RCT Entities:
BACKGROUND: In COPDpatients, reversibility is currently evaluated from the changes of forced expiratory volume at 1s (ΔFEV1) and forced vital capacity (ΔFVC). By lowering peripheral airway smooth muscle tone, bronchodilators should decrease dynamic hyperinflation, gas trapping, and possibly dyspnea at rest. Hence, we hypothesize that specific airway resistance changes (ΔsRAW) should better characterize the acute response to bronchodilators. METHODS: On two days, 60 COPDpatients underwent dyspnea evaluation (VAS score) and pulmonary function testing at baseline and one hour after placebo or 300μg indacaterol administration. RESULTS: Spirographic and ΔsRAW-based criteria identified as responders 24 and 45 patients, respectively. ΔsRAW correlated with changes of intrathoracic gas volume (ΔITGV) (r=0.61; p<0.001), residual volume (ΔRV) (r=0.60; p<0.001), ΔFVC (r=0.44; p=0.001), and ΔVAS (r=0.73; p<0.001), while ΔFEV1 correlated only with ΔFVC (r=0.34; p=0.008). Significant differences in terms of ΔITGV (p=0.002), ΔRV (p=0.023), and ΔVAS (p<0.001) occurred only if patients were stratified according to ΔsRAW. CONCLUSIONS: In assessing the acute functional effect of bronchodilators, ΔsRAW-based criterion is preferable to FEV1-FVC-based criteria, being more closely related to bronchodilator-induced improvements of lung mechanics and dyspnea at rest.
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