Bronchodilator responsiveness in patients with copd

The degree of acute improvement in spirometric indices after Bronchodilator inhalation varies among chronic obstructive pulmonary disease (COPD) patients, and depends upon the type and dose of Bronchodilator and the timing of administration. Acute Bronchodilator responsiveness at baseline was examined in a large cohort of patients with moderate-to-very-severe COPD participating in the Understanding Potential Long-term Impacts on Function with Tiotropium (UPLIFT) trial, a 4-yr randomised double-blind trial evaluating the efficacy of 18 μg tiotropium daily in reducing the rate of decline in lung function. After wash-out of respiratory medications, patients received 80 μg ipratropium followed by 400 μg salbutamol. Spirometry was performed before and 90 min following ipratropium administration. The criteria used for forced expiratory volume in one second (FEV 1 ) responsiveness were: ≥12% increase over baseline and ≥200 mL; ≥15% increase over baseline; and ≥10% absolute increase in the percentage predicted value. Of the patients, 5,756 had data meeting the criteria for analysis (age 64.5 yrs; 75% male; baseline FEV 1 1.10 L (39.3% predicted) and forced vital capacity (FVC) 2.63 L). Compared with baseline, mean improvements were 229 mL in FEV 1 and 407 mL in FVC. Of these patients, 53.9% had ≥12% and ≥200 mL improvement in FEV 1 , 65.6% had ≥15% improvement in FEV 1 , and 38.6% had ≥10% absolute increase in FEV 1 % pred. The majority of patients with moderate-to-very-severe chronic obstructive pulmonary disease demonstrate meaningful increases in lung function following administration of inhaled anticholinergic plus sympathomimetic Bronchodilators.

Bronchodilator response in the lung health study over 11 yrs

Long-term changes in Bronchodilator response in people with mild chronic obstructive pulmonary disease were assessed in this study. Changes in forced expiratory volume in one second (FEV1) in response to isoproterenol was measured in 4,194 participants in the Lung Health Study annually for 5 yrs, and again 11 yrs after study entry. Responses were quantitated in terms of mL (absolute), as per cent of the pre-Bronchodilator value (relative), and as a per cent of the predicted normal value (% predicted). At baseline, the mean pre-Bronchodilator FEV1 was 75.4% predicted, and responses were small. Relative and percentage predicted responses were similar in males and females; and correlated positively with methacholine reactivity, and negatively with smoking intensity and age. Baseline Bronchodilator responses did not correlate with subsequent decline in FEV1. There was a substantial increase in response over the first year of the study, largely due to smoking cessation, with larger increases in those who stopped smoking. After the first year absolute responses changed little in those who maintained smoking cessation, but increased in those who did not. Mean relative and percentage predicted responses increased in all participants throughout the study. There was substantial annual variability of absolute response, and it was poorly reproducible in individual participants. In conclusion, smoking cessation increased Bronchodilator response, and response did not predict the rate of decline of forced expiratory volume in one second.

long term treatment benefits with tiotropium in copd patients with and without short term Bronchodilator responses

Objectives: To determine whether long-term symptomatic improvement occurs in COPD patients with maintenance Bronchodilator therapy despite a nonsignificant short-term improvement in FEV 1 following Bronchodilator inhalation obtained at a single time point. Methods: Data obtained during two identical 1-year, placebo-controlled trials of tiotropium, 18 μg once daily, were analyzed retrospectively to determine the associations of long-term improvements in lung function and patient health status with short-term improvements in FEV 1 , as measured on the first day of treatment. Based on the presence or absence of a short-term improvement in FEV 1 of ≥ 12% and ≥ 200 mL, respectively, patients who had been treated with tiotropium were characterized as being responsive to tiotropium (TIO-R) or poorly responsive to tiotropium (TIO-PR). Results: Baseline characteristics were similar other than baseline FEV 1 , which was higher in the TIO-R group than in both the TIO-PR and placebo groups (p 1 was 1.08 L in the TIO-R group (n = 263), 0.95 L in the TIO-PR (n = 255), and 0.99 L in the placebo group (n = 328). The mean (± SD) morning predose FEV 1 at 1 year significantly (p 1 response to the end-of-trial trough response ( r = 0.43), but there was only a weak correlation to TDI focal score ( r = 0.17) or SGRQ total score ( r = −0.12). Conclusions: Tiotropium was effective in the treatment of patients with COPD, irrespective of the presence or absence of a short-term response on the first day of treatment. The short-term Bronchodilator response should not be used as a definitive criterion for prescribing long-term treatment with inhaled Bronchodilators.

Bronchodilator responsiveness in patients with copd

The degree of acute improvement in spirometric indices after Bronchodilator inhalation varies among chronic obstructive pulmonary disease (COPD) patients, and depends upon the type and dose of Bronchodilator and the timing of administration. Acute Bronchodilator responsiveness at baseline was examined in a large cohort of patients with moderate-to-very-severe COPD participating in the Understanding Potential Long-term Impacts on Function with Tiotropium (UPLIFT) trial, a 4-yr randomised double-blind trial evaluating the efficacy of 18 μg tiotropium daily in reducing the rate of decline in lung function. After wash-out of respiratory medications, patients received 80 μg ipratropium followed by 400 μg salbutamol. Spirometry was performed before and 90 min following ipratropium administration. The criteria used for forced expiratory volume in one second (FEV 1 ) responsiveness were: ≥12% increase over baseline and ≥200 mL; ≥15% increase over baseline; and ≥10% absolute increase in the percentage predicted value. Of the patients, 5,756 had data meeting the criteria for analysis (age 64.5 yrs; 75% male; baseline FEV 1 1.10 L (39.3% predicted) and forced vital capacity (FVC) 2.63 L). Compared with baseline, mean improvements were 229 mL in FEV 1 and 407 mL in FVC. Of these patients, 53.9% had ≥12% and ≥200 mL improvement in FEV 1 , 65.6% had ≥15% improvement in FEV 1 , and 38.6% had ≥10% absolute increase in FEV 1 % pred. The majority of patients with moderate-to-very-severe chronic obstructive pulmonary disease demonstrate meaningful increases in lung function following administration of inhaled anticholinergic plus sympathomimetic Bronchodilators.

long term treatment benefits with tiotropium in copd patients with and without short term Bronchodilator responses

Objectives: To determine whether long-term symptomatic improvement occurs in COPD patients with maintenance Bronchodilator therapy despite a nonsignificant short-term improvement in FEV 1 following Bronchodilator inhalation obtained at a single time point. Methods: Data obtained during two identical 1-year, placebo-controlled trials of tiotropium, 18 μg once daily, were analyzed retrospectively to determine the associations of long-term improvements in lung function and patient health status with short-term improvements in FEV 1 , as measured on the first day of treatment. Based on the presence or absence of a short-term improvement in FEV 1 of ≥ 12% and ≥ 200 mL, respectively, patients who had been treated with tiotropium were characterized as being responsive to tiotropium (TIO-R) or poorly responsive to tiotropium (TIO-PR). Results: Baseline characteristics were similar other than baseline FEV 1 , which was higher in the TIO-R group than in both the TIO-PR and placebo groups (p 1 was 1.08 L in the TIO-R group (n = 263), 0.95 L in the TIO-PR (n = 255), and 0.99 L in the placebo group (n = 328). The mean (± SD) morning predose FEV 1 at 1 year significantly (p 1 response to the end-of-trial trough response ( r = 0.43), but there was only a weak correlation to TDI focal score ( r = 0.17) or SGRQ total score ( r = −0.12). Conclusions: Tiotropium was effective in the treatment of patients with COPD, irrespective of the presence or absence of a short-term response on the first day of treatment. The short-term Bronchodilator response should not be used as a definitive criterion for prescribing long-term treatment with inhaled Bronchodilators.

repeatability and Bronchodilator reversibility of lung function in young children

Knowledge of short- and longer-term repeatability of lung function in health and disease is essential to determine Bronchodilator reversibility thresholds and to recognise if changes in lung function represent disease progression, therapeutic intervention or normal variability.

Multiple-breath washout indices (lung clearance index, conductive ventilation inhomogeneity ( S cond)) and specific airway resistance (s R aw) were measured in healthy children and stable wheezers. Measurements were performed at baseline and after 20 min without intervention to assess repeatability and determine Bronchodilator reversibility thresholds. Bronchodilator reversibility was assessed by repeating baseline measurements 20 min after inhaled salbutamol.

28 healthy controls, mean±sd age 6.1±0.7 years and 62 wheezers 5.4±0.6 years were tested. Baseline variability in multiple-breath washout indices and s Raw was not significantly different between wheezers and healthy controls. Significant Bronchodilator reversibility was only observed in wheezers for S cond (16%), but in both wheezers (37%) and healthy controls (20%) for s R aw. Some wheezers and healthy controls demonstrated increases in multiple-breath washout indices post-Bronchodilator.

Lung clearance index and s R aw demonstrate low baseline variability in healthy and diseased subjects. Neither multiple-breath washout indices nor s R aw are ideal for assessing Bronchodilator reversibility in young children with stable wheeze. These findings will help to interpret the effect of therapeutic interventions in children with respiratory diseases.