Alternative methods for assessing bronchodilator reversibility in chronic obstructive pulmonary disease.

摘要: BACKGROUND—Bronchodilator reversibility testing is recommended in all patients with chronic obstructive pulmonary disease (COPD) but does not predict improvements breathlessness or exercise performance. Two alternative ways of assessing lung mechanics—measurement end expiratory volume (EELV) using the inspiratory capacity manoeuvre and application negative pressure (NEP) during tidal breathing to detect airflow limitation—do relate degree COPD. Their usefulness as points bronchodilator has been examined. METHODS—We studied 20 clinically stable COPD (mean age 69.9 (1.5) years, 15 men, forced one second (FEV1) 29.5 (1.6)% predicted) flow limitation assessed by their maximum flow-volume loop. Spirometric parameters, slow vital (SVC), (IC), NEP were measured seated, before after nebulised saline, at intervals 5 mg salbutamol 500 µg ipratropium bromide. The attended twice treatment order was randomised. RESULTS—Mean FEV1, FVC, SVC, IC unchanged saline varied. FEV1 improved significantly (0.11 (0.02) l 0.09 l, respectively) did other volumes further significant increases combination. Tidal mean increased bronchodilators fell only combination treatment. initial score unrelated subsequent changes volume. CONCLUSIONS—NEP an appropriate measurement acute responsiveness. Changes larger than those may be more easily detected. However, our data showed no evidence for separation "reversible" "irreversible" groups whatever outcome measure adopted.