دورية أكاديمية
أعرض في EDS

Variability of bronchodilator response and effects of inhaled corticosteroid treatment in obstructive airways disease. Dutch CNSLD Study Group.

التفاصيل البيبلوغرافية
العنوان: Variability of bronchodilator response and effects of inhaled corticosteroid treatment in obstructive airways disease. Dutch CNSLD Study Group.
المؤلفون: Kerstjens HA; Department of Pulmonary Medicine, University Hospital Groningen, The Netherlands., Brand PL, Quanjer PH, van der Bruggen-Bogaarts BA, Koëter GH, Postma DS
المصدر: Thorax [Thorax] 1993 Jul; Vol. 48 (7), pp. 722-9.
نوع المنشور: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: British Medical Assn Country of Publication: England NLM ID: 0417353 Publication Model: Print Cited Medium: Print ISSN: 0040-6376 (Print) Linking ISSN: 00406376 NLM ISO Abbreviation: Thorax Subsets: MEDLINE
أسماء مطبوعة: Original Publication: London : British Medical Assn.
مواضيع طبية MeSH: Beclomethasone/*administration & dosage , Bronchi/*physiopathology , Lung Diseases, Obstructive/*drug therapy, Administration, Inhalation ; Adolescent ; Adult ; Albuterol/administration & dosage ; Asthma/drug therapy ; Asthma/physiopathology ; Bronchial Provocation Tests ; Double-Blind Method ; Female ; Forced Expiratory Volume ; Humans ; Ipratropium/administration & dosage ; Lung Diseases, Obstructive/physiopathology ; Male ; Middle Aged ; Prognosis ; Terbutaline/administration & dosage
مستخلص: Background: In the day to day care of obstructive airways diseases (asthma and chronic obstructive pulmonary disease) important decisions such as disease classification and choice of therapy are based on assessment of the bronchodilator response. However, surprisingly little is known of the long term course of the bronchodilator response in patients with obstructive airways disease.
Methods: Data from a multicentre trial were used in which 274 patients aged 18-60 years with airways obstruction were selected with PC20 < 8 mg/ml and FEV1 < 95% CI of predicted. FEV1 was measured before and 20 minutes after 1000 micrograms terbutaline and 40 minutes after an additional 80 micrograms ipratropium bromide. Data were analysed from 185 patients who were followed up for 21 months (five measurements). Four different expressions of bronchodilator response (BDR) were examined for change under long term therapy, long term variability, and prognostic value in predicting response to inhaled corticosteroids.
Results: There was a significant reduction in BDR of 117 ml after three months of treatment with a beta 2 agonist plus a corticosteroid (BA + CS), but not after bronchodilators only. Significant reductions with BA + CS were also found in BDR as a percentage of initial FEV1, and in BDR as a percentage of predicted FEV1. Bronchodilator tests were quite variable (SD 186 ml or 11% of initial value) and less than half of the patients could consistently be classified as "irreversible" with recommended cutoff levels. The bronchodilator response at the start of the study proved to be a poor predictor of improvement in FEV1 under BA + CS treatment (correct prediction 60%).
Conclusions: Bronchodilator responses decrease substantially with inhaled corticosteroid therapy, and within subject variability is considerable both in asthma and chronic obstructive pulmonary disease. Dichotomous decisions on whether patients are "irreversible" according to any single bronchodilator measurement should therefore be made with great caution. The bronchodilator response cannot be used accurately as a predictor of response to inhaled corticosteroids in obstructive airways disease.
References: Br Med J. 1975 Feb 22;1(5955):430-2. (PMID: 1090337)
Eur Respir J. 1992 Sep;5(8):975-81. (PMID: 1426206)
Thorax. 1978 Apr;33(2):214-8. (PMID: 351848)
Ann Intern Med. 1982 Jan;96(1):17-21. (PMID: 7032378)
J Allergy Clin Immunol. 1982 May;69(5):467-73. (PMID: 6210726)
Thorax. 1984 Dec;39(12):928-32. (PMID: 6515598)
J Allergy Clin Immunol. 1985 Jan;75(1 Pt 1):1-13. (PMID: 2578492)
Am Rev Respir Dis. 1985 Oct;132(4):858-64. (PMID: 4051321)
Am Rev Respir Dis. 1986 May;133(5):814-9. (PMID: 3706890)
Am Rev Respir Dis. 1986 Jun;133(6):1171-80. (PMID: 3717766)
Thorax. 1988 Apr;43(4):265-7. (PMID: 3406912)
Chest. 1988 Oct;94(4):718-22. (PMID: 2971515)
Eur Respir J. 1988 Jun;1(6):531-5. (PMID: 2971564)
Am Rev Respir Dis. 1988 Aug;138(2):317-20. (PMID: 3195831)
Thorax. 1990 Mar;45(3):190-4. (PMID: 2330551)
Thorax. 1991 Jun;46(6):454-6. (PMID: 1858087)
Thorax. 1991 Jan;46(1):43-5. (PMID: 1831301)
Eur Respir J. 1992 Jan;5(1):21-31. (PMID: 1533595)
Thorax. 1992 Jun;47(6):429-36. (PMID: 1496502)
N Engl J Med. 1992 Nov 12;327(20):1413-9. (PMID: 1357553)
Clin Allergy. 1977 May;7(3):235-43. (PMID: 908121)
المشرفين على المادة: GR88G0I6UL (Ipratropium)
KGZ1SLC28Z (Beclomethasone)
N8ONU3L3PG (Terbutaline)
QF8SVZ843E (Albuterol)
تواريخ الأحداث: Date Created: 19930701 Date Completed: 19940510 Latest Revision: 20190503
رمز التحديث: 20231215
مُعرف محوري في PubMed: PMC464656
DOI: 10.1136/thx.48.7.722
PMID: 8153921
قاعدة البيانات: MEDLINE
الوصف
تدمد:0040-6376
DOI:10.1136/thx.48.7.722