Santus Pierachille, Radovanovic Dejan, Henchi Sonia, Di Marco Fabiano, Centanni Stefano, D'Angelo Edgardo, Pecchiari Matteo
Dipartimento di Scienze della Salute, Università degli Studi di Milano, Pneumologia Riabilitativa Fondazione Salvatore Maugeri-IRCCS, Milan, Italy.
Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.
Respir Physiol Neurobiol. 2014 Jun 15;197:36-45. doi: 10.1016/j.resp.2014.03.012. Epub 2014 Apr 12.
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.
On two days, 60 COPD patients underwent dyspnea evaluation (VAS score) and pulmonary function testing at baseline and one hour after placebo or 300μg indacaterol administration.
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.
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.
在慢性阻塞性肺疾病（COPD）患者中，目前通过1秒用力呼气容积（ΔFEV1）和用力肺活量（ΔFVC）的变化来评估可逆性。通过降低外周气道平滑肌张力，支气管扩张剂应可减少动态肺过度充气、气体潴留，并可能减轻静息时的呼吸困难。因此，我们推测特定气道阻力变化（ΔsRAW）应能更好地表征对支气管扩张剂的急性反应。
60例COPD患者在两天内接受了呼吸困难评估（视觉模拟评分法[VAS]评分），并在基线时以及给予安慰剂或300μg茚达特罗后1小时进行了肺功能测试。
根据肺量计和基于ΔsRAW的标准分别确定了24例和45例反应者。ΔsRAW与胸腔内气体容积变化（ΔITGV）（r = 0.61；p < 0.001）、残气量变化（ΔRV）（r = 0.60；p < 0.001）、ΔFVC（r = 0.44；p = 0.001）和ΔVAS（r = 0.73；p < 0.001）相关，而ΔFEV1仅与ΔFVC相关（r = 0.34；p = 0.008）。仅当根据ΔsRAW对患者进行分层时，ΔITGV（p = 0.002）、ΔRV（p = 0.023）和ΔVAS（p < 0.001）才出现显著差异。
在评估支气管扩张剂的急性功能效果时，基于ΔsRAW的标准优于基于FEV1 - FVC的标准，因为它与支气管扩张剂引起的肺力学改善和静息时呼吸困难的关系更为密切。
