Shin Hong-Joon, Kim Tae-Ok, Kim Yu-Il, Kim Sang-Hoon, Kim Hyun Kuk, Kim Yong-Hyun, Byun Min Kwang, Jung Ki-Suck, Yoo Kwang-Ha, Lee Jae Seung, Lim Sung-Chul
Division of Pulmonary Medicine, Department of Internal Medicine, Chonnam National University Hospital, Kwangju, South Korea.
Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, South Korea.
J Thorac Dis. 2021 Feb;13(2):511-520. doi: 10.21037/jtd-20-985.
There are a few studies about paradoxical bronchodilator response (BDR), which means a decrease in forced expiratory volume in 1 second (FEV) or forced vital capacity (FVC) after short-acting bronchodilator administration in patients with chronic obstructive pulmonary disease (COPD). We evaluated the effect of paradoxical BDR on the clinical outcomes of COPD patients in South Korea.
We analyzed the KOrea COpd Subgroup Study team (KOCOSS) cohort data in South Korea between January 2012 and December 2017. BDR was defined as at least a 12% and 200-mL reduction in FEV or FVC after bronchodilator administration.
A total of 1,991 patients were included in this study. A paradoxical BDR was noted in 57 (2.9%) patients and was independently associated with worse dyspnea and poor quality of life. High C-reactive protein (CRP) levels were associated with a paradoxical BDR (OR, 1.05; 95% CI, 1.01-1.09; P=0.003). However, paradoxical BDR was not associated with severe acute exacerbations. Pre-bronchodilator FEV (L) showed a higher area under the curve (AUC) for predicting severe acute exacerbations than the post-bronchodilator FEV (L) in the paradoxical BDR group (0.788 0.752).
A paradoxical reduction of FEV or FVC after bronchodilator administration may be associated with chronic inflammation in the airway and independently associated with worse respiratory symptoms and poor quality of life.
关于矛盾性支气管扩张反应（BDR）的研究较少，矛盾性支气管扩张反应是指慢性阻塞性肺疾病（COPD）患者在使用短效支气管扩张剂后1秒用力呼气容积（FEV）或用力肺活量（FVC）下降。我们评估了矛盾性BDR对韩国COPD患者临床结局的影响。
我们分析了2012年1月至2017年12月期间韩国慢性阻塞性肺疾病亚组研究团队（KOCOSS）的队列数据。BDR定义为使用支气管扩张剂后FEV或FVC至少降低12%且降低200毫升。
本研究共纳入1991例患者。57例（2.9%）患者出现矛盾性BDR，且与更严重的呼吸困难和生活质量差独立相关。高C反应蛋白（CRP）水平与矛盾性BDR相关（OR，1.05；95%CI，1.01 - 1.09；P = 0.003）。然而，矛盾性BDR与严重急性加重无关。在矛盾性BDR组中，支气管扩张剂使用前的FEV（L）在预测严重急性加重方面的曲线下面积（AUC）高于支气管扩张剂使用后的FEV（L）（0.788对0.752）。
支气管扩张剂使用后FEV或FVC的矛盾性降低可能与气道慢性炎症有关，并与更严重的呼吸道症状和生活质量差独立相关。
