Bojana Butorac Petanjek

Bronchodilator Response in Patients with Persistent Allergic Asthma Could Not Predict Airway Hyperresponsiveness

Anticholinergics, or specific antimuscarinic agents, by inhibition of muscarinic receptors cause bronchodilatation, which might correlate with activation of these receptors by the muscarinic agonist methacholine. The aim of this study was to determine whether a positive bronchodilator response to the anticholinergic ipratropium bromide could predict airway hyperresponsiveness in patients with persistent allergic asthma. The study comprised 40 patients with mild and moderate persistent allergic asthma. Diagnosis was established by clinical and functional follow-up (skin-prick test, spirometry, bronchodilator tests with salbutamol and ipratropium bromide, and methacholine challenge testing). The bronchodilator response was positive to both bronchodilator drugs in all patients. After salbutamol inhalation, forced expiratory volume in 1 second (FEV1) increased by 18.39 ± 6.18%, p < .01, whereas after ipratropium bromide, FEV1 increased by 19.14 ± 6.74%, p < .01. The mean value of FEV1 decreased by 25.75 ± 5.16%, p < .01 after methacholine (PC20 FEV1 [provocative concentration of methacholine that results in a 20% fall in FEV1] from 0.026 to 1.914 mg/mL). Using linear regression, between methacholine challenge testing and bronchodilator response to salbutamol, a positive, weak, and stastistically significant correlation for FEV1 was found (p < .05). Correlations between methacholine challenge testing and the bronchodilator response to ipratropium bromide were positive and weak but not statistically significant. The positive bronchodilator response to ipratropium bromide could not predict airway hyperresponsiveness.

Does positive bronchodilator reversibility testing predict positive bronchoprovocative methacholine challenge testing in suspected asthma patients

Aim: The study aims to present the relation between positive outcome of bronchodilator testing (BDT) and positive bronchoprovocative methacholine challenge testing (BPT) in 282 patients that were diagnosed under the suspicion of asthma, but with normal basal spirometry. Methods: Spirometry with bronchodilator test with salbutamol (400µg) and bronchoprovocative methacholine challenge testing were performed in all patients. The methacholine test was considered positive at PC 20 FEV1 Results: Out of 282 patients, 100 were male (35.5%), the number of smokers was 33 (11.7%). The average value of basal FEV 1 expressed as mean was 101±13.3 percent of reference value. The frequency of positive BPT was diagnosed in 142 out of 282 cases (50.4 %). The frequency of positive BDT was diagnosed in 50 out of 282 cases (17.7 %). In 113 subjects with positive methacholine challenge tests the BDT was negative (79.6%). Out of 50 positive BDT subjects only in 29 patients (20.4% of all methacholine positive cases) were found positive methacholine challenge tests and in 21 patients (42%) were found negative. In 119 cases (42%) with suspected asthma symptoms BPT and BDT were both negative. While the frequency of positive BDT in different age categories didn9t reach significance level (P th year of life. Conclusion: Observed differences in BDT and BPT in cases of suspected asthma and its clinical implications indicate the need for further research especially of influence of ageing on respiratory system.

Predictor parameters for exercise intolerance in patients with chronic obstructive pulmonary disease (COPD)

Aim: The aim of this study was to investigate whether skeletal muscle and nutrition status parameters besides lung function parameters can predict exercise intolerance in COPD patients. Methods: The study recruited 140 patients with moderate (GOLD 2) and severe (GOLD 3) stable COPD. In all patients exercise tolerance was measured using a six-minute walk test (6-MWT). Lung function measurements (spirometry, lung diffusion), assessment of the level of dyspnea, fatigue, nutrition status and skeletal muscle function parameters were performed in all patients. Results: Age, peak expiratory flow (PEF), CO diffusion coefficient, general fatigue, waist circumference, suprailiac and abdominal skin folds, left inspiratory muscle strenght and thoracic vertebra index (OTT) were depicted as parameters which can explain 58,16% of the variability for the 6-MWT (m) results. The model for 6-MWT (%) explaining 48,60% variability of the test results depicted GOLD stage, body mass index, physical fatigue, waist circumference, suprailiac and abdominal skin folds, left inspiratory muscle strenght, OTT and lower limbs lenght as significant predictors. Discriminant analysis (excluding FVC and FEV 1 from the list of independent variables) depicted PEF, left inspiratory musle strenght, 6-MWT (%), fat free mass index, mental fatigue, difference in Borg dyspnea score and heart rate at the end of 6-MWT as significant predictor variables for the COPD severity stage with the 86,43% of diagnostic accuracy (GOLD 2 or GOLD 3). Conclusion: Our results suggest that skeletal muscle parameters and nutrition status parameters are independent predictor parameters for exercise intolerance and COPD severity stages.