Does the different amount of short-acting bronchodilator drugs have different effects on small airway response in bronchodilator test?

Ji Hyeon Baek; Homin Jang; You Hoon Jeon; Bo Seon Seo; Seung Jin Lee; Hye Mi Jee; Kyung Suk Lee; Young-Ho Jung; Youn Ho Sheen; Man Yong Han

doi:10.4168/aard.2016.4.4.284

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Baek, Jang, Jeon, Seo, Lee, Jee, Lee, Jung, Sheen, and Han: Does the different amount of short-acting bronchodilator drugs have different effects on small airway response in bronchodilator test?

Original Article

Allergy, Asthma & Respiratory Disease 2016; 4(4): 284-289.

Published online: 31 July 2016

DOI: https://doi.org/10.4168/aard.2016.4.4.284

Does the different amount of short-acting bronchodilator drugs have different effects on small airway response in bronchodilator test?

Ji Hyeon Baek¹, Homin Jang², You Hoon Jeon¹, Bo Seon Seo³, Seung Jin Lee³, Hye Mi Jee³, Kyung Suk Lee³, Young-Ho Jung³, Youn Ho Sheen², Man Yong Han³

¹Department of Pediatrics, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.

²Department of Pediatrics, CHA Gangnam Medical Center, CHA University, Seoul, Korea.

³Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, Korea.

Correspondence to: Man Yong Han. Department of Pediatrics, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea. Tel: +82-31-780-6262, Fax: +82-31-780-5239, drmesh@gmail.com

Received 9 February 2016 Revised 4 May 2016 Accepted 18 May 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/).

Abstract

Purpose

It is recommended to use 200 (2 puffs) or 400 (4 puffs) µg of salbutamol in the bronchodilator response (BDR) test. We aimed to compare the difference between these 2 doses with regard to small airway dysfunction.

Methods

One hundred sixteen subjects who visited the hospital for diagnosis or follow-up of asthma were consecutively enrolled between June 1 and November 31, 2013. The subjects were randomly assigned to the BDR test at the 2 doses (200 or 400 µg of salbutamol), with physicians blinded to the group each subject was assigned to and undertook the BDR test using the spirometry and impulse oscillometry system (IOS).

Results

A total of 116 subjects participated in this study; the mean age was 7.8±3.6 years. The number of participants who were assigned to 2 and 4 puffs groups was 59 and 57, respectively. The mean age was older in the 4 puffs group than in the 2 puffs group (P=0.008). There were no significant difference in spirometric and oscillometric parameters between the 2 and 4 puffs groups. However, in subgroup analysis of asthmatic patients on maintenance therapy (n=21), there was a significant difference in relative changes in Rrs5 between the 2 and 4 puffs groups (16.4%±9.6% vs. 28.7%±8.8%, P=0.035). The forced expiratory volume of 1 second showed a significant correlation with resistance in the 2 puffs group and with reactance in the 4 puffs group.

Conclusion

There was a significant relationship between the amounts of bronchodilators administered and the small airway dysfunction in children with asthma on maintenance therapy. Further research is warranted to delineate changes in spirometric and IOS measures in accordance with the different amounts of bronchodilators administered.

Keywords: Asthma, Bronchodilator, Respiratory function test, Spirometry, Airway resistance

Figures and Tables

Fig. 1

Changes in Rrs5 (A) and Xrs5 (B) of impulse oscillometry system according to changes in forced expiratory volume of 1 second (FEV₁) of spirometry (r=0.216, P=0.021 vs. r=0.250, P=0.007).

Fig. 2

The dotted line on the x-axis represents a 12% change in forced expiratory volume of 1 second (FEV₁) of spirometry and the one on the y-axis a 34% change in Rrs5 of impulse oscillometry system, thus showing where subjects are classified according to the 2 results.

Table 1

Clinical characteristics of 2 puff and 4 puff dose with salbutamol for bronchodilator response

Characteristic	2 Puff (n = 59)	4 Puff (n = 57)	P-value
Age (yr)	6.92 ± 3.40	8.65 ± 3.54	0.008
Male sex	39 (66.1)	31 (44.3)	0.197
Height (cm)	118.6 ± 19.0	131.3 ± 21.8	0.001
Monitoring asthma	14 (23.7)	7 (12.3)	0.109
Lung function test
Pre FEV₁ (z-score)	−0.61 ± 1.73	0.83 ± 1.74	0.507
Pre FEV₁ (Predicted)	94.9 ± 14.9	91.3 ± 16.4	0.229
Pre FEV₁/FVC (z-score)	−0.49 ± 1.05	−0.64 ± 1.37	0.503
Pre FEV₁/FVC (%)	89.3 ± 5.6	88.5 ± 5.7	0.292
Pre Rrs5 (z-score)	1.01 ± 1.01	0.73 ± 1.13	0.169
Pre Xrs5 (z-score)	0.31 ± 0.52	0.17 ± 0.57	0.178

Values are presented as mean±standard deviation or number (%).

FEV₁, forced expiratory volume of 1 second; FVC, forced vital capacity.

Table 2

Correlation of percent change of FEV1 and IOS parameter

FEV₁	Rrs5		Xrs5		Rrs10		Xrs10		AX
FEV₁	r	P-value	r	P-value	r	P-value	r	P-value	r	P-value
2 Puff	0.273	0.038	0.023	0.866	0.334	0.010	0.061	0.650	0.134	0.317
4 Puff	0.167	0.222	0.452	0.001	0.088	0.521	0.303	0.023	0.352	0.008
Total	0.216	0.021	0.252	0.007	0.192	0.041	0.211	0.024	0.266	0.004

FEV₁, forced expiratory volume of 1 second; IOS, impulse oscillometry system.

r means Pearson correlation coefficient;

Table 3

Difference of spiometric and oscillometric lung function test between the 2 puff and 4 puff with salbutamol

	z-score difference			Relative percent change difference
	2 Puff	4 Puff	P-value	2 Puff	4 Puff	P-value
Spirometry
FEV₁	0.63 ± 0.66	0.55 ± 0.65	0.542	6.53 ± 6.78	6.52 ± 7.89	0.993
FVC	0.34 ± 0.62	0.23 ± 0.72	0.364	3.58 ± 6.76	2.72 ± 7.16	0.507
FEV₁/FVC	0.49 ± 0.76	0.61 ± 0.94	0.449
FEF_25%–75%	0.83 ± 0.83	0.83 ± 0.66	0.991	23.2 ± 26.0	21.6 ± 17.7	0.706
IOS
Rrs5	0.99 ± 0.71	0.89 ± 0.77	0.47	17.7 ± 9.8	18.7 ± 12.9	0.639
Rrs10	0.67 ± 0.62	0.60 ± 0.82	0.604	15.3 ± 11.6	12.3 ± 36.0	0.556
Xrs5	0.42 ± 0.38	0.45 ± 1.25	0.826	19.5 ± 13.0	20.2 ± 51.3	0.928
Xrs10	0.69 ± 0.57	0.64 ± 0.50	0.617	35.2 ± 22.0	36.9 ± 33.7	0.753
AX	0.65 ± 0.57	0.57 ± 0.49	0.384	33.6 ± 17.1	33.7 ± 22.0	0.976

Values are presented as mean±standard deviation.

FEV₁, forced expiratory volume of 1 second; FVC, forced vital capacity; FEF_25%–75%, forced expiratory flow 25%–75%.

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ORCID iDs: Man Yong Han
https://orcid.org/http://orcid.org/0000-0002-9077-5779
Similar articles

Does the different amount of short-acting bronchodilator drugs have different effects on small airway response in bronchodilator test?

Abstract

Purpose

Methods

Results

Conclusion

Figures and Tables

Fig. 1

Changes in Rrs5 (A) and Xrs5 (B) of impulse oscillometry system according to changes in forced expiratory volume of 1 second (FEV1) of spirometry (r=0.216, P=0.021 vs. r=0.250, P=0.007).

Fig. 2

The dotted line on the x-axis represents a 12% change in forced expiratory volume of 1 second (FEV1) of spirometry and the one on the y-axis a 34% change in Rrs5 of impulse oscillometry system, thus showing where subjects are classified according to the 2 results.

Table 1

Clinical characteristics of 2 puff and 4 puff dose with salbutamol for bronchodilator response

Table 2

Correlation of percent change of FEV1 and IOS parameter

Table 3

Difference of spiometric and oscillometric lung function test between the 2 puff and 4 puff with salbutamol

References

Changes in Rrs5 (A) and Xrs5 (B) of impulse oscillometry system according to changes in forced expiratory volume of 1 second (FEV₁) of spirometry (r=0.216, P=0.021 vs. r=0.250, P=0.007).

The dotted line on the x-axis represents a 12% change in forced expiratory volume of 1 second (FEV₁) of spirometry and the one on the y-axis a 34% change in Rrs5 of impulse oscillometry system, thus showing where subjects are classified according to the 2 results.