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Bronchodilator Responsiveness Measured by Spirometry and Impulse Oscillometry in Patients with Asthma After Short Acting Antimuscarinic and/or Beta-2-Agonists Inhalation

van der Burg, Nicole M D LU orcid ; Ekelund, Carl ; Bjermer, Leif H LU ; Aronsson, David LU ; Ankerst, Jaro LU orcid and Tufvesson, Ellen LU (2024) In Journal of Asthma and Allergy 17. p.21-32
Abstract

BACKGROUND: Bronchodilator responsiveness (BDR) in asthma involves both the central and peripheral airways but is primarily relieved with beta-2-agonists and evaluated by spirometry. To date, antimuscarinics can be added as a reliever medication in more severe asthma. We hypothesize that combining both short-acting beta-2 agonist (SABA) and short-acting muscarinic antagonist (SAMA) could also improve the responsiveness in mild-moderate asthma. Therefore, we aimed to compare the direct effects of inhaling SABA alone, SAMA alone or combining both SABA and SAMA on the central and peripheral airways in asthma.

METHODS: Twenty-three patients with mild-moderate BDR in asthma performed dynamic spirometry and impulse oscillometry before... (More)

BACKGROUND: Bronchodilator responsiveness (BDR) in asthma involves both the central and peripheral airways but is primarily relieved with beta-2-agonists and evaluated by spirometry. To date, antimuscarinics can be added as a reliever medication in more severe asthma. We hypothesize that combining both short-acting beta-2 agonist (SABA) and short-acting muscarinic antagonist (SAMA) could also improve the responsiveness in mild-moderate asthma. Therefore, we aimed to compare the direct effects of inhaling SABA alone, SAMA alone or combining both SABA and SAMA on the central and peripheral airways in asthma.

METHODS: Twenty-three patients with mild-moderate BDR in asthma performed dynamic spirometry and impulse oscillometry before (baseline) and multiple timepoints within an hour after inhalation of SABA (salbutamol), SAMA (ipratropium bromide), or both SABA and SAMA at three different visits.

RESULTS: The use of SAMA alone did not show any improvement compared to the use of SABA alone. Inhalation of SABA+SAMA, however, averaged either similar or better BDR than SABA alone in FEV
1, MMEF, FVC, R5, R20 and R5-R20. Inhaling SABA+SAMA reached a stable BDR in more patients within 0-10 minutes and also reached the FEV
1 (Δ%)>12% faster (3.5 minutes) than inhaling SABA alone (5.1 minutes). Inhaling SABA+SAMA was significantly better than SAMA alone in FEV
1 (
p = 0.015), MMEF (
p = 0.0059) and R20 (
p = 0.0049). Using these three variables highlighted a subgroup (30%, including more males) of patients that were more responsive to inhaling SABA+SAMA than SABA alone.

CONCLUSION: Overall, combining SAMA with SABA was faster and more consistent at increasing the lung function than SABA alone or SAMA alone, and the additive effect was best captured by incorporating peripheral-related variables. Therefore, SAMA should be considered as an add-on reliever for mild-moderate patients with BDR in asthma.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
BDR, central airway, mild-moderate asthma, peripheral airways, SABA, SAMA
in
Journal of Asthma and Allergy
volume
17
pages
12 pages
publisher
Dove Medical Press Ltd.
external identifiers
  • scopus:85183881049
  • pmid:38264293
ISSN
1178-6965
DOI
10.2147/JAA.S442217
language
English
LU publication?
yes
additional info
© 2024 van der Burg et al.
id
ed899cdf-d688-4278-b9e1-30bf0dbda651
date added to LUP
2024-02-05 13:17:21
date last changed
2024-04-16 14:11:24
@article{ed899cdf-d688-4278-b9e1-30bf0dbda651,
  abstract     = {{<p>BACKGROUND: Bronchodilator responsiveness (BDR) in asthma involves both the central and peripheral airways but is primarily relieved with beta-2-agonists and evaluated by spirometry. To date, antimuscarinics can be added as a reliever medication in more severe asthma. We hypothesize that combining both short-acting beta-2 agonist (SABA) and short-acting muscarinic antagonist (SAMA) could also improve the responsiveness in mild-moderate asthma. Therefore, we aimed to compare the direct effects of inhaling SABA alone, SAMA alone or combining both SABA and SAMA on the central and peripheral airways in asthma.</p><p>METHODS: Twenty-three patients with mild-moderate BDR in asthma performed dynamic spirometry and impulse oscillometry before (baseline) and multiple timepoints within an hour after inhalation of SABA (salbutamol), SAMA (ipratropium bromide), or both SABA and SAMA at three different visits.</p><p>RESULTS: The use of SAMA alone did not show any improvement compared to the use of SABA alone. Inhalation of SABA+SAMA, however, averaged either similar or better BDR than SABA alone in FEV<br>
 1, MMEF, FVC, R5, R20 and R5-R20. Inhaling SABA+SAMA reached a stable BDR in more patients within 0-10 minutes and also reached the FEV<br>
 1 (Δ%)&gt;12% faster (3.5 minutes) than inhaling SABA alone (5.1 minutes). Inhaling SABA+SAMA was significantly better than SAMA alone in FEV<br>
 1 (<br>
 p = 0.015), MMEF (<br>
 p = 0.0059) and R20 (<br>
 p = 0.0049). Using these three variables highlighted a subgroup (30%, including more males) of patients that were more responsive to inhaling SABA+SAMA than SABA alone.<br>
 </p><p>CONCLUSION: Overall, combining SAMA with SABA was faster and more consistent at increasing the lung function than SABA alone or SAMA alone, and the additive effect was best captured by incorporating peripheral-related variables. Therefore, SAMA should be considered as an add-on reliever for mild-moderate patients with BDR in asthma.</p>}},
  author       = {{van der Burg, Nicole M D and Ekelund, Carl and Bjermer, Leif H and Aronsson, David and Ankerst, Jaro and Tufvesson, Ellen}},
  issn         = {{1178-6965}},
  keywords     = {{BDR; central airway; mild-moderate asthma; peripheral airways; SABA; SAMA}},
  language     = {{eng}},
  pages        = {{21--32}},
  publisher    = {{Dove Medical Press Ltd.}},
  series       = {{Journal of Asthma and Allergy}},
  title        = {{Bronchodilator Responsiveness Measured by Spirometry and Impulse Oscillometry in Patients with Asthma After Short Acting Antimuscarinic and/or Beta-2-Agonists Inhalation}},
  url          = {{http://dx.doi.org/10.2147/JAA.S442217}},
  doi          = {{10.2147/JAA.S442217}},
  volume       = {{17}},
  year         = {{2024}},
}