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Research ArticleOriginal Research

Spirometric Response to Bronchodilator and Eucapnic Voluntary Hyperpnea in Adults With Asthma

Hans Christian Haverkamp, David A Kaminsky, Sterling M McPherson and Charles G Irvin
Respiratory Care August 2021, 66 (8) 1282-1290; DOI: https://doi.org/10.4187/respcare.08421
Hans Christian Haverkamp
Department of Nutrition and Exercise Physiology, Washington State University-Health Sciences Spokane, Elson S. Floyd College of Medicine, Spokane, Washington.
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  • For correspondence: [email protected]
David A Kaminsky
Department of Medicine, University of Vermont, Vermont Lung Center, Burlington, Vermont.
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Sterling M McPherson
Department of Medical Education and Clinical Sciences, Washington State University-Health Sciences Spokane, Elson S. Floyd College of Medicine, Spokane, Washington.
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Charles G Irvin
Department of Medicine, University of Vermont, Vermont Lung Center, Burlington, Vermont.
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Abstract

BACKGROUND: The spirometric response to fast-acting bronchodilator is used clinically to diagnose asthma and in clinical research to verify its presence. However, bronchodilator responsiveness does not correlate with airway hyper-responsiveness measured with the direct-acting stimulus of methacholine, demonstrating that bronchodilator responsiveness is a problematic method for diagnosing asthma. The relationship between bronchodilator responsiveness and airway hyper-responsiveness assessed with indirect-acting stimuli is not known.

METHODS: Retrospectively, the spirometric responses to inhaled bronchodilator and a eucapnic voluntary hyperpnea challenge (EVH) were compared in 39 non-smoking adult subjects with asthma (26 male, 13 female; mean ± SD age 26.9 ± 7.8 y; mean ± SD body mass index 26.3 ± 4.7 kg/m2). All subjects met one or both of 2 criteria: ≥ 12% and 200 mL increase in FEV1 after inhaled bronchodilator, and ≥ 10% decrease in FEV1 after an EVH challenge.

RESULTS: Overall, FEV1 increased by 9.9 ± 7.9% after bronchodilator (3.93 ± 0.97 to 4.28 ± 0.91 L, P < .001) and decreased by 23.9 ± 15.0% after the EVH challenge (3.89 ± 0.89 to 2.96 ± 0.88 L, P < .001). However, the change in FEV1 after bronchodilator did not correlate with the change after EVH challenge (r = 0.062, P = .71). Significant bronchodilator responsiveness predicted a positive response to EVH challenge in 9 of 33 subjects (sensitivity 27%). Following EVH, the change in FEV1 strongly correlated with the change in FVC (FEV1 percent change vs FVC percent change, r = 0.831, P < .001; FEV1 ΔL vs FVC ΔL, r = 0.799, P < .001).

CONCLUSIONS: These results extend previous findings that demonstrate a lack of association between bronchodilator responsiveness and methacholine responsiveness. Given the poor concordance between the spirometric response to fast-acting bronchodilator and the EVH challenge, these findings suggest that the airway response to inhaled β2-agonist must be interpreted with caution and in the context of its determinants and limitations.

  • airway hyperresponsiveness
  • bronchoconstriction
  • bronchoprovocation challenge
  • bronchodilator responsiveness
  • spirometry

Footnotes

  • Correspondence: Hans Christian Haverkamp PhD, Washington State University-Health Sciences Spokane, Spokane, Washington. E-mail: hans.haverkamp{at}wsu.edu
  • This work was supported in part by National Institutes of Health grant P20GM103449. The authors have disclosed no conflicts of interest.

  • Copyright © 2021 by Daedalus Enterprises
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Respiratory Care: 66 (8)
Respiratory Care
Vol. 66, Issue 8
1 Aug 2021
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Spirometric Response to Bronchodilator and Eucapnic Voluntary Hyperpnea in Adults With Asthma
Hans Christian Haverkamp, David A Kaminsky, Sterling M McPherson, Charles G Irvin
Respiratory Care Aug 2021, 66 (8) 1282-1290; DOI: 10.4187/respcare.08421

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Spirometric Response to Bronchodilator and Eucapnic Voluntary Hyperpnea in Adults With Asthma
Hans Christian Haverkamp, David A Kaminsky, Sterling M McPherson, Charles G Irvin
Respiratory Care Aug 2021, 66 (8) 1282-1290; DOI: 10.4187/respcare.08421
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Keywords

  • airway hyperresponsiveness
  • bronchoconstriction
  • bronchoprovocation challenge
  • bronchodilator responsiveness
  • spirometry

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