International Journal of COPD (May 2020)

Role of the Bronchodilator Test Defined by the Forced Vital Capacity in Chronic Obstructive Pulmonary Disease Phenotyping

  • Zhang X,
  • Wu Z,
  • Liu Y,
  • Jiang S

Journal volume & issue
Vol. Volume 15
pp. 1199 – 1206

Abstract

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Xiaoling Zhang,1,* Zhenchao Wu,2– 4,* Yi Liu,1,2,4 Shujuan Jiang1,4 1Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong, People’s Republic of China; 2Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250000, Shandong, People’s Republic of China; 3Department of Pulmonary and Critical Care Medicine, The Third Affiliated Hospital of Shandong First Medical University, Jinan 250000, Shandong, People’s Republic of China; 4Shandong Key Laboratory of Infectious Respiratory Disease, Jinan 250000, Shandong, People’s Republic of China*These authors contributed equally to this workCorrespondence: Shujuan Jiang Email [email protected]: In clinical practice, some chronic obstructive pulmonary disease (COPD) patients experienced a remarkable increase in forced vital capacity (FVC) after bronchodilator administration, whereas forced expiratory volume in the first second (FEV1) remains substantially unchanged. We assume this may relate to airway inflammatory type. We aim to analyze the clinical characteristics and explore the usefulness of the bronchodilator test, especially FVC, in this new COPD phenotype.Patients and Methods: A total of 346 COPD patients with exacerbation who underwent bronchodilator tests, fractional exhaled nitric oxide (FeNO) measurements and blood eosinophil counts were analyzed. The characteristics, FeNO levels, and blood eosinophil counts were compared between patients with and without significant bronchodilator responsiveness in terms of FVC.Results: Patients with significant FVC responsiveness displayed poorer lung function and higher FeNO levels compared with those without considerable FVC responsiveness (Z= − 5.042 to − 0.375, p=0.000– 0.022). There is a discernible linear relationship between FeNO levels and FVC responsiveness to bronchodilator use (r=0.251, P=0.001). The application of bronchodilator responsiveness of FVC for detecting high FeNO levels in COPD patients exhibited relatively high sensitivity (61.8%) and specificity (86.7%).Conclusion: We demonstrated that COPD patients with significant FVC responsiveness had higher FeNO levels than non-responders and established a simple method for detecting high FeNO values. FVC responders may be identified as a separate group of COPD patients.Keywords: COPD, pulmonary function test, bronchodilator responsiveness, forced vital capacity, fractional exhaled nitric oxide

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