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Paradoxical bronchospasm in U.S. military veterans with COPD or asthma at a tertiary VA medical center in Chicago, Illinois - 14/08/21

Doi : 10.1016/j.resmer.2021.100855 
Malvika Kaul, MD 1, 2, , Karen Turner, RRT, MBA 1, Israel Rubinstein, MD 1, 2
1 Section of Pulmonary, Critical Care, and Sleep Medicine, Medical Service, Jesse Brown VA Medical Center 
2 Division of Pulmonary, Critical Care, Sleep and Allergy Medicine, Department of Medicine, University of Illinois at Chicago Chicago, Illinois 60612, USA 

Correspondence Author: Malvika Kaul, MD, Fellow Medical Service (111), Jesse Brown VA Medical Center, 820 South Damen Avenue, Chicago, Illinois 60612, USAFellow Medical Service (111)Jesse Brown VA Medical Center820 South Damen AvenueChicagoIllinois60612USA
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Abstract

Inhaled short-acting β2-adrenergic agonists can rarely elicit paradoxical bronchospasm (PB), which may be fatal. The purpose to this study was to determine whether post-bronchodilator PB is reported in spirometry test results of veterans with Chronic Obstructive Pulmonary Disease (COPD) or asthma followed at the Jesse Brown Veterans Affairs (VA) Medical Center in Chicago between 2017-2020. Eighteen of 1,150 test reports reviewed were identified with post-bronchodilator PB (1.5%).12 out of the 18 identified patients with PB had COPD, 4 hadasthma and 2 had asthma/COPD. No report alluded to post-bronchodilator PB. Among the identified PB patients, there were 17 males and one female, 14 African Americans, 3 Caucasian and one Latinx, aged 67±8 years (mean±SD) with BMI 28±5 kg/m2. Thirteen were ex-tobacco smokers, 4 current smokers and one never smoked. Most recent chest CT revealed emphysema in 8 veterans with COPD and bronchial wall thickening in 3. Chest radiographs of 4 veterans with asthma were unremarkable. All veterans were treated with inhaled β2-adrenergic agonists. Five were treated with cardio selective beta1 blockers and 10 for gastroesophageal reflux disease. Eleven veterans were diagnosed with obstructive sleep apnea. In 12 veterans, inhaled albuterol (4 actuations)-induced decrease in FEV1 was 22±8% and 367±167 mL from baseline. In 6 veterans, only FVC decreased significantly from baseline (14±3% and 448±179 mL). No veteran reported respiratory symptoms during or after spirometry testing. Two veterans died during follow-up. Based on spirometry test reports, inhaled β2-adrenergic agonists were discontinued in 2 veterans with COPD and asthma. We propose that post-bronchodilator PB observed during spirometry testing of veterans should be recognized and reported, and its possible clinical implications addressed accordingly.

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Key Words : spirometry, bronchoconstriction, β2-adrenoceptor agonist, COPD, asthma, African Americans


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