Changes in oscillatory impedance and nitrogen washout with combination fluticasone/salmeterol therapy in COPD - 06/02/14

Doi : 10.1016/j.rmed.2013.10.004

Sophie C. Timmins ^a,^b,^c,^d,^⁎ , Chantale Diba ^a,^d , Robin E. Schoeffel ^a,^b,^c , Cheryl M. Salome ^a,^c,^d , Gregory G. King ^a,^b,^c,^d , Cindy Thamrin ^a
^a The Woolcock Institute of Medical Research, Glebe, NSW 2037, Australia
^b Department of Respiratory Medicine Royal North Shore Hospital, St Leonards, NSW 2065, Australia
^c The Sydney Medical School, The University of Sydney, NSW 2006, Australia
^d Cooperative Research Centre for Asthma and Airways, Glebe, NSW 2037, Australia

^∗Corresponding author. Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, PO Box M77, Missenden Rd, Camperdown, NSW 2050, Australia. Tel.: +61 413536767; fax: +61 2 9114 0014.

Summary

Introduction

Combination inhaled corticosteroid/long-acting bronchodilator (ICS/LABA) therapy reduces the exacerbation rate and improves spirometry and quality of life in COPD. We hypothesized that ICS/LABA therapy also improves small airway function measured by FOT.

Methods

14 subjects with COPD were commenced on combination fluticasone propionate/salmeterol therapy for 3 months. At baseline, subjects completed the St George Respiratory Questionnaire (SGRQ) and underwent standard pulmonary function tests as well as forced oscillation technique (FOT) and single and multiple breath nitrogen washouts. All tests were repeated at the completion of 3 months of therapy.

Results

Subjects were of mean (SD) age 65.9 years (8.4), BMI 30.0 (5.6), pack years 51.4 (21.1), post-bronchodilator FEV₁% predicted 62.7 (20). At baseline, mean SGRQ total was 39.0 (17.7) and FRC% predicted 125.4 (31.3). From FOT, Rrs-total was 5.69 (1.29) cmH₂O/L/s, Xrs-total −3.48 (2.16) cmH₂O/L/s, EFL Index 3.51 (2.45) cmH₂O/L/s. After 3 months of therapy, there were significant improvements in SGRQ score (−13.81, p < 0.0001) despite no change in FEV₁ (+40 mL, p = 0.14). From FOT, total resistance (−0.63 cmH₂O/L/s, p = 0.0004), reactance (+1.2 cmH₂O/L/s, p = 0.013), and expiratory flow limitation (−1.21 cmH₂O/L/s, p = 0.02) also improved. There were no significant changes in ventilation heterogeneity indices.

Conclusion

Combination therapy is associated with improvements in small airways function in COPD, despite an absence of change in FEV₁. FOT may be a clinically useful marker of small airway function in COPD that is responsive to treatment.

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Keywords : COPD, Physiology, Forced oscillation technique, Therapy

Plan

☆	Institution: All work for this paper was conducted at Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia.

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Vol 108 - N° 2

P. 344-350 - février 2014 Retour au numéro

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Changes in oscillatory impedance and nitrogen washout with combination fluticasone/salmeterol therapy in COPD - 06/02/14

Summary

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Conclusion

Plan

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