Bronchodilatation: response in FEV1 and VC
An increase in FEV1 after administering a bronchodilator drug is usually accompanied by an increase in the VC. The correlation is not very strong: the VC may increase while the FEV1 diminishes, and vice versa. The data relate to about 4300 patients in whom spirometry was performed before and after bronchodilatation at Dijkzigt Ziekenhuis, Rotterdam.
Bronchodilator effectiveness has historically focused on improvement in the FEV1. However, the more severe the airway obstruction in COPD, the larger the improvement in the FVC in many patients with no or a small response in FEV1. Such a 'volume response' might be due to a more complete expiration, reflected by an increased forced expiratory time (FET), but occurs also when FET has not increased after bronchodilation. The 'volume response' is clinically relevant, as disclosed by decreased dyspnea and improved exercise performance.
- Belman MJ, Botnick WC, Shin JW. Inhaled bronchodilators reduce dynamic hyperinflation during exercise in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1996; 153: 967-975. PubMed
- Cerveri I, Pellegrino R, Dore R, Corsico A, Fulgoni P, van de Woestijne KP, Brusasco V. Mechanisms for isolated volume response to a bronchodilator in patients with COPD. J Appl Physiol. 2000;88: 1989-1995. PubMed
- O'Donnell DE, Forkert L, Webb KA. Evaluation of bronchodilator responses in patients with "irreversible" emphysema. Eur Respir J 2001;18: 914-920. PubMed
- Newton, MF, O’Donnell, DE, Forkert, L Response of lung volumes to inhaled salbutamol in a large population of patients with severe hyperinflation. Chest 2002; 121, 1042-1050. PubMed
- Figueroa-Casas JB, Diez A.R, Rondelli M, Figueroa-Casas M, Figueroa-Casas JC. Assessment of bronchodilator response through changes in lung volumes in chronic airflow obstruction. Medicina (B. Aires) 2003; 63: 377-382. PubMed
- Hur GY, Lee SH, Jung JY, Kim SJ, Lee KJ, Lee EJ, Jung HC, Lee SY, Kim JH, Shin C, Shim JJ, In KH, Kang KH, Yoo SH. Isolated volume response to a bronchodilator and GOLD classification in patients with COPD. Tuberc Respir Dis 2005; 59: 23-29. Korean. PubMed
- Schermer T, Heijdra Y, Zadel S, van den Bemt L, Boonman-de Winter L, Dekhuijzen R, Smeele I. Flow and volume responses after routine salbutamol reversibility testing in mild to very severe COPD. Respir Med 2007;101: 1355-13-62. PubMed
- Walker PP, Calverley PM. The volumetric response to bronchodilators in stable chronic obstructive pulmonary disease. COPD 2008;5: 147-152. PubMed
- Ben Saad H, Préfaut C, Tabka Z, Zbidi A, Hayot M. The forgotten message from gold: FVC is a primary clinical outcome measure of bronchodilator reversibility in COPD. Pulm Pharmacol Ther 2008; 21: 767-773. PubMed
- Tashkin DP, Celli B, Decramer M, Liu D, Burkhart D, Cassino C, Kesten S. Bronchodilator responsiveness in patients with COPD. Eur Respir J 2008; 31: 742–750. PubMed
- Zhang FQ, Zheng JP, Wang JH, Lu WB, Wu RX, Li XS, Xian QZ, Gao Y, Jiang M. Comparison of lung volume response with airflow response to bronchodilator in patients with chronic obstructive pulmonary disease. Article in Chinese]. Zhonghua Jie He He Hu Xi Za Zhi 2010; 33: 109-113. PubMed
- Deesomchok A, Webb KA, Forkert L, Lam YM, Ofir D, Jensen D, O'Donnell DE. Lung hyperinflation and its reversibility in patients with airway obstruction of varying severity. COPD 2010; 7: 428-437. PubMed