Current Bronchodilator Responsiveness Criteria Underestimate Asthma in Older Adults
| Autor: | Demetra Antimisiaris, Rangaraj K. Gopalraj, Barbara J. Polivka, Bryan L. Beatty, Rodney J. Folz, Rodrigo Cavallazzi, Rachel Vickers-Smith |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Pulmonary and Respiratory Medicine
Spirometry medicine.medical_specialty Multivariate analysis medicine.drug_class Critical Care and Intensive Care Medicine Logistic regression Bronchial Provocation Tests Pulmonary function testing Forced Expiratory Volume Internal medicine Bronchodilator Humans Medicine Suspected asthma Aged Original Research Asthma medicine.diagnostic_test business.industry General Medicine Middle Aged medicine.disease Bronchodilator Agents Cross-Sectional Studies business Asthma Control Test |
| Zdroj: | Respir Care |
| ISSN: | 1943-3654 0020-1324 |
| DOI: | 10.4187/respcare.07132 |
| Popis: | BACKGROUND: Asthma is common in older adults and is confirmed by demonstration of variable expiratory air-flow limitations, typically evaluated by spirometric assessment of bronchodilator responsiveness. However, many patients with clinically suspected asthma and documented air-flow obstruction do not exhibit a post-bronchodilator response that meets or exceeds current established guidelines. We investigated if extending the time from bronchodilator administration to assessment of bronchodilator response increases the yield of spirometry for the diagnosis of asthma in older adults. METHODS: This was a cross-sectional study. The subjects were non-smokers, ≥ 60 y old, and with suspected asthma. Subjects were characterized as (1) those with a positive bronchodilator response on the 30-min post-bronchodilator spirometry, (2) those with a positive bronchodilator response on the 60-min post-bronchodilator spirometry, and (3) those without a positive bronchodilator response but with a positive methacholine challenge test. Factors associated with a late response to bronchodilator were evaluated by using bivariate analysis and by multivariate analysis by using a logistic regression model. RESULTS: This study enrolled 165 subjects. Of these, 81 (49.1%) had a positive bronchodilator response on 30-min post-bronchodilator spirometry; 25 (15.2%) had a positive bronchodilator response on the 1-h post-bronchodilator spirometry; and 59 (35.8%) had no positive bronchodilator response but had a positive methacholine challenge test. On multivariable regression analysis, those with a higher baseline percentage of predicted FEV1, higher scores on a standard asthma control test, and wheezing and/or cough after exercise were more likely to either have a late bronchodilator response or no bronchodilator response. CONCLUSIONS: Our study showed that a late positive response to bronchodilator use was more common than previously presumed in older subjects with suspected asthma. Pulmonary function testing laboratories should consider routinely reassessing spirometry at 1 h after bronchodilator use if the earlier assessment did not reveal a significant response. |
| Databáze: | OpenAIRE |
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