Abstract Although the diagnosis and assessment of airflow obstruction is accomplished by pulmonary function test measurements (PFTs),1 it has recently become clear that comparing PFTs before and after bronchodilator (BD) is of limited value either to (1) separate chronic obstructive pulmonary diseases (COPD) from asthma2 or (2) predict the long-term clinical response of patients with COPD to BD therapy.3 The article by Guyatt et al4 in this issue of the Archives adds to the growing evidence that PFTs before and after BD are indeed imperfect guides to predicting clinical response to BD therapy in COPD. We will review the potential reasons that may explain this finding. See also p 1949. Traditionally, the mainstay of therapy in COPD has been the use of pharmacologic agents directed at improving the basic physiologic abnormality of chronic airflow obstruction.5 The principal BDs used have been a variety of inhaled sympathomimetic References 1. Task Group appointed by the ATS Scientific Assembly on Clinical Problems: Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma. Am Rev Respir Dis 1987;136:225-231.Crossref 2. Gross NJ: COPD: A disease of reversible air-flow obstruction. Am Rev Respir Dis 1986;133:725-726. 3. Taylor DR, Buick B, Kinney C, et al: The efficacy of orally administered theophylline, inhaled salbutamol, and a combination of the two as chronic therapy in the management of chronic bronchitis with reversible air-flow obstruction. Am Rev Respir Dis 1985;131:747-751. 4. Guyatt GH, Townsend M, Nogradi S, et al: Acute response to bronchodilator: An imperfect guide for bronchodilator therapy in chronic airflow limitation. Arch Intern Med 1988;148:1949-1952.Crossref 5. Hodgkin JE (ed): Chronic Obstructive Pulmonary Disease . Park Ridge, Ill, American College of Chest Physicians, 1979. 6. Committee on Emphysema (American College of Chest Physicians, Snider G. [Chairman]): Criteria for the assessment of reversibility in airway obstruction. Chest 1974;65:552-553.Crossref 7. Rozas CJ, Goldman AL: Daily spirometric variability. Arch Intern Med 1982;142:1287-1291.Crossref 8. Pennock BE, Rogers RM, McCaffree DR: Changes in measured spirometric indices: What is significant? Chest 1981;80:97-99.Crossref 9. Dull WL, Alexander MR: Theophylline in stable chronic airflow obstruction: A reappraisal. Arch Intern Med 1984;144: 2399-2401.Crossref 10. Dull WL, Alexander MR, Sadoul P: The efficacy of isoproterenol for predicting the response to orally administered theophylline in chronic obstructive pulmonary disease. Am Rev Respir Dis 1982;126:656-659. 11. Eliasson O, Degraff AC: The use of criteria for reversibility and obstruction to define patient groups for bronchodilator trials. Am Rev Respir Dis 1985;132:858-864. 12. Owens MW, Kinasewitz GT, Strain DS: Evaluating the effects of chronic therapy in patients with irreversible air-flow obstruction. Am Rev Respir Dis 1986;134:935-937. 13. Jenne JW, Siever JR, Druz WS, et al: The effect of maintenance theophylline therapy on lung work in severe chronic obstructive pulmonary disease while standing and walking. Am Rev Respir Dis 1984;130:600-605. 14. Ramsdell JW, Nachtwey FJ, Moser KM: Bronchial hyperreactivity in chronic obstructive bronchitis. Am Rev Respir Dis 1982;126:829-832. 15. Mahler DA, Rosiello RA, Harver A, et al: Comparison of clinical dyspnea ratings and psychophysical measurements of respiratory sensation in obstructive airway disease. Am Rev Respir Dis 1987;135:1229-1233. 16. Pineda H, Haas F, et al: Accuracy of pulmonary function tests in predicting exercise tolerance in chronic obstructive pulmonary disease. Chest 1984;86:564-567.Crossref 17. Mahler DA, Weinberg DH, et al: The measurement of dyspnea: Contents, interobserver agreement, and physiologic correlates of two new clinical indexes. Chest 1985;85:751-758.Crossref 18. Gottfried SB, Redline S, Altose MD: Respiratory sensation in chronic obstructive pulmonary disease. Am Rev Respir Dis 1985;132:954-959. 19. Killian KJ, Campbell EJ: Dyspnea. Thorax 1985;29:787-828. 20. Aubier M, Roussos C: Effect of theophylline on respiratory muscle function. Chest 1985;88:91S-96S.Crossref 21. Howell S, Roussos C: Isoproterenol and aminophylline improve contractility of fatigued canine diaphragm. Am Rev Respir Dis 1984;129:118-124. 22. Matthay RA, Berger HJ, Loke J, et al: Effects of aminophylline upon right and left ventricular performance in chronic obstructive pulmonary disease. Am J Med 1978;65:903-909.Crossref 23. Matthay RA: Effects of theophylline on cardiovascular performance in chronic obstructive pulmonary disease. Chest 1985;88:112S-116S.Crossref 24. Mahler DA, Matthay RA, Snyder PE, et al: Sustained-release theophylline reduces dyspnea in nonreversible obstructive airway disease. Am Rev Respir Dis 1985;131:22-25. 25. Eaton ML, Green BA, Church TR, et al: Efficacy of theophylline in 'Irreversible' airflow obstruction. Ann Intern Med 1980;92:758-761.Crossref 26. Eaton ML, MacDonald FM, Church TR, et al: Effects of theophylline on breathlessness and exercise tolerance in patients with chronic airflow obstruction. Chest 1982;5:538-542.Crossref
Archives of Internal Medicine – American Medical Association
Published: Sep 1, 1988
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