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Respir Med. 2014 Feb;108(2):344-50. doi: 10.1016/j.rmed.2013.10.004. Epub 2013 Oct 10.

Changes in oscillatory impedance and nitrogen washout with combination fluticasone/salmeterol therapy in COPD.

Author information

1
The Woolcock Institute of Medical Research, Glebe, NSW 2037, Australia; Department of Respiratory Medicine Royal North Shore Hospital, St Leonards, NSW 2065, Australia; The Sydney Medical School, The University of Sydney, NSW 2006, Australia; Cooperative Research Centre for Asthma and Airways, Glebe, NSW 2037, Australia. Electronic address: stimmins@med.usyd.edu.au.
2
The Woolcock Institute of Medical Research, Glebe, NSW 2037, Australia; Cooperative Research Centre for Asthma and Airways, Glebe, NSW 2037, Australia. Electronic address: chantale@woolcock.org.au.
3
The Woolcock Institute of Medical Research, Glebe, NSW 2037, Australia; Department of Respiratory Medicine Royal North Shore Hospital, St Leonards, NSW 2065, Australia; The Sydney Medical School, The University of Sydney, NSW 2006, Australia. Electronic address: rschoeff@nssachs.health.nsw.gov.au.
4
The Woolcock Institute of Medical Research, Glebe, NSW 2037, Australia; The Sydney Medical School, The University of Sydney, NSW 2006, Australia; Cooperative Research Centre for Asthma and Airways, Glebe, NSW 2037, Australia. Electronic address: cms@woolcock.org.au.
5
The Woolcock Institute of Medical Research, Glebe, NSW 2037, Australia; Department of Respiratory Medicine Royal North Shore Hospital, St Leonards, NSW 2065, Australia; The Sydney Medical School, The University of Sydney, NSW 2006, Australia; Cooperative Research Centre for Asthma and Airways, Glebe, NSW 2037, Australia. Electronic address: ggk@woolcock.org.au.
6
The Woolcock Institute of Medical Research, Glebe, NSW 2037, Australia. Electronic address: cindy.thamrin@woolcock.org.au.

Abstract

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.

KEYWORDS:

COPD; Forced oscillation technique; Physiology; Therapy

PMID:
24144670
DOI:
10.1016/j.rmed.2013.10.004
[Indexed for MEDLINE]
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