Influence of baseline airway calibre and pulmonary emphysema on bronchial responsiveness in patients with chronic obstructive pulmonary disease

Abstract

Study objective: Bronchial hyper-responsiveness (BHR) is widely observed in patients with chronic obstructive pulmonary disease (COPD). However, its clinical significance in COPD has not yet been established. To determine the factors that influence BHR in COPD, multiple linear regression analysis was used to analyse the relationship between BHR to methacholine and baseline forced expiratory volume in 1 s (FEV 1), vital capacity (VC), residual volume (RV)/total lung capacity (TLC), static compliance (Cst), transfer coefficient of the lung ( Kco), and the percentage of low attenuation area (%LAA) determined by computed tomographic (CT) scan. Methods: Bronchial responsiveness to methacholine was determined in 63 patients with COPD by the dosimeter method and expressed as PD 20FEV 1. Residual volume and TLC were determined by body plethysmography. The percentage of low attenuation area was defined as the percentage of area less than — 960 Hounsfield unit on a CT scan of the thorax. Results: Forced expiratory volume in 1s (%predicted) and %LAA correlated with BHR ( P=0·023 and 0·020, respectively), while VC (%pred), RV/TLC, Cst and Kco did not. The coefficient of determination was 0·43. The regression analysis showed that a 10% increase in FEV 1 (%pred) and a 10% decrease in %LAA would increase log(PD 20FEV 1) by 0·145 and 0·117, respectively. Conclusions: A considerable proportion of the BHR in COPD is related to functional abnormalities and morphologic changes of emphysema, such as decreased baseline airway calibre and destruction of the lung parenchyma.