Post Bronchodilator Research Articles

Prevalence of airway reversibility in connective tissue disease-interstitial lung disease (CTD-ILD)

Background: Spirometry is the most reproducible and objective measurement of airflow limitation. Improvement in FEV1 and/or FVC by 12% or 200ml after using bronchodilator is definitive of reversible airway disease.[1] Several conditions like sarcoidosis predominantly involve the interstitium have nevertheless been associated with reversible airways obstruction. Connective tissue diseases (CTDs) form another important subgroup of interstitial lung disease(ILD). CTDs usually produce a restrictive pattern of lung involvement on spirometry, but might have unrecognized additional reversible airway obstruction. Seeking out and treating the latter components of disease may be crucial in optimizing lung function and alleviating the breathlessness that is common to the problem. Aim: The aim of this study is therefore to determine the post bronchodilator response in patients with connective tissue disease related interstitial lung disease (CTD-ILD) and thus potentially help improve quality of life by addressing the latter component by inhaled bronchodilator-steroid therapy. Methods: Consecutive patients with a confirmed diagnosis of CTD-ILD were identified in the out-patient clinics of our institute. CTD was diagnosed by a combination of clinical and serological parameters. ILD was confirmed by high resolution computed tomography (HRCT) images. 

A study of Spirometric parameters in non asthmatic allergic rhinitis

IntroductionAllergic rhinitis (AR) is a common IgE -mediated inflammatory condition characterised by sneezing, nasal congestion, itching and rhinorrhoea. Nasal allergy is a strong risk factor for the onset of asthma in adults. Bronchial hyper-responsiveness (BHR) is a distinct feature of pathophysiology in asthma. Spirometric parameters like Forced Expiratory Volume in first second [FEV1] and Forced Expiratory Flow [FEF 25–75%] are known to be impaired in patients with allergic rhinitis. We studied these parameters in subjects of AR who have never experienced any chest symptoms. It is well known that, subjects with allergic rhinitis are at greater risk of developing overt bronchial asthma in future. MethodsAll patients presented with symptoms of allergic rhinitis without history of bronchial asthma were included. Patients those who were clinically diagnosed with allergic rhinitis were evaluated with absolute eosinophilic count, serum IgE and Spirometric assessment. In spirometry, post bronchodilator FEV1 reversibility and post bronchodilator FEF 25–75% values were used to assess lower airway abnormalities. ResultsAmong 61 subjects, 32 were males and 29 were females. The maximum numbers [28] of patients were in 21–35 age group. Absolute eosinophil count was elevated in 38% of patients. 33% of patients showed elevated IgE values above 1000. 43% of patients showed FEV1 reversibility which is a sign of Bronchial hyperreactivity. 5% of patients showed impaired post bronchodilator FEF 25–75% which indicates presence of small airway disease. There was significant correlation between FEV1 reversibility and elevated IgE. ConclusionImpaired spirometric parameters indicate coexistence of bronchial impairment and hence predisposition to progression from allergic rhinitis alone to overt asthma in future. Thus careful evaluation of lower airway has to be done to rule out coexisting subclinical asthma.

Treatment outcome among Post TB obstructive airways diseases and COPD: A prospective cohort study.

Context:Post Tubercular Obstructive Airways Diseases (Post-TB OAD) is a sequela of Pulmonary TB but diseases progression may not same like Chronic Obstructive Pulmonary Diseases (COPD).Aim:To compare the frequency and severity of exacerbations, change of FEV1, frequency of hospitalization and mortality among COPD and post TB OAD patients.Setting and Design:Hospital-based prospective cohort study.Methods and Material:COPD cohort was diagnosed based on symptoms, history of exposure to risk factors and post bronchodilator FEV1/FVC ratio <70%. Post TB OAD cohort was diagnosed like COPD along with past history of Pulmonary TB. Both cohorts were followed up every 3-monthly intervals for up to 12 months.Statistical Analysis:Comparison of categorical variable was done by Chi-square test and continuous variable by unpaired t test. Longitudinal data of FEV1% were analyzed by repeated measure ANOVA test.Results:Totally, 68 patients with Post TB OAD and 66 COPD patients were taken into this study. The frequency of exacerbation (3.52 ± 1.84 verses 2.70 ± 1.37), number of severe exacerbation (56 verses 24) and frequency of hospitalization (1.37 ± 0.81 verses 0.97 ± 0.94) more seen in post-TB OAD cohort in compared to COPD cohort which is statistically significant. Mortality more seen in post-TB OAD group (14 verses 6). Rate of decline FEV1 per year more seen in Post-TB OAD (0.27 ± 0.28 lit verses 0.17 ± 0.26 liter) as compared to COPD. There was overall decreasing trend of FEV1% over period of 12 month but without any difference among two cohort.Conclusion:There was more in frequency of exacerbations, number of severe exacerbations, frequency of hospitalization and number of mortalities among post TB OAD compared to COPD.

Factors Associated with Persistence of Severe Asthma from Late Adolescence to Early Adulthood.

Asthma severity in children generally starts mild but may progress and stay severe for unknown reasons. Identify factors in childhood that predict persistence of severe asthma in late adolescence and early adulthood. The Childhood Asthma Management Program is the largest and longest asthma trial in 1041 children aged 5-12 years with mild to moderate asthma. We evaluated 682 participants from the program with analyzable data in late adolescence (age 17-19) and early adulthood (age 21-23). Severe asthma was defined using criteria from the American Thoracic Society and the National Asthma Education and Prevention Program to best capture severe asthma. Logistic regression with stepwise elimination was used to analyze clinical features, biomarkers, and lung function predictive of persistence of severe asthma. In late adolescence and early adulthood 12% and 19% of the patents had severe asthma, respectively; only 6% were severe at both time periods. For every 5% decrease in post bronchodilator FEV1/FVC in childhood, the odds of persistence of severe asthma increased 2.36-fold (95% CI: 1.70-3.28; p <0.0001), for participants with maternal smoking during pregnancy odds of persistence of severe asthma increased 3.17-fold (95% CI: 1.18-8.53, p=0.02). Reduced growth lung function trajectory was significantly associated with persistence of severe asthma compared to normal growth. Lung function and maternal smoking during pregnancy were significant predictors of severe asthma from late adolescence to early adulthood. Interventions to preserve lung function early may prevent disease progression.

Comparison of demographic, clinical, spirometry, and radiological parameters between smoking and non-smoking COPD patients in rural Gujarat, India.

Context:A total of 20% of Chronic Obstructive Pulmonary Disease(COPD) patients are non-smokers due to preventable causes, such as biomass fuel exposure, post tuberculous sequelae, occupational exposure, air pollution, persistent chronic asthma, and genetic predisposition.Aims:To compare smokers and non-smokers with COPD.Settings and Design:An observational study was conducted at a tertiary care hospital on 60 patients diagnosed with COPD, (GOLD criteria), who were divided into smoker and non-smoker groups.Subjects and Methods:Demographic data, clinical profile, smoking history, and radiological data were collected and compared. Exclusion criteria were individuals having active pulmonary tuberculosis and reversible air flow limitations.Statistical Analysis Used:Using STATA 14.2, quantitative and qualitative data were presented using descriptive statistics.Results:A total of 100% of smokers were male, whereas 70% of non-smokers were female. Compared to non-smokers (16.67%), smokers (26.6%) presented with higher grade of dyspnea. A statistically significant difference was seen with more smokers diagnosed as severe (40%) and very severe (30%) COPD compared to non-smokers with mild (16.67%) and moderate (46.67%) COPD (P < 0.012), Post bronchodilator FEV1 among smokers (42.63) compared to non-smokers (56.63) (P < 0.01) and decrease in FEV1 as the grade of dyspnea increased (P < 0.002). Compared to 36.67% in non-smokers, 70% smokers showed emphysematous x-rays.Conclusions:In our study we found majority of non-smokers to be female, and smokers had a higher grade of dyspnea, more severe COPD, lower post bronchodilator FEV1, and more emphysematous changes on x-rays.

Efficacy of spirometry in COPD patients with pulmonary hypertension: A study in a tertiary care unit

Therapy for COPD patients, in particular those with advanced stage, is generally disappointing and frustrating for both the doctors and patient. Of the symptoms, dyspnea is an important and debilitating symptom for which most patient with COPD seek medical attention. For the evaluation of lung function test for pulmonary hypertension, arterial PO2 and FEV1 seem to be most reliable.COPD was diagnosed as per GOLD criteria. Baseline FEV was measured by spirometer. The patient then received two puffs of salbutamol. 15 minutes later 3-5 forced expiratory maneuver was repeated and the best FEV was recorded. Symptoms Score, and dyspnea grade were correlated with FEV both pre and post bronchodilator. The mean age of the 52 patients was 60±10.6 Years. The mean symptom score was 4.07 with SD : ± 0.81. 7.69% patients were in MRC dyspnea scale grade 1, 21.15% patients had grade 2 dyspnea, 25% patients had grade 3 dyspnea, 40.38% patients had grade 4 dyspnea and 5.76% patients had dyspnea of grade 5. There was a strong significance in the correlation of Symptom scale with Pre bronchodilator % predicted FEVand with post bronchodilator % predicted FEVThere was a high correlation between dyspnea and pulmonary hypertension measured by percentage predictive value. Spirometry was found to be very useful for the diagnosis and staging of COPD. This could be used in primary diagnosis of patients with COPD.

Assessment of severity of sleep apnea in obstructive airway diseases patients at tertiary care hospital

Obstructive sleep apnea if remains untreated can lead to excessive daytime sleepiness, diminished performance and overall poor quality of life. Factors that increase vulnerability of sleep apnea include age, male sex, obesity, family history, craniofacial abnormalities and certain health behaviors such as alcohol abuse and smoking. Previously diagnosed cases of COPD and bronchial asthma (as per guidelines) having symptoms of obstructive sleep apnea were also included in this study. This present study was planned to study assessing of severity of sleep apnea in obstructive airway diseases patients.The present study was conducted in sleep laboratory of the Department of Pulmonary Medicine of a tertiary care hospital that caters to population of diverse groups. Patients after clinical examination and spirometry with post bronchodilator reversibility were categorized into bronchial asthma and COPD. Subsequently, polysomnography was done of these patients to study the sleep pattern. Amongst patients with COPD, 11 (16.42%) had mild COPD, 26 (38.80%) had moderate COPD, 22 (32.84%) had severe COPD and 08 (11.94%) patients had very severe COPD. 38.71% and 29.03% that is 12 and 09 out of 31 patients had moderate and severe asthma respectively. Again 19.36% and 12.90% that is 06 and 04 patients had mild persistent and intermittent asthma respectively. 17(25.37%) patients of COPD were found to have obstructive sleep apnea and 09 (29.03%) patients of asthma had obstructive sleep apnea. In patients with overlap syndrome had more severe hypercapnia (mean PaCO 48.88 ±0.017), and nocturnal desaturation (mean 85.35% ±0.022) Patients having moderate COPD had severe OSA. Patients having severe asthma had severe OSA with correlation coefficient R = -0.527 with p value &amp;#60;0.001 meaning negative linear correlation between AHI and % FEV1 of predicted of asthma patients.

Study of sleep patterns in asthma and COPD diseases at tertiary care hospital in India

Sleep is the natural periodic suspension of consciousness during which the powers of the body are recovered. It is a natural periodic state of rest for the mind and body, in which the eyes usually close and consciousness is completely or partially lost so that there is a decrease in bodily movement and responsiveness to external stimuli. Present study was planned to study the sleep patterns in various respiratory diseases at Tertiary care Hospital in India.The present study was conducted in sleep laboratory of the Department of Pulmonary Medicine of a tertiary care hospital that caters to population of diverse groups. Patients after clinical examination and spirometry with post bronchodilator reversibility were categorized into bronchial asthma and COPD. Subsequently polysomnography was done of these patients to study the sleep pattern. Total sleep time appears to be decreased in COPD patients with mean value of 284.3 (± 43.02) minutes, with decreased sleep efficiency of 66.64 % (± 0.074). Study group patients have frequent awakenings with average of 17.73 (± 6.15). They have decreased slow wave sleep (S3 and S4 stages) with mean value for S3 is 2.81% (± 0.68) and for S4 is 6.45% (± 1.64). The mean value for REM sleep in these patients is 12.42% (± 2.72) and that for S1 and S2 is 13.99% (± 4.84) and 64.62% (± 4.72) respectively. Total sleep time appears to be decreased in asthmatic patients with mean value of 299.89 (± 45.17) minutes, with decreased sleep efficiency of 68.38% (± 0.065). Study group patients have frequent awakenings with average of 21.03% (± 7.44). In patients with Asthma &amp; COPD, polysomnography study suggests poor sleep quality characterized by decreased total sleep time, decreased sleep efficiency, frequent awakenings, altered sleep architecture with decreased slow wave sleep and REM sleep.

Comparison of clinical outcomes of inhaled formoterol or fluticasone versus formoterol or mometasone in the patients of bronchial asthma

Background: This study was undertaken because of paucity of literature regarding outcomes of inhaled formeterol/fluticasone versus formoterol/mometasone in asthmatic patients.Methods: Fifty newly (male/female) recruited cases of bronchial asthma were diagnosed on the basis of spirometry. The patients were allocated to two groups viz group A and B. Group-A received mometasone furoate/formoterol (200/10 μg OD) and Group-B received fluticasone/formoterol (200/10 μg OD) respectively. The drugs were administered through metered-dose inhaler (MDI).Results: The mean FEV1/FVC ratio recorded (64.40±9.01) before starting the treatment has significantly changed to (68.92±8.58) after starting the treatment. Mean forced expiratory volume (47.56±14.73%) noted before the use of bronchodilator also changed to mean FEV1 63.98±15.17. Mean forced expiratory volume recorded before treatment (55.02±5.01) in a group who were treated with formoterol/mometasone combination changed to (72.06±5.86) after treatment. However, the mean forced expiratory volume recorded before treatment 54.92±4.47 in a group who were treated with formoterol/fluticasone combination changed to 75.48±5.03 after the treatment. While comparing the two treatment regimens, it is evident from the results that there is no significant difference in FEV1 between the groups. However, the post bronchodilator FEV1 was significantly (p&lt;0.001) higher among the patient group which were treated with fluticasone/formoterol combination than the group who were treated with mometasone/formoterol combination. No significant adverse effect of either of two regimens was observed thus showing that both the combinations are comparatively safe for use.Conclusions: This study reveals that both the treatment regimens showed a significant improvement in lung functions without any significant adverse event.

Applicability of 2017 Global Initiative for Chronic Obstructive Lung Disease guidelines in diagnosing COPD in a tertiary care hospital

Chronic obstructive pulmonary disease (COPD) is one of the common conditions that physicians frequently diagnose and treat both in the hospital and outpatient setting. Every year, a new report is generated based on an analysis of published studies which attempts to improve the way physicians handle COPD. In 2011 and 2017, the traditional GOLD guidelines were revised, and it included exacerbation history and COPD Assessment Test (CAT) and modified Medical Research Council Dyspnoea Scale (mMRC) in diagnosis of the disease. This study we used patients’ symptoms, risk factors and exacerbation history to diagnose COPD as per 2017 guidelines and checked its accuracy by confirming with spirometry. A prospective study, in which 105 patients with history suggestive of COPD were classified according to ABCD tool, later these patients were subjected to spirometry to confirm the diagnosis of COPD and severity. The results obtained were analysed by statistical software SPSS-V.24. About 79% of the population diagnosed to have COPD by ABCD tool were confirmed using spirometry, the rest 21% either had spirometric post bronchodilator FEV1/FVC &amp;#62;0.7 or significant reversibility. CAT and mMRC test correlate with the spirometric FEV1 predicted percentage.On comparing ABCD and Spirometric grading most of them had severe airway obstruction and these people were mostly distributed in group B and D of ABCD grading. The utility of 2017 GOLD consensus in diagnosing COPD in the Indian scenario was studied. The ABCD tool of GOLD consensus will be helpful in diagnosing COPD in a resource limited setting, primary care centres were spirometry is not available.

Association of occupational dust exposure with combined chronic obstructive pulmonary disease and pneumoconiosis: a cross-sectional study in China.

ObjectivesOccupational dust exposure may induce various lung diseases, including pneumoconiosis and chronic obstructive pulmonary disease (COPD). The features of combined COPD and pneumoconiosis have not been well described, and this may hamper the management. This study aimed to describe the prevalence and characteristics as well as the risk factors of the combined diseases.DesignA cross-sectional study.Setting and participants758 patients with pneumoconiosis were recruited at a single-medical centre. Of these, 675 patients with pneumoconiosis, including asbestosis, silicosis, coal workers’ pneumoconiosis and other pneumoconiosis, was eligible for analysis.Primary outcome measuresCOPD was diagnosed based on clinical features and/or history of exposure to risk factors and post bronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio <0.7. Clinical data were collected from predesigned medical reports. The patients underwent both chest radiograph and high-resolution CT scans. Risk factors for combined COPD and pneumoconiosis were analysed using regression analysis.ResultsCOPD prevalence overall was 32.7% (221/675) and was the highest in silicosis (84/221) and coal workers’ pneumoconiosis (100/221). COPD prevalence increased with smoking pack-years, dust exposure duration and pneumoconiosis stage. Patients with combined diseases had lower body mass index, higher smoking index and worse pulmonary function. Risk factors for combined diseases included heavy smoking, silica or coal exposure and advanced pneumoconiosis. The interaction between dust exposure and smoking in COPD was also identified. The risk of combined COPD significantly increased with heavy smoking and silica or coal exposure (OR 5.49, 95% CI 3.04 to 9.93, p<0.001).ConclusionsCOPD is highly prevalent in patients with pneumoconiosis, especially patients with silicosis and coal workers’ pneumoconiosis. Occupational dust exposure as well as heavy smoking is associated with an increased risk of combined COPD and pneumoconiosis, which demands an effective preventive intervention.

Study of spirometry parameters in suspected asthmatic children in a tertiary care hospital

Background: Asthma in children is difficult to diagnose due to inability of young children to successfully perform spirometry. However some parameters in the spirometry which are relatively effort independent can be very helpful in confirming the diagnosis of asthma. This study was conducted to find out the most commonly affected spirometry parameter in the suspected cases of childhood asthma.Methods: Total 56 children were studied between 7 to 18 years who came for outpatient visit or admitted in the paediatric ward and were clinically suspected to be asthmatic based on asthma predictive index. They were subjected to spirometry in our institute. Baseline and post bronchodilator values of spirometry parameters were studied and analysed using standard statistical tests.Results: Baseline Forced expiratory flow between 25% and 75% of vital capacity (FEF25-75%) was found to be the most commonly affected spirometry parameter in confirming the diagnosis of suspected asthmatics and correlated with the clinical diagnosis of childhood asthma.Conclusions: FEF25-75% can aid in confirming the diagnosis of suspected asthmatic children who are otherwise not treated as asthmatics and remain undiagnosed in view of not meeting the established spirometry criteria for asthma due to poor performance and ignorance of looking at this important and effort independent parameter.

Knowledge, attitude and practices among parents of asthmatic children in Rajasthan: a hospital based descriptive observational study

Background: Asthma is chronic inflammatory disorder associated with variable airflow obstruction and bronchial hyper responsiveness with different phenotypes. The objective of this study was to study the knowledge, attitude and practices among parents of Asthmatic children.Methods: It was a prospective observational study, conducted at Fortis Hospital Jaipur, from April 2016 to March 2018. All Asthmatic children fulfilling inclusion were included, 120 children were studied. A detailed interview of all the children/parents was conducted by pre-validated KAP questionnaire. Subjects were labelled as Bronchial Asthma in children above 5 years of age on the basis of symptoms and measurement of Peak Expiratory Flow (PEF) both baseline and post bronchodilator by PEF meter and in children less than 5 years of age by clinical symptoms, family history and response to bronchodilator according to GINA guidelines. Statistical analysis was done by one-way ANOVA test and Chi-square test.Results: In this study 26.4% parents were ignorant about etiology, 32% believed it to be allergy and 39.62% believed it to be hereditary. 1.9% had misconception of contagious. 68% parents know that their child have asthma while 32% parents did not know. Majority (52.1%) attributed it to cold air and rainy season followed by Dust mite and pollution in (42%).Conclusions: Knowledge about Asthma has improved over last few decades but still needs replenishment. Knowledge gap between recommended and actual practices, lack of adherence to aerosol therapy and fear of medication side-effects still persists. Parental education is important part of management of Asthma.

Prevalence of Airflow Obstruction as Measured by Spirometry, in Rural Southern Indian Adults

Rural population-based estimates of airflow obstruction based on spirometry are unavailable from southern India. This study assessed the prevalence of spirometry-defined airflow obstruction in Vellore, Tamil Nadu.A cross sectional survey was done in nine villages, among adults aged ≥30 years, where previous cardiovascular surveys had been conducted (1994, 2011). Population proportional to size sampling was used to select 20 clusters, with sampling from all streets proportional to the number of households. One person randomly selected per household was interviewed for symptoms and risk factors. A respiratory therapist performed pre and post bronchodilator spirometry on all, following American Thoracic Society criteria. Airflow obstruction was defined as pre-bronchodilator Forced Expiratory Volume 1 s/Forced Vital Capacity (FEV1/FVC) < Lower Limit of Normal (LLN, derived from local prediction equations) and compared to other criteria.Of 1015 participants, 787 completed technically acceptable spirometry. The prevalence of airflow obstruction was 9.0% (95% CI: 5.8%–9.6%, 71). Fixed obstruction (post bronchodilator FEV1/FVC < LLN) was 4.6% (95% CI: 3.1%–6.1%, 36), and 4.1% (95% CI: 2.7%–5.5%, 32) using post bronchodilator FEV1/FVC < 70%. The GOLD criteria missed 56% (40) of those with airflow obstruction, of which 87.5% were females. Although 63.4% with airflow obstruction had moderate to severe disease, 82.2% were not on treatment and only 48.9% reported symptoms in the previous year.This study estimates prevalence of airflow obstruction based on spirometry in rural southern India. Despite significant impairment on spirometry, majority were undiagnosed, and half did not report symptoms.

Evaluating the FEV1/FVC ratio in the lower range of normality as a marker of worse clinical outcomes in asthmatic subjects without airway obstruction.

We should continually improve tools for evaluating asthma. The aim of this study was to evaluate whether the FEV1/FVC ratio in the lower range of normality is associated with worse outcomes in asthmatics without airway obstruction. We screened asthmatics at eight clinics. Subjects answered the Asthma Control Questionnaire and underwent spirometry. We assigned individuals without airway obstruction in three groups according to the post bronchodilator FEV1/FVC ratio: lower range of normality, intermediary range of normality and upper range of normality. Asthma outcomes were hospital admission due to asthma during the preceding year, non-controlled asthma symptoms and moderate-high inhaled maintenance therapy need. In subjects from six to 18 years old, the rate of hospital admission was higher in the group with FEV1/FVC ratio in the lower range of normality as compared with the other two groups but the frequency of non-controlled symptoms of asthma and moderate-high dose of inhaled maintenance therapy need was similar. From 19 to 59 years old, the rate of moderate-high inhaled maintenance therapy need was higher in the group with FEV1/FVC ratio in the lower range of normality as compared with the other two groups, but the frequency of hospital admissions and non-controlled symptoms of asthma was similar. Above 59 years old, there was no difference in clinical asthma outcomes between lung function groups. FEV1/FVC ratio in the lower range of normality is a marker of worse clinical outcomes in asthmatics without airway obstruction.

Overview of epidemiology, pathophysiology, diagnosis and staging with 2020 Updates

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease. It is among the fastest growing chronic diseases diagnosed in the world today. COPD is the third most common cause of death in the United States and is predicted to get worse. It is characterized by the development of an exaggerated inflammatory response of the lungs to noxious substances such as tobacco or air pollution. If the exposure becomes recurrent or persistent, the lungs develop chronic inflammatory response leading to lung parenchymal damage, air trapping and progressive airflow limitation. The Diagnosis of COPD is usually made in the contest of symptoms, exposure to risk factors and spirometry evidence of airway obstruction with post bronchodilator spirometry FEV1/FVC < 0.70. Most patients with COPD first sick medical attention when they develop dyspnea. Once the diagnosis of COPD has been confirmed, the treatment is geared mainly towards preventing exacerbations and eliminating risk factors and exposures. Several treatments combinations can be used in patients with stable COPD to prevent exacerbations and to improve their quality of life. Patients with COPD exacerbations have to be appropriately diagnosed and promptly treated to prevent complications. Patient’s symptoms, the degree of airflow limitation, risk of exacerbations and the presence of comorbidities have to be assessed. Both pharmacological and non-pharmacological interventions have been used in the management of COPD.

An association between asthma and vitamin D: A prospective study in a tertiary care hospital

Introduction: One of the most common chronic diseases is asthma and is related to the hyperresponsiveness of the airways due to prolonged inflammation. The causes for asthma is said to be raised IgE levels and mast cell granulations which are modulated by Vitamin D. Materials and Methods: 50 patients who were confirmed having asthma were included into the present study. Sputum and blood eosinophil count, IgE levels as well as Vitamin D levels were investigated for all the patients. All the patients were subjected to pre and post bronch odilator spirometry for FEV1 and FVC. Results: The mean for the Sputum eosinophil count was calculated and was found to be high in the 31(10.13 3.8) Vitamin D deficient group while it was in the normal range (1.97 1.36) among the people with sufficient vitamin D levels. Similar increased levels of eosinophils was seen in the serum and also in the IgE levels. Majority of the patients (14 in number) with deficient Vit D levels had severe asthma (45.2%) and 9 (29%) had moderate asthma. Mild asthma was seen in 6 (19.4%) and intermittent in 2 (6.5%). Atopy was seen in 21 of the patients with deficient Vit D levels and the mean FEV1 % was 61.6 3.7 among the patients with vit D deficient persons and 83.1 6.4 in the vit D sufficient patients Conclusion: Early detection of the vitamin D levels may help in assessing asthma and its severity in the early stages enabling early and effective treatment, thereby reducing the cost and hospitalization, not to mention the acute exacerbations due to asthma. Keywords: Vitamin D, Asthma, IgE, Pulmonary function test.

ROLE OF BRONCHODILATOR TESTING IN IDENTIFYING COPD, ASTHMA, AND ASTHMA-COPD OVERLAP SYNDROME: NHANES III ANALYSIS

SESSION TITLE: Asthma: From Blood Biomarkers to Biologics and Disease Burden SESSION TYPE: Original Investigations PRESENTED ON: 10/21/2019 1:30 PM - 2:30 PM PURPOSE: Spirometry with Bronchodilator (BD) testing is not routinely utilized in clinical practice to diagnose chronic obstructive pulmonary disease (COPD) despite the recommendation to use the post BD ratio of forced expiratory volume in the first second (FEV1) over forced vital capacity (FVC).1,2 We aimed to determine the role of BD testing in avoiding COPD overdiagnosis and identifying subjects with possible alternate diagnosis like asthma and asthma-COPD overlap syndrome (ACOS). METHODS: The National Health and Nutrition Examination Survey (NHANES) data was analyzed from 2007-2012.3 Subjects age ≥ 40 years with spirometry studies meeting the American Thoracic Society (ATS) quality standards were included. Blood eosinophil count ≥ 300cells/μL and FEV1 change > 12% and > 200ml with BD testing were used to define blood eosinophilia and BD reversibility (BDR) respectively. Asthma history was identified using NHANES question “Has a doctor or health care professional ever told that you have Asthma?”. Subjects with probable ACOS were identified using two major criteria (Post-BD FEV1/FVC < 0.7, and asthma history or FEV1 change ≥ 400ml in cases without asthma history) along with any one minor criteria (BDR or blood eosinophilia).4 Post-BD FEV1/FVC ≥ 0.7 with BDR and/or blood eosinophilia were used to identify probable asthma cases. We analyzed non-weighted samples using SPSS version 21. RESULTS: We identified 8002 subjects age ≥40 years who completed pre-BD spirometry testing, 625 of them met ATS spirometry quality standards and had a pre-BD FEV1/FVC < 0.7. Of these 625 subjects, 381(61%) had post-BD FEV1/FVC < 0.70 confirming irreversible airway obstruction. Among these 381 subjects with post-BD FEV1/FVC < 0.7, twelve (3.1%) subjects had asthma history and BDR; 16 (4.2%) had asthma history and blood eosinophilia; 2 (0.7%) had FEV1 change ≥ 400ml and blood eosinophilia making ACOS more likely than COPD alone in these subjects. Among the remaining 244 cases (39%) with pre-BD FEV1/FVC < 0.7 but post- BD ratio ≥ 0.7, twenty-four (9.8%) had BDR alone and 10 of these had BDR and eosinophilia making asthma more likely. Moreover, 18 of the 24 subjects with BDR and 6 of the 10 subjects with BDR and eosinophilia had no prior asthma history and would likely be misdiagnosed as COPD if pre-BD FEV1/FVC ratio alone was used. CONCLUSIONS: Routine underutilization of spirometry with BD testing may lead to over diagnose 39% of subjects as having COPD. Further evaluation for potential asthma would be needed in 9.8% of these subjects. Moreover, post-BD spirometry values along with the recommended criteria for ACOS help identify 8% of COPD subjects who likely have ACOS. CLINICAL IMPLICATIONS: Routine use of Post-BD spirometry values will not only prevent over diagnosis of COPD but also help identifying subjects with potential ACOS and asthma. DISCLOSURES: No relevant relationships by Srinadh Annangi, source=Web Response No relevant relationships by Angel Coz Yataco, source=Web Response

A SINGLE-CENTER RETROSPECTIVE EVALUATION OF ENDOBRONCHIAL VALVES FOR LUNG VOLUME REDUCTION IN EMPHYSEMA PATIENTS

SESSION TITLE: Wednesday Electronic Posters 4 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM PURPOSE: Lung volume reduction (LVR) surgery was shown to improve exercise tolerance in patients with emphysema. Criner et al. (LIBERATE) reinforced the utility of endobronchial valve (EBV) placement in patients with emphysema and hyperinflation to improve lung function. In this study we report our experience with bronchoscopic LVR following the commercial availability of EBVs. METHODS: Retrospective review of patients who were treated by bronchoscopic LVR over a 6-month period at a single site. Inclusion criteria were age ≥40 with emphysema and hyperinflation with Total Lung Capacity (TLC) >100% predicted and Residual Volume (RV) >150% predicted. Data gathered include baseline characteristics, 45-day spirometric data, and complications (pneumothorax, pleural effusion, COPD exacerbation, arrhythmia). The primary endpoint was post bronchodilator response FEV1 ≥ 15% increase from baseline. Secondary endpoints were TLC change, absolute change in FEV1, and complication rates of EBV. RESULTS: A total of 18 patients were treated during this period. The average age of the patients evaluated was 69 years-old. 61% of patients were female (11) and 88.9% were Caucasian (16). Baseline 6 minute walk distance (6MWD) was 251 meters. The average baseline RV was 4.54L (217% of predicted) and baseline post-bronchodilator FEV1 was 750mL (30.3% predicted). At the 45-day mark, our patients had a FEV1 increase of 79.2mL (increase of 3% predicted), 30.7% showed an improvement in FEV1 ≥15% from baseline. RV decrease was on average 190mL. Total lung volume reduction on average was 610mL with 75% exhibiting a decrease ≥350mL. Regarding complications, 38.9% of our patients did have post-procedure pneumothorax with 22.2% of the patients requiring partial or total EBV removal. 27.8% of patients did have post procedure COPD exacerbation requiring medical attention with 80% of those patients having COPD exacerbations in the first 45 days. One patient had a previous treatment with vapor to the contralateral lung and another had alpha 1 antitrypsin deficiency. Both had positive outcomes. CONCLUSIONS: At the 45-day point, our center’s experience provided similar positive results as the LIBERATE study. Additionally, our patients exhibited a comparable incidence of pneumothorax post EBV placement. To our knowledge, this is the first and largest published single center experience on EBV for lung volume reduction since the Food and Drug Administration (FDA) approved the device in June 2018. We anticipate similar positive results at the one-year mark. CLINICAL IMPLICATIONS: Heterogeneous and homogeneous emphysema can be effectively treated with endobronchial valves to improve patients’ lung function. DISCLOSURES: No relevant relationships by Raed Alalawi, source=Web Response No relevant relationships by Richard Sue, source=Web Response No relevant relationships by Steve Tseng, source=Web Response No relevant relationships by Leigha Vick, source=Web Response

ACLIDINIUM BROMIDE TREATMENT STRATIFIED BY EXACERBATION HISTORY: EFFECTS ON EXACERBATIONS AND MAJOR CARDIOVASCULAR EVENTS IN PATIENTS WITH COPD AND HIGH CARDIOVASCULAR RISK (ASCENT-COPD)

ACLIDINIUM BROMIDE TREATMENT STRATIFIED BY EXACERBATION HISTORY: EFFECTS ON EXACERBATIONS AND MAJOR CARDIOVASCULAR EVENTS IN PATIENTS WITH COPD AND HIGH CARDIOVASCULAR RISK (ASCENT-COPD)