Multidetector-row computed tomography assessment of adding budesonide/formoterol to tiotropium in patients with chronic obstructive pulmonary disease.

BACKGROUND: In patients with chronic obstructive pulmonary disease (COPD), multidetector-row computed tomography (MDCT) showed that tiotropium dilated the inner diameters in airways from the third to the sixth generation of the bronchi. Here we aimed to evaluate the morphological effect by adding a budesonide/formoterol combination to tiotropium in COPD patients using three-dimensional MDCT. METHODS: Pulmonary function tests, St. George's Respiratory Questionnaire (SGRQ) and MDCT imaging studies were performed at the beginning and after budesonide/formoterol combination treatment for 12 weeks in 14 patients with COPD. RESULTS: The median age was 73.5 years and the mean forced expiratory volume in 1 s (FEV1) as a percentage of the predicted value was 57.2 ± 18.3%. The luminal area in the fifth generation bronchi and the emphysema volume/CT-derived total lung volume were significantly correlated with FEV1 at baseline (r = 0.682, p < 0.02 and r = -0.868, p < 0.001, respectively). The average luminal area and wall area percentage in the third, fourth and fifth generations were correlated with the SGRQ total score. Budesonide/formoterol induced insignificant pulmonary function changes and significant symptoms improvement. CT images showed an increased inner luminal area and decreased wall area after budesonide/formoterol treatment. Average luminal area was significantly increased from 24.3 ± 9.7 to 26.0 ± 9.9 mm(2) in the third generation, 13.0 ± 6.5 to 14.7 ± 7.3 mm(2) in the fourth generation, 8.0 ± 4.8 to 9.4 ± 4.9 mm(2) in the fifth generation and 5.6 ± 2.7 to 6.7 ± 3.6 mm(2) in the sixth generation (p < 0.01). The average increase of the third generation luminal area was correlated with the FEV1 increase (r = 0.632, p < 0.03). The wall area percentage significantly decreased from 51.5 ± 9.2 to 49.1 ± 9.7 in the third generation, 56.1 ± 9.7 to 53.0 ± 11.1 in the fourth generation, and 62.3 ± 9.9 to 57.6 ± 9.8 in the fifth generation (p < 0.05). Emphysema volume/CT-derived total lung volume was unchanged with treatment. CONCLUSION: MDCT demonstrated budesonide/formoterol induced bronchodilation in the non-small airway. CT imaging can evaluate drug therapeutic effect and may provide additional insights into pharmacotherapy for COPD.

Relationship of the asthma control test with pulmonary function and exhaled nitric oxide.

BACKGROUND: The Asthma Control Test (ACT) is a short, simple, patient-based tool for identifying patients with poorly controlled asthma; however, its value in practice has yet to be demonstrated. OBJECTIVE: To clarify the relationship of ACT scores and clinical parameters, including pulmonary function tests, peak expiratory flow (PEF) indices, and exhaled nitric oxide (eNO) levels. METHODS: The study included 105 patients with asthma who underwent routine checkups by asthma specialists since September 1, 2006, through January 31, 2007. All patients had been taking inhaled corticosteroids with or without other medications for asthma for at least 3 months. The patients completed the ACT questionnaire and underwent testing for eNO and spirometry. PEF indices, including PEF percentage of predicted value (%PEF), lowest PEF during 1 week expressed as a percentage of the highest PEF (Min%Max PEF), and PEF variability, were also analyzed in patients undergoing PEF monitoring. RESULTS: The ACT scores ranged from 8 to 25 (median, 24), and total control was obtained in 45 patients (42.8%). The PEF indices and eNO values in the total control group were significantly better than those in the less controlled groups. However, the ACT scores were weakly correlated with percentage of predicted forced expiratory volume in 1 second (r = 0.219), %PEF (r = 0.387), Min%Max PEF (r = 0.354), PEF variability (r = -0.351), and eNO values (r = -0.310). Total control of ACT included uncontrolled conditions in physiologic and inflammatory parameters. CONCLUSION: ACT should be used in combination with pulmonary function tests and/or eNO measurements.