The following is a summary of “Residual reversibility in COPD patients already on long-acting bronchodilator: The OscilloRevers Study,” published in the February 2024 issue of Pulmonology by Rouzic et al.

Dyspnea is a multifaceted symptom of chronic obstructive pulmonary disease (COPD) that does not consistently correlate with lung function metrics. While long-acting bronchodilators (LAB) are known to alleviate dyspnea, some patients continue to experience persistent symptoms despite this treatment. This study aims to investigate residual reversibility and clinical response following the administration of short-acting bronchodilators (SAB) in COPD patients who are already receiving LAB therapy and report ongoing dyspnea.

Researchers enrolled COPD patients experiencing persistent dyspnea (modified Medical Research Council scale (mMRC) ≥1) despite stable treatment with at least one LAB. Spirometry, plethysmography, and impulse oscillometry (IOS) were conducted at peak LAB effect and repeated 45 minutes after administering two SAB (400 µg of salbutamol and 80 µg of ipratropium). Dyspnea improvement was assessed 45 minutes post-SAB using a two-sided visual analog scale (VAS), ranging from -100 mm for maximal improvement to +100 mm for maximal deterioration.

The analysis included twenty-two COPD patients, predominantly male (59.1%), with a mean age of 60.6 years and a median FEV1 of 54% of predicted values. Half of the patients reported severe baseline dyspnea (mMRC ≥2). Following SAB administration, spirometric and plethysmographic measurements showed statistically significant improvements. Additionally, IOS parameters such as reactance at 5 Hz (X5) and area of reactance (AX) exhibited enhancement. Half of the patients reported clinically relevant reductions in resting dyspnea post-SAB. However, no correlation was observed between dyspnea improvement and functional measurements.

In COPD patients receiving regular LAB therapy, 50% experienced notable reductions in resting dyspnea after additional administration of dual short-acting bronchodilators. The physiological mechanisms underlying this improvement warrant further investigation.

Source: sciencedirect.com/science/article/abs/pii/S2590041223000946