Seguridad y tolerancia de la prueba de provocación bronquial con manitol inhalado en la EPOC leve- moderada / Safety and tolerance of the inhaled mannitol bronchial provocation test in mild-moderate COPD

INTRODUCCIÓN: la prueba de provocación bronquial con manitol inhalado (Osmohale(R)) es un test indirecto de medición de la hiperrespuesta bronquial. Se desconoce su utilidad clínica en pacientes con EPOC y su perfil de seguridad en pacientes con EPOC leve-moderado. MATERIAL Y MÉTODOS: estudio observacional prospectivo en el que participaron pacientes con EPOC leve-moderado, atendidos ambulatoriamente durante la fase de estabilidad de su enfermedad. Para todos los pacientes se recogieron los datos de función pulmonar y puntuación del cuestionario CAT. Se sometió a los pacientes a un test de provocación bronquial comercializado (Osmohale(R)). RESULTADOS: participaron en el estudio 72 pacientes con EPOC leve-moderado. En un 26% de los participantes se demostró la existencia de HRB. No hubo ningún abandono de la prueba por efectos adversos. La prueba fue bien tolerada por los pacientes, con la tos como efecto secundario más frecuentemente comunicado. La prueba fue segura, con una caída media del FEV1 del 10% y un tiempo medio de realización de la misma de 27 minutos. CONCLUSIONES: la prueba de provocación bronquial con manitol inhalado es un procedimiento seguro y bien tolerado en pacientes con EPOC leve-moderado

INTRODUCTION: bronchial provocation test with inhaled mannitol (Osmohale(R)) is and indirect approach to the measurement of bronchial hyperresponsiveness (BHR). Neither its clinical utility in COPD nor the secutiry profile en mild to moderate COPD patients is well kwon. MATERIAL AND METHODS: this was an observational prospective study enrrolling mild to moderate COPD patients in an outpatient setting during stability period. Data about lung fuction and CAT questionaire were collected from all patients. Aproved bronchial provocation test (Osmohale (R)) was performed. RESULTS: 72 mild to moderate COPD patients were included. BHR could be assesed in 26% of the sample. There was no drop out due to adverse events. The test was well tolerated, with cough being the most reported adverse event. The test was safe, with a mean FEV1 drop of 10% and a mean performance time of 27 minutes. CONCLUSIONS: bronchial provocation test with inhaled manitol is a safe and well tolerated procedure in mild to moderate COPD patients

Diagnostic performance of the measurement of nitric oxide in exhaled air in the diagnosis of COPD phenotypes.

INTRODUCTION: COPD is a highly heterogeneous disease that has a serious impact on affected populations. Patients share some of the features of bronchial asthma, often summarized under the term ACOS (asthma-COPD overlap syndrome). The objective of this study is to evaluate the utility of the measurement of nitric oxide in exhaled air (FENO50) in the diagnosis of COPD phenotypes. MATERIAL AND METHODS: The study comprised cross-sectional observation of patients receiving assistance during a respiratory outpatient visit. Patient data was collected on lung function, FENO, questionnaires scoring CAT®(COPD Assessment Test), and COPD clinical phenotype. RESULTS: 192 patients were studied: 103 with COPD; 16 healthy non-smokers; 30 healthy smokers; and 43 asthmatics. COPD patients were grouped by phenotype: 34 non exacerbators (33.0%); 22 ACOS (21.3%); 13 frequent exacerbators with emphysema (12.6%); and 34 frequent exacerbators with chronic bronchitis (33.0%). ACOS patients showed significantly higher FENO50 values compared to the others after adjustments for confounding factors. FENO50 demonstrated greater diagnostic accuracy than the bronchodilator test (BT) in the diagnosis of ACOS and COPD phenotypes (AUC 0.79 vs 0.74), with an optimal cut-off value of 19 ppb (sensitivity 0.68, specificity 0.75). CONCLUSIONS: Patients with COPD have different levels of FENO50 depending on the COPD phenotype. FENO50 measurement provides better diagnostic accuracy than BT, with an optimal cut-off value of 19 ppb.