Bronchodilator responsiveness testing

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Why might one still test for a bronchodilator response in patients with normal FEV1 and FEV1%?

High clinical suspicion of airflow obstruction

Which pulmonary function parameters are usually evaluated before and after bronchodilator therapy?

FEV1 and specific airway resistance/conductance (sRaw, sGaw)

How long should short-acting β2 agonists (SABA) be withheld before pulmonary function testing?

4-6 hours

What is the recommended interval between administration and repeat testing for short-acting β2 agonists?

10-15 minutes Signup and view all the answers

How long should long-acting muscarinic antagonists (LAMA) be withheld before pulmonary function testing?

36-48 hours Signup and view all the answers

What is the recommended dose of albuterol for testing purposes?

400 mcg Signup and view all the answers

Why is an interval of 30 minutes recommended after administration of ipratropium bromide before repeat testing?

To allow for optimal assessment of bronchodilator response Signup and view all the answers

Why do some patients who use bronchodilators shortly before testing still show significant improvement after a repeated dose?

The medication may not have fully taken effect yet Signup and view all the answers

Why are lung volumes and Dlco also evaluated before and after bronchodilator therapy?

They may also respond to bronchodilator therapy Signup and view all the answers

What is the significance of withholding certain medications before pulmonary function testing?

To prevent interference with test results Signup and view all the answers

What is the recommended dose of ipratropium bromide delivered by MDI?

160 mcg delivered as four inhalations of 40 mcg each Signup and view all the answers

What indicates a need to stabilize the patient during bronchodilator testing?

Marked changes in heart rate, rhythm, or blood pressure or symptoms such as chest pain Signup and view all the answers

How is the % de mudança pós BD calculated?

(post BD value - value before BD)/predicted value x 100 Signup and view all the answers

What is considered significant for reversibility of airway obstruction in FEV1 or FVC?

Increases greater than 10% relative to the predicted value Signup and view all the answers

What is the diagnostic criteria for exercise-induced bronchospasm based on FEV1 change post-exercise?

10% or greater fall in FEV1 Signup and view all the answers

What is one of the most common errors in spirometry?

Failure to exhale completely Signup and view all the answers

What does poor repeatability in a subject suggest during spirometry testing?

Poor effort or lack of cooperation Signup and view all the answers

What treatment was given to the subject experiencing exercise-induced bronchospasm?

Regimen of inhaled short-acting β2 agonist before exercise Signup and view all the answers

What monitoring device can be provided to patients with asthma to track lung function?

Portable peak flow meter Signup and view all the answers

What is the recommended withholding time before pulmonary function testing for Ultra-LABA medications?

36 hours Signup and view all the answers

How many breaths can children take from a holding chamber after a single actuation of an MDI?

Up to 4 breaths Signup and view all the answers

What percentage increase in sGaw is considered significant after the use of a bronchodilator?

30% to 40% Signup and view all the answers

What is the recommended duration to jog on a treadmill at 85% of predicted maximal heart rate for a specific test (Exercise induced bronchospasm) acording to the text un ruppels manual ?

6 minutes Signup and view all the answers

What should be recommended if no significant improvement is observed after bronchodilator therapy?

Trial of bronchodilator therapy may still be recommended if clinically indicated Signup and view all the answers

How should the FEF25%–75% or V max50 flows be corrected when used for assessment?

Isovolume-corrected for changes in the FVC Signup and view all the answers

What interpretive strategies should be considered for bronchodilator responsiveness testing?

Check if prebronchodilator and postbronchodilator measurements are repeatable within 150 mL, look for greater than 10% improvement in FEV1 and FVC, and consider a trial of bronchodilator therapy if no significant improvement is observed. Signup and view all the answers

What is the withholding time for long-acting β2 agonists (LABA) before pulmonary function testing?

24 hours Signup and view all the answers

How long should short-acting muscarinic antagonists (SAMA) be withheld before pulmonary function testing?

12 hours Signup and view all the answers

What are the conditions necessary for a usable FEV1 measurement? (4)

<ol> <li>Extrapolated volume < 5% of FVC or 100 ml, whichever is greater, 2. Absence of evidence of an incorrect zero flow setting, 3. No coughing in the first second of expiration 4. No glottis closure in the first second of expiration</li> </ol> Signup and view all the answers

Two respiratory maneuvers that are not dependent of FVC?

MVV and FEV1 Signup and view all the answers