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An Imperfect Guide for Bronchodilator Therapy in Chronic Airflow Limitation

Gordon H. Guyatt, MD; Marie Townsend; Sharon Nogradi, MSc; Stewart O. Pugsley, MD; Jana L. Keller; Michael T. Newhouse, MD

Arch Intern Med. 1988;148(9):1949-1952.

Abstract
• We conducted a four-period cross-over randomized trial in which we found that patients with chronic airflow limitation demonstrated symptomatic improvement with both inhaled albuterol and oral theophylline. The response, however, was not uniform. We therefore tested the ability of acute change in forced expired volume in one second (FEV₁) following inhaled beta agonist to predict long-term symptomatic response to albuterol and theophylline. We found that the reproducibility of acute change in FEV₁ over three repetitions was poor (intraclass correlation 0.17). Furthermore, the mean improvement in FEV₁ following inhaled albuterol across the three repetitions did not relate closely to symptomatic response to either albuterol or theophylline. We conclude that acute response to inhaled beta agonist is not useful for identifying patients with chronic airflow limitation who are likely to benefit from bronchodilator treatment.

(Arch Intern Med 1988;148:1949-1952)

Author Affiliations
From the Departments of Clinical Epidemiology and Biostatistics (Dr Guyatt, and Ms Townsend, Keller, and Nogradi), and Medicine (Drs Guyatt, Pugsley, and Newhouse), McMaster University, Hamilton, Ontario, Canada.

Footnotes
Accepted for publication April 15, 1988.

Presented to the Canadian Thoracic Society at a meeting of the Royal College of Physicians and Surgeons of Canada, Winnipeg, Manitoba, Sept 12, 1987.

Reprint requests to McMaster University Health Sciences Centre, Room 3H7, 1200 Main St West, Hamilton, Ontario, Canada L8N 3Z5 (Dr Guyatt).

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