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Improvement from pulmonary hyperinflation and bronchial obstruction following sympathomimetics systemically given in
1Department of Pediatrics, University of Berne/Switzerland.
Insights
Systemic beta-2-agonists like salbutamol show varied efficacy in infants with bronchopulmonary disease. Treatment response depends on initial lung function abnormalities, with specific effects on hyperinflation and airway resistance.
Area of Science:
- Pediatric Pulmonology
- Pharmacology
- Respiratory Physiology
Background:
- Infants with bronchopulmonary disease exhibit diverse functional disorders.
- Assessing treatment efficacy requires understanding individual lung function profiles.
Purpose of the Study:
- To evaluate the functional disorders and treatment efficacy of systemic salbutamol in infants with bronchopulmonary disease.
- To stratify infants into functional groups based on lung function parameters and assess their response to beta-2-agonists.
Main Methods:
- Infant whole-body plethysmography was used to measure thoracic gas volume (TGV) and airway resistance (Raw).
- Sixty infants (64 data sets) with respiratory distress syndrome survivors, recurrent wheezing, or cystic fibrosis were studied.
- Vector analysis (circular statistics) was employed to evaluate the response to systemic salbutamol (Ventolin).
Main Results:
- Infants were stratified into four functional groups: normal, pulmonary hyperinflation, hyperinflation with bronchial obstruction, and bronchial obstruction.
- Systemic beta-2-agonists demonstrated a volume response in 63% of infants with hyperinflation.
- A flow response was observed in 54% of infants with bronchial obstruction, and a mixed response in 70% with mixed abnormalities.
Conclusions:
- The efficacy of systemic beta-2-agonists varies based on the infant's initial lung function abnormalities.
- Accurate assessment of both TGV and Raw changes is crucial for distinguishing functional groups and predicting treatment response.
- Stratification into functional response groups aids in understanding individualized treatment effects for pediatric respiratory conditions.
Abstract:
Functional disorders and efficacy of treatment with a beta-2-agonist salbutamol (Ventolin), 0.225 mg/kg bodyweight, systemically given, were evaluated by infant whole-body plethysmography in 60 infants (64 data sets) with broncho-pulmonary disease belonging to three diagnostic groups: 24 survivors after respiratory distress syndrome, 21 patients with recurrent wheezing, and 15 infants with cystic fibrosis. The values of thoracic gas volume (IGV) and airway resistance (Raw) prior to the drug administration showed a scattered distribution, which was unrelated to the 3 diagnostic groups. Therefore, stratification into 4 functional groups was performed. In 25 tests (22 infants) normal lung function (TGV less than 130% pred., Raw less than 130% pred.); in 16 tests pulmonary hyperinflation (TGV greater than 130% pred., Raw less than 130% pred.); in 10 tests hyperinflation and bronchial obstruction (TGV and Raw greater than 130% pred.); and in 13 tests (12 patients) bronchial obstruction (TGV less than 130% pred; Raw greater than 130% pred.) were found. The response to beta-2-agonists was evaluated by vector analysis (circular statistics) revealing different response groups. With respect to the initial lung function abnormality and due to a stratification into different "response groups", beta adrenoreceptor agonists showed a volume-response (decrease in end-expiratory level) in 63% of infants with pulmonary hyperinflation, a flow response (improvement of airway resistance) in 54% of infants with predominantly bronchial obstruction and a mixed-response (decrease of TGV and Raw) in 70% of infants with mixed functional abnormalities, at least if the drug is given systemically. However, distinction into functional groups and its response to a sympathomimetic agent is only possible when both, changes in TGV and concomitant changes in Raw are accurately assessed.