CHICAGO — It is rare, but inhaled short-acting β2-adrenergic agonists can elicit paradoxical bronchospasm (PB), which may be fatal. A new study raised concerns that the condition might be unrecognized at the VHA.
A new study sought to determine whether post-bronchodilator PB is reported in spirometry test results of veterans with chronic obstructive pulmonary disease (COPD) or asthma followed at the Jesse Brown VAMC.
An article in Respiratory Medicine and Research reported that 18 of 1,150 test reports reviewed from 2017 to 2020 were identified with post-bronchodilator PB (1.5%). Of the 18 patients with PB, 12 had COPD, four had asthma, and two had both.1
No report referred to post-bronchodilator PB, however.
Researchers noted that, among the identified PB patients, 17 were men and one was a woman. In addition, 14 patients were African Americans, three Caucasian and one Latinx. The mean age was 67 with BMI 28±5 kg/m2. The study team determined that 13 were ex-tobacco smokers, four current smokers and one who never smoked.
The authors add that most recent chest CT revealed emphysema in eight veterans with COPD and bronchial wall thickening in three, while chest radiographs of four veterans with asthma were unremarkable.
They advise that all veterans were treated with inhaled β2-adrenergic agonists. In the aftermath, five were treated with cardio selective beta1 blockers and 10 for gastroesophageal reflux disease, while 11 veterans were diagnosed with obstructive sleep apnea.
In 12 of the veterans, researchers noted that inhaled albuterol (four actuations) induced decrease in FEV1 was 22±8% and 367±167 mL from baseline. In six veterans, only FVC decreased significantly from baseline (14±3% and 448±179 mL).
While no veteran reported respiratory symptoms during or after spirometry testing, two of the patients died during follow-up. Based on spirometry test reports, inhaled β2-adrenergic agonists were discontinued in two veterans with COPD and asthma.
“We propose that post-bronchodilator PB observed during spirometry testing of veterans should be recognized and reported, and its possible clinical implications addressed accordingly,” the authors emphasized.
- Kaul M, Turner K, Rubinstein I. Paradoxical bronchospasm in U.S. military veterans with COPD or asthma at a tertiary VA medical center in Chicago, Illinois. Respir Med Res. 2021 Nov;80:100855. doi: 10.1016/j.resmer.2021.100855. Epub 2021 Aug 14. PMID: 34450560.