Paradoxical bronchospasm ‘a rare and unrecognized’ phenotype of veterans with COPD, asthma
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Paradoxical bronchospasm is rare and is not generally reported in spirometry test results of U.S. veterans with COPD or asthma, researchers reported at the CHEST Annual Meeting.
“Paradoxical bronchospasm, though rare, is a clinically significant entity. It is known to be associated with worse respiratory outcomes, especially with increased risk of frequency of exacerbations in obstructive lung disease,” Malvika Kaul, MD, pulmonary and critical care fellow at the University of Illinois and the Jesse Brown Veterans Affairs Medical Center, Chicago, said during a virtual presentation. “It has been reported in two large COPD studies but has not been reported or addressed in high-risk populations, such as veterans who have high prevalence of obstructive lung diseases like COPD.”
Kaul and colleagues performed a retrospective review of 1,150 pre- and postbronchodilator spirometry test results from 2017 to 2020. The tests were performed among U.S. veterans with COPD and/or asthma treated at the Jesse Brown VA Medical Center.
Paradoxical bronchospasm was defined as a decrease of at least 12% and 200 mL in FEV1 and/or FVC from baseline after inhalation of four puffs of albuterol.
Of all reviewed spirometry test reports, 18 met the criteria for paradoxical bronchospasm.
“Interestingly, none of their test results reported or recognized paradoxical bronchospasm,” Kaul said.
Of the 18 reports with paradoxical bronchospasm, 12 veterans had COPD, four had asthma, and two had asthma and COPD.
The demographics of veterans with paradoxical bronchospasm were as follows: mean age of 67.8 years, predominantly male, majority Black and mean BMI of 28.5. Most had a history of smoking, either current or prior, and had underlying obstructive sleep apnea and/or GERD.
Emphysema was present among five of the 12 veterans with COPD, none of the veterans with asthma only, and in all veterans with asthma and COPD.
“Paradoxical bronchospasm could represent a distinct, rare and unrecognized phenotype in obstructive lung diseases,” Kaul said. “We conclude that paradoxical bronchospasm should be recognized, reported and has clinical implications [that should be] addressed accordingly. We hope, in the future, education of clinicians about this phenomenon is emphasized and presence and significance of paradoxical bronchospasm in respiratory diseases, other than obstructive lung diseases, also be evaluated.”