The incidence of airflow obstruction in bronchial carcinoma, its relation to breathlessness, and response to bronchodilator therapy

摘要

Breathlessness is a common symptom in patients with primary bronchial carcinoma and is often not well-controlled. Most patients are ex- or current smokers, and therefore are at high risk for co-existing chronic obstructive pulmonary disease (COPD). The incidence of airflow obstruction in patients with bronchial carcinoma, its relation to breathlessness, and response to bronchodilator therapy was examined prospectively. Fifty-seven consecutive patients attending our outpatient clinic with bronchial carcinoma diagnosed in the preceding 12 months were studied (22 female, 35 male, mean age 68.4 years). Spirometry was performed and breathlessness rated. Those with airflow obstruction (FEV_1:FVC < 65% and FEV_1 < 70% predicted) and who judged themselves to have moderate or severe breathlessness, were offered a trial of bronchodilator therapy. The response to regular inhaled fenoterol and ipratropium bromide by metered dose inhaler (MDI) and large volume spacer, and to regular nebulized salbutamol and ipratropium bromide was assessed by home peak flow recordings, spirometry and two subjective scores: (a) rating of breathlessness on a simple four-point scale, and (b) activity score of the St George's Respiratory Questionnaire. There was very strong association between airflow obstruction and breathlessness. Twenty-eight patients (49%) had airflow obstruction, and we had breathlessness ratings on 26 of these patients of whom 18 (69%) had rated it as moderate or severe. Only four of the patients with airflow obstruction and breathlessness were using bronchodilator therapy. There was no significant difference in the mean age, time from diagnosis, tumour site, or smoking history between the groups with, and without, airflow obstruction. There was no association between cell type and the presence of airflow obstruction. Seventeen patients accepted the offer of a trial of bronchodilator therapy, of whom 15 patients remained well enough to complete it. Home peak expiratory flow rate (PEFR), rose from 233 l min~(-1) to 247 l min~(-1) with MDI bronchodilators, and to 256 l min~(-1) with nebulized bronchodilators. Mean FEV_1 rose from 1.18 l to 1.31 l following 2 weeks of MDI bronchodilators, and to 1.35 l with nebulized drugs. For the group, there was no additional benefit from nebulized drugs over the MDI. Eight patients showed objective improvement - PEFR and/or FEV_1 increasing by > 15% of baseline. Nine patients felt that their breathing had been helped 'quite a lot' or 'a great deal', but four patients had not experienced objective benefit. Breathlessness rating improved significantly following bronchodilators, falling from 2.53 pre-treatment to 1.87 following MDI use, and to 1.79 with nebulized drugs. There was no significant improvement in mean activity scores. We conclude that untreated airflow obstruction is commonly present in patients with bronchial carcinoma, is strongly associated with breathlessness, and that these patients may benefit from simple bronchodilator treatment.