A case of a smoking patient: but is she really a smoker with suspected pre-COPD?
Some individuals with obstructive pulmonary diseases can have respiratory symptoms and/or structural lesions or physiological abnormalities, without airflow obstruction. These subjects are labelled “Pre-COPD” or PRISM (Preserved Ratio Impaired Spirometry) like says new GOLD Document(1)
Underlying inflammation in asthma increases the activity of the cholinergic nervous system, contributing to bronchoconstriction/airway hyper-responsiveness (AHR) and mucus hypersecretion. Inhaled anticholinergics with shorter duration of action were initially used and then discontinued when other bronchodilators became available.Aclidinium bromide reduce AHR and eosinophilic airway inflammation in an acute model of asthma(2-3).
A young 41-year-old woman came to my attention in August 2022 for cough and dyspnoea under moderate-intense exertion. In remote pathological anamnesis nothing relevant, with the exception of the use of cigarette smoke and the presence of an asthmatic daughter. He performed blood tests and allergy tests which were all normal. I did spirometry which was normal: FEV1: 129%, FVC: 132% FEV1/FVC: 103% PEF: 107%.
On objective examination, there is an obstructive finding in diffuse forced exhalation. I advised to carry out therapy with Aclidinium Bromide 2 BID until November 2022. By repeating the spirometry during the therapy, the presence of the picture is always noted at the normal limits but with the following values: FEV1: 143% (+14%) FVC: 147%(+15%) PEF: 127%(+20%).No more diffuse obstructive finding on physical examination of the chest, only rhonchi in the left apical site. I conclude by considering the patient as non-allergic bronchial asthma in a smoker.
This case demonstrates how the use of aclidinium bromide in bronchial asthma in humans may enable the diagnosis of the condition and, in my opinion, could be a possible new method to test for long-term airway hyperresponsiveness if the use of salbutamol gives a negative test in the first instance (more than 50% of subjects have a negative test on first time). However, we need to carry out randomized controlled trials to validate this method.
1 Marco Umberto Scaramozzino, 2 Giovanni Sapone
1.MD Pulmonologist Director Ambulatory of Pulmonology “La madonnina” Reggio Calabria (RC), Italy Author, mail: firstname.lastname@example.org
2.Head of Nursing Department of Cardiology Polyclinic M.d.c. Reggio Calabria (RC), Italy mail: email@example.com
3 Sheenam S. United Lincolnshire Hospitals NHS Trust, Lincolnshire Department General Medicine.
- GOLD Document 2023
- Antoniu SA. Expert Opin Investig Drugs. 2011 Jun;20(6):871-3.
- Damera G, Jiang M, Zhao H, Fogle HW, Jester WF, Freire J, Panettieri RA Jr. Eur J Pharmacol. 2010 Dec 15;649(1-3):349-53.