Prevalence of paradoxical bronchoconstriction after inhaled albuterol

Purpose: Paradoxical bronchoconstriction with resulting decreased airflow occurs in some patients after administration of bronchodilators. This study assessed the frequency of paradoxical bronchoconstriction in a reallife clinical setting at a large academic medical center. Procedures: We analyzed data from 4593 patients who underwent pre-and post-bronchodilator spirometry testing. We assessed the forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) before and after the administration of an inhaled short-acting beta(2)-agonist. Patients were categorized into 3 groups: bronchodilation, no significant change and paradoxical bronchoconstriction. Main findings: When assessing response to bronchodilators, 201 (4.4%) patients demonstrated significant bronchoconstriction, whereas 849 (18.5%) showed bronchodilation. The majority (3543 or 77.1%) had no significant change. There were no significant relationships noted between paradoxical bronchoconstriction and sex, race/ethnicity or body mass index. Conclusions: A significant subset of patients experience paradoxical bronchoconstriction after albuterol administration. Further research to better understand the clinical implications of paradoxical acute bronchoconstriction is needed.