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Thamrin C, Robinson PD, Farah CS, King GG. Technical standards for respiratory oscillometry and bronchodilator response cut-offs. Eur Respir J 2022; 59:13993003.02663-2021. [DOI: 10.1183/13993003.02663-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/21/2021] [Indexed: 11/05/2022]
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Tamminen P, Kerimov D, Viskari H, Aittoniemi J, Syrjänen J, Lehtimäki L. Lung function during and after acute respiratory infection in COVID-19 positive and negative outpatients. Eur Respir J 2022; 59:13993003.02837-2021. [PMID: 35058250 PMCID: PMC8785400 DOI: 10.1183/13993003.02837-2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/21/2021] [Indexed: 11/23/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been associated with prolonged post-acute symptoms in at least 10% of patients [1, 2]. The majority of published data evaluates hospitalised patients with severe SARS-CoV-2 disease (COVID-19) with symptoms and pulmonary function defects several months after discharge [1]. Most of the infected subjects develop mild symptoms and are treated as outpatients. Though they are also reported to suffer from prolonged symptoms, their lung function is studied far less. Furthermore, the prolonged symptoms and objectively measurable findings are usually not compared to a group suffering from airway infection caused by other pathogens [2]. As spirometry and other aerosol-producing procedures are minimised during the pandemic, there are no reports on lung function during acute COVID-19. At acute phase, outpatients with mild COVID-19 had more symptoms, higher small airway resistance and poorer lung elasticity compared to outpatients with other respiratory infections, but there was no difference between the groups after 2 monthshttps://bit.ly/3nalPye
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Robertson L, Machado F, Rutkowski S, Silva L, Miranda S, Farver-Vestergaard I, Janssens T, Sylvester KP, Burtin C, Šajnić A, Cruz J. ERS International Congress 2021: Highlights from the Allied Respiratory Professionals assembly. ERJ Open Res 2022; 8:00674-2021. [PMID: 35615415 PMCID: PMC9125039 DOI: 10.1183/23120541.00674-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/21/2021] [Indexed: 11/22/2022] Open
Abstract
This paper provides an overview of some of the most memorable sessions that were (co)organised by the Allied Respiratory Professionals Assembly during the 2021 European Respiratory Society International Congress, which was held online for the second consecutive year due to the COVID-19 pandemic. Early Career Members from Assembly 9 summarised the content of the sessions (three oral communication sessions, two symposia and one Expert View) with the support of the chairs from the four Assembly groups: Respiratory Function Technologists and Scientists (Group 9.01); Physiotherapists (Group 9.02); Nurses (Group 9.03); and Psychologists and Behavioural Scientists (Group 9.04). The sessions covered the following topics: impact of COVID-19 on lung function and healthcare services, and the importance of quality assurance and technology in lung function assessment; diagnosis and management of sarcopenia in patients with chronic respiratory disease; maintenance of the effects of pulmonary rehabilitation; solutions outside the hospital for the management of patients with COVID-19 in need of health care; the nursing perspective during the COVID-19 pandemic; and psychological and behavioural issues in respiratory care. This highlights article provides valuable insight into the latest scientific data and emerging areas affecting clinical practice of allied respiratory professionals. This article provides an overview of outstanding sessions that were (co)organised by @ERS_Assembly9 during #ERSCongress 2021https://bit.ly/332uZWy
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204
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Chaya S, Zar HJ, Gray DM. Lung Function in Preschool Children in Low and Middle Income Countries: An Under-Represented Potential Tool to Strengthen Child Health. Front Pediatr 2022; 10:908607. [PMID: 35769219 PMCID: PMC9234953 DOI: 10.3389/fped.2022.908607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/10/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The burden of respiratory disease is high in low-middle income countries (LMIC). Pulmonary function tests are useful as an objective measure of lung health and to track progression. Spirometry is the commonest test, but its use is limited in preschool children. Other lung function methods have been developed but their use in LMIC has not been well described. AIM To review the use of preschool lung function testing in children in LMIC, with particular reference to feasibility and clinical applications. METHODS Electronic databases "PubMed", "Scopus"," Web of Science", and "EBSCO host" were searched for publications in low and middle income countries on preschool lung function testing, including spirometry, fractional exhaled nitric oxide (FeNO), oscillometry, interrupter technique, tidal breathing and multiple breath washout (MBW), from 1 January 2011 to 31 January 2022. Papers in English were included and those including only children ≥6 years were excluded. RESULT A total of 61 papers from LMIC in Asia, South America, Africa, Eurasia or the Middle East were included. Of these, 40 included spirometry, 7 FeNO, 15 oscillometry, 2 interrupter technique, and 2 tidal breathing. The papers covered test feasibility (19/61), clinical application (46/61) or epidemiological studies (13/61). Lung function testing was successful in preschool children from LMIC. Spirometry was the most technically demanding and success gradually increased with age. CONCLUSION Preschool lung function testing is under-represented in LMIC for the burden of respiratory disease. These tests have the potential to strengthen respiratory care in LMIC, however access needs to be improved.
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Affiliation(s)
- Shaakira Chaya
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Diane M Gray
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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205
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Zhao N, Wu F, Peng J, Zheng Y, Tian H, Yang H, Deng Z, Wang Z, Li H, Wen X, Xiao S, Huang P, Dai C, Lu L, Zhou K, Chen S, Zhou Y, Ran P. Preserved ratio impaired spirometry is associated with small airway dysfunction and reduced total lung capacity. Respir Res 2022; 23:298. [PMID: 36316732 PMCID: PMC9620623 DOI: 10.1186/s12931-022-02216-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 10/06/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Preserved ratio impaired spirometry (PRISm) refers to decreased forced expiratory volume in 1 s (FEV1) in the setting of preserved ratio. Little is known about the role of PRISm and its complex relation with small airway dysfunction (SAD) and lung volume. Therefore, we aimed to investigate the associations between PRISm and SAD and lung volume. METHODS We conducted a cross-sectional community-dwelling study in China. Demographic data, standard respiratory epidemiology questionnaire, spirometry, impulse oscillometry (IOS) and computed tomography (CT) data were collected. PRISm was defined as post-bronchodilator FEV1/FVC ≥ 0.70 and FEV1 < 80% predicted. Spirometry-defined SAD was defined as at least two of three of the post-bronchodilator maximal mid-expiratory flow (MMEF), forced expiratory flow 50% (FEF50), and forced expiratory flow 75% (FEF75) less than 65% of predicted. IOS-defined SAD and CT-defined gas trapping were defined by the fact that the cutoff value of peripheral airway resistance R5-R20 > 0.07 kPa/L/s and LAA- 856>20%, respectively. Analysis of covariance and logistic regression were used to determine associations between PRISm and SAD and lung volume. We then repeated the analysis with a lower limit of normal definition of spirometry criteria and FVC definition of PRISm. Moreover, we also performed subgroup analyses in ever smoker, never smoker, subjects without airway reversibility or self-reported diagnosed asthma, and subjects with CT-measured total lung capacity ≥70% of predicted. RESULTS The final analysis included 1439 subjects. PRISm had higher odds and more severity in spirometry-defined SAD (pre-bronchodilator: odds ratio [OR]: 5.99, 95% confidence interval [95%CI]: 3.87-9.27, P < 0.001; post-bronchodilator: OR: 14.05, 95%CI: 8.88-22.24, P < 0.001), IOS-defined SAD (OR: 2.89, 95%CI: 1.82-4.58, P < 0.001), and CT-air trapping (OR: 2.01, 95%CI: 1.08-3.72, P = 0.027) compared with healthy control after adjustment for confounding factors. CT-measured total lung capacity in PRISm was lower than that in healthy controls (4.15 ± 0.98 vs. 4.78 ± 1.05 L, P < 0.05), after adjustment. These results were robust in repeating analyses and subgroup analyses. CONCLUSION Our finding revealed that PRISm was associated with SAD and reduced total lung capacity. Future studies to identify the underlying mechanisms and longitudinal progression of PRISm are warranted.
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Affiliation(s)
- Ningning Zhao
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Fan Wu
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Jieqi Peng
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Youlan Zheng
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Heshen Tian
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Huajing Yang
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Zhishan Deng
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Zihui Wang
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Haiqing Li
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Xiang Wen
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Shan Xiao
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Peiyu Huang
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Cuiqiong Dai
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Lifei Lu
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Kunning Zhou
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Shengtang Chen
- Medical Imaging Center, Wengyuan County People’s Hospital, Shaoguan, China
| | - Yumin Zhou
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Pixin Ran
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
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206
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Wu J, Zhang H, Shi Y, Wang J, Han Y, Zhang Q, Wang N, Liu S, Zhang Y, Zi H, Wang F, Liu A, Song Y, Jia C, Feng Y, Liu Q, Wan L, Ji M, Long Z, Huang J, Liu L, Sun Y, Tang S, Dong X, Zhou X, Jiang W, Shen L, Jiang H. Reference values of impulse oscillometry (IOS) for healthy Chinese children aged 4-17 years. Respir Res 2022; 23:182. [PMID: 35831898 PMCID: PMC9281015 DOI: 10.1186/s12931-022-02080-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/05/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To establish the predicted value of pulmonary function determined by impulse oscillometry (IOS) in children (4-17 years old) in China. METHODS A total of 6270 healthy children aged 4-17 years in China were included. The Master Screen IOS pulmonary function device (Jaeger Co, Germany) was used to detect the respiratory impedance (Zrs), resonant frequency (Fres), respiratory system resistance (Rrs) and respiratory system reactance (Xrs) at various oscillation frequencies, and the indices above were analysed. Stepwise multivariate regression was used to establish the regression equation of related parameters of IOS in different sexes, ages, height, and weight. RESULTS The differences in the main IOS parameters between different age stages were statistically significant regardless of sex (P < 0.05). The stepwise multivariate regression analysis showed that IOS parameters were related to height, age, and weight, and most IOS parameters were most closely related to height (the absolute value of the regression coefficient was the largest). With increasing age and height, the values of Z5, R5, R20, R5-R20, and Fres decreased, while the value of X5 increased. Through height, age, and weight, we obtained the normal predicted values equation of children's IOS parameters. Compared with the other reference equations, our reference equation is more suitable for Chinese children. CONCLUSIONS The study revealed the reference values of IOS parameters in healthy Chinese children. In the evaluation of results for lung function measurements, this predicted value equation is more consistent with the characteristics of Chinese children than other reference equations. CLINICAL TRIAL ChiCTR: 1800019029.
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Affiliation(s)
- Jinhong Wu
- grid.16821.3c0000 0004 0368 8293Department of Respiratory Medicine, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127 China
| | - Hao Zhang
- Department of Internal Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - Yongsheng Shi
- Department of Pediatric Respiratory, Maternity and Child-Care Hospital of Gansu Province, Lanzhou, 730050 China
| | - Jinrong Wang
- Department of Pediatric Respiratory, Affiliated Provincial Hospital of Shandong First Medical University, Jinan, 250021 China
| | - Yuling Han
- grid.27255.370000 0004 1761 1174Department of Respiratory, Qilu Children’s Hospital of Shandong University, Jinan, 250022 China
| | - Qiaoling Zhang
- Department of Pediatric Respiratory, Maternal and Child Health Hospital in Inner Mongolia Autonomous Region, Hohhot, 010020 China
| | - Ning Wang
- grid.452902.8Asthma Centre of Xi’an Children’s Hospital, Xi’an, 710003 China
| | - Sha Liu
- grid.488412.3Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, Chongqing, 400014 China
| | - Yuehua Zhang
- Pediatrics Infection Disease Ward, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, 570208 China
| | - Huifen Zi
- grid.489937.80000 0004 1757 8474Department of Pediatrics, Baotou Central Hospital, Baotou, 014040 China
| | - Fei Wang
- Department of Pediatric Respiratory, Guiyang Maternal and Child Health Hospital (Guiyang Children’s Hospital), Guiyang, 550003 China
| | - Aihong Liu
- Department of Respiratory Medicine, Children’s Hospital of Shanxi, Taiyuan, 030013 China
| | - Yuxin Song
- Department of Allergy, Harbin Children’s Hospital, Harbin, 150010 China
| | - ChunMei Jia
- Department of Pediatric Respiratory, The Fourth Hospital of Baotou (Baotou Children’s Hospital), Baotou, 014030 China
| | - Yong Feng
- grid.412467.20000 0004 1806 3501Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, 110004 China
| | - Quanhua Liu
- grid.412987.10000 0004 0630 1330Department of Pulmonology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092 China
| | - liya Wan
- grid.417022.20000 0004 1772 3918Respiratory department of Tianjin Children’s Hospital, Tianjin, 300074 China
| | - Minghong Ji
- grid.59053.3a0000000121679639Department of Pediatric, The First Affiliated Hospital of USTC Anhui Provincial Hospital, Hefei, 230001 China
| | - Zhen Long
- grid.33199.310000 0004 0368 7223Department of Pediatric Respiratory Medicine, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070 China
| | - Jianfeng Huang
- grid.411333.70000 0004 0407 2968Department of Pulmonology, Children’s Hospital of Fudan University, Shanghai, 201102 China
| | - Li Liu
- grid.430605.40000 0004 1758 4110Department of Pediatric Respiratory, The First Hospital of Jilin University, Changchun, 130021 China
| | - Yun Sun
- General Pediatric, Yinchuan Women and Children Healthcare Hospital, Yinchuan, 750001 China
| | - Suping Tang
- grid.256112.30000 0004 1797 9307Department of Asthma and Tracheitis, Fuzhou Children’s Hospital, Fujian Medical University, Fuzhou, 350000 China
| | - Xiaoyan Dong
- grid.16821.3c0000 0004 0368 8293Department of Pulmonology, Shanghai Children’s Hospital, Affiliated to Shanghai Jiao Tong University, Shanghai, 200040 China
| | - Xiaojian Zhou
- grid.16821.3c0000 0004 0368 8293Department of Pediatrics, Shanghai First People’s Hospital, Affiliated to Shanghai Jiao Tong University, Shanghai, 200080 China
| | - Wenhui Jiang
- grid.413428.80000 0004 1757 8466Department of Respiratory, Guangzhou Women and Children’s Medical Center, Guangzhou, 510623 China
| | - Li Shen
- grid.412524.40000 0004 0632 3994Department of Respiratory, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, Shanghai, 200025 China
| | - Haohua Jiang
- grid.412524.40000 0004 0632 3994Department of Respiratory, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, Shanghai, 200025 China
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207
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Lin LM, Chang YJ, Yang KD, Lin CH, Chien JW, Kao JK, Lee MS, Chiang TI, Lin CY, Tsai YG. Small Airway Dysfunction Measured by Impulse Oscillometry and Fractional Exhaled Nitric Oxide Is Associated With Asthma Control in Children. Front Pediatr 2022; 10:877681. [PMID: 35783300 PMCID: PMC9247317 DOI: 10.3389/fped.2022.877681] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Impulse oscillometry (IOS) and fractional exhaled nitric oxide (FeNO) are sensitive and non-invasive methods to measure airway resistance and inflammation, although there are limited population-based studies using IOS and FeNO to predict asthma control. OBJECTIVE This study aimed to investigate the utility of IOS and FeNO for assessing childhood asthma control in terms of small airway dysfunction and airway inflammation. METHODS This prospective observational cohort study enrolled 5,018 school children (aged 6-12 years), including 560 asthmatic children and 140 normal participants. FeNO, spirometry, IOS, bronchial dilation test, total IgE, and childhood asthma control test (C-ACT) were measured. FeNO, IOS, spirometry, and C-ACT results were correlated with childhood asthma with and without control. RESULTS Uncontrolled asthmatic children had abnormal FeNO, IOS, and spirometric values compared with control subjects (P < 0.05). IOS parameters with R5, R5-R20, X5, Ax, △R5, and FeNO can predict lower C-ACT scales by the areas under receiver operating characteristic curves (AUCs) (0.616, 0.625, 0.609, 0.622, 0.625, and 0.714). A combination of FeNO (>20 ppb) with IOS measure significantly increased the specificity for predicting uncontrolled asthma patients compared with FeNO alone (P < 0.01). A multiple regression model showed that small airway parameter (R5-R20) was the strongest risk factor [OR (95% CI): 87.26 (7.67-993.31)] for uncontrolled asthma patients. Poor control with lower C-ACT scales correlated with high FeNO (r = -0.394), R5 (r = -0.106), and R5-R20 (r = -0.129) in asthmatic children (P < 0.05). CONCLUSION A combined use of FeNO and IOS measurements strongly predicts childhood asthma with or without control.
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Affiliation(s)
- Liang-Mei Lin
- Respiratory Therapy Section for Children, Changhua Christian Children's Hospital, Changhua, Taiwan
| | - Yu-Jun Chang
- Epidemiology and Biostatistics Center and Big Data Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Kuender D Yang
- Departments of Pediatrics, Mackay Memorial Hospital, Taipei City, Taiwan.,Department of Microbiology and Immunology, National Defense Medical Center, Taipei City, Taiwan
| | - Ching-Hsiung Lin
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.,Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan.,Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan.,Department of Recreation and Holistic Wellness, MingDao University, Changhua, Taiwan
| | - Jien-Wen Chien
- Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, Taiwan.,Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Jun-Kai Kao
- Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, Taiwan.,Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.,Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan.,Frontier Molecular Medical Research Center in Children, Changhua Christian Children Hospital, Changhua, Taiwan.,School of Medicine, Kaohsiung Medical University, Taichung, Taiwan
| | - Ming-Sheng Lee
- Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, Taiwan
| | - Tsay-I Chiang
- College of Nursing, Hungkuang University, Taichung, Taiwan
| | - Ching-Yuang Lin
- Division of Pediatric Nephrology, Children's Hospital, China Medical University, Taichung, Taiwan
| | - Yi-Giien Tsai
- Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, Taiwan.,Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.,School of Medicine, Kaohsiung Medical University, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
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208
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Veneroni C, Pompilio PP, Alving K, Janson C, Nordang L, Dellacà R, Johansson H, Malinovschi A. Self-reported exercise-induced dyspnea and airways obstruction assessed by oscillometry and spirometry in adolescents. Pediatr Allergy Immunol 2022; 33:e13702. [PMID: 34797002 PMCID: PMC9299675 DOI: 10.1111/pai.13702] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Self-reported exercise-induced dyspnea (EID) is common among adolescents. Possible underlying pathologies are exercise-induced bronchoconstriction (EIB) and laryngeal obstruction (EILO). The forced oscillation technique (FOT) may evaluate exercise-induced changes in airway caliber. AIM To investigate in adolescents the relationship between EID, EIB (post-exercise fall in forced expiratory volume in 1s (FEV1 )≥10%), EILO, and post-exercise challenge changes in FOT parameters. METHODS One hundred and forty-three subjects (97 with EID) of 13-15 years old underwent a standardized exercise challenge with FOT measurement and spirometry repeatedly performed between 2 and 30 min post-exercise. EILO was studied in a subset of 123 adolescents. Subjects showing greater changes than the healthy subgroup in the modulus of the inspiratory impedance were considered FOT responders. RESULTS EID-nonEIB subjects presented similar post-exercise changes in all FOT parameters to nonEID-nonEIB adolescents. Changes in all FOT parameters correlated with FEV1 fall. 45 of 97 EID subjects responded neither by FEV1 nor FOT to exercise. 19 and 18 subjects responded only by FEV1 (onlyFEV1 responders) or FOT (onlyFOTresponders), respectively. Only a lower baseline forced vital capacity (FVC)%predicted and a higher FEV1 /FVC distinguished the onlyFEV1 responders from onlyFOTresponders. FOT parameters did not present specific post-exercise patterns in EILO subjects. CONCLUSION FOT can be used to identify post-exercise changes in lower airway function. However, EID has a modest relation with both FEV1 and FOT responses, highlighting the need for objective testing. More research is needed to understand whether onlyFEV1 responders and onlyFOTresponders represent different endotypes.
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Affiliation(s)
- Chiara Veneroni
- TechRes Lab, Department of Electronics, Information and Biomedical Engineering (DEIB), Politecnico di Milano University, Milan, Italy
| | - Pasquale Pio Pompilio
- TechRes Lab, Department of Electronics, Information and Biomedical Engineering (DEIB), Politecnico di Milano University, Milan, Italy
| | - Kjell Alving
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory Medicine, Sleep and Allergy, Uppsala University, Uppsala, Sweden
| | - Leif Nordang
- Dept of Surgical Sciences, Otorhinolaryngology, and Head and Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Raffaele Dellacà
- TechRes Lab, Department of Electronics, Information and Biomedical Engineering (DEIB), Politecnico di Milano University, Milan, Italy
| | - Henrik Johansson
- Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden.,Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
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209
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Radics BL, Gyurkovits Z, Makan G, Gingl Z, Czövek D, Hantos Z. Respiratory Oscillometry in Newborn Infants: Conventional and Intra-Breath Approaches. Front Pediatr 2022; 10:867883. [PMID: 35444964 PMCID: PMC9013809 DOI: 10.3389/fped.2022.867883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/02/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Oscillometry has been employed widely as a non-invasive and standardized measurement of respiratory function in children and adults; however, limited information is available on infants. AIMS To establish the within-session variability of respiratory impedance (Zrs), to characterize the degree and profile of intra-breath changes in Zrs and to assess their impact on conventional oscillometry in newborns. METHODS 109 healthy newborns were enrolled in the study conducted in the first 5 postpartum days during natural sleep. A custom-made wave-tube oscillometry setup was used, with an 8-48 Hz pseudorandom and a 16 Hz sinusoidal signal used for spectral and intra-breath oscillometry, respectively. A resistance-compliance-inertance (R-C-L) model was fitted to average Zrs spectra obtained from successive 30-s recordings. Intra-breath measures, such as resistance (Rrs) and reactance (Xrs) at the end-expiratory, end-inspiratory and maximum-flow points were estimated from three 90-s recordings. All natural and artifact-free breaths were included in the analysis. RESULTS Within-session changes in the mean R, C and L values, respectively, were large (mean coefficients of variation: 10.3, 20.3, and 26.6%); the fluctuations of the intra-breath measures were of similar degree (20-24%). Intra-breath analysis also revealed large swings in Rrs and Xrs within the breathing cycle: the peak-to-peak changes amounted to 93% (range: 32-218%) and 41% (9-212%), respectively, of the zero-flow Zrs magnitude. DISCUSSION Intra-breath tracking of Zrs provides new insight into the determinants of the dynamics of respiratory system, and highlights the biasing effects of mechanical non-linearities on the average Zrs data obtained from the conventional spectral oscillometry.
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Affiliation(s)
- Bence L Radics
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Zita Gyurkovits
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary
| | - Gergely Makan
- Department of Technical Informatics, University of Szeged, Szeged, Hungary
| | - Zoltán Gingl
- Department of Technical Informatics, University of Szeged, Szeged, Hungary
| | - Dorottya Czövek
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Zoltán Hantos
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
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210
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Gupta N. Can oscillometry be a substitute to spirometry in the indigent? Lung India 2022; 39:74-76. [PMID: 34975057 PMCID: PMC8926232 DOI: 10.4103/lungindia.lungindia_72_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The practical difficulties of using spirometry in a 3-year-old girl are highlighted, especially during the COVID-19 era. Oscillometry, a tidal breath-based technique, has shown promising future to reliably assess lung functions in the vulnerable cohort. A simple algorithmic approach has been provided till reference values can be established with multicenter studies.
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Affiliation(s)
- Neeraj Gupta
- Department of Pediatrics, Division of Pediatric Emergency, Critical Care, Pulmonology and Allergic Disorders, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
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211
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Bokov P, Jallouli-Masmoudi D, Amat F, Houdouin V, Delclaux C. Small airway dysfunction is an independent dimension of wheezing disease in preschool children. Pediatr Allergy Immunol 2022; 33:e13647. [PMID: 34378250 DOI: 10.1111/pai.13647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Whether small airway dysfunction (SAD), which is prevalent in asthma, helps to characterize wheezing phenotypes is undetermined. The objective was to assess whether SAD parameters obtained from impedance measurement and asthma probability are linked. METHODS One hundred and thirty-nine preschool children (mean age 4.7 years, 68% boys) suffering from recurrent wheezing underwent impulse oscillometry that allowed calculating peripheral resistance and compliance of the respiratory system (markers of SAD) using the extended RIC model (central and peripheral resistance, inertance, and peripheral compliance). Children were classified using the probability-based approach of GINA guidelines (few, some, and most having asthma). A principal component analysis (PCA) that determined the dimensions of wheezing disease evaluated the links between SAD and asthma probability. RESULTS Forty-seven children belonged to the few, 28 to the some, and 64 to the most having asthma groups. Whereas their anthropometrics and measured parameters were similar, the most having asthma group exhibited the lowest mean value of airway inertance after bronchodilator probably due to airway inhomogeneities. PCA characterized four independent dimensions including a peripheral resistance (constituted by baseline peripheral compliance, Frs, R5Hz, R5-20Hz, X5Hz, and AX), a central resistance (baseline central resistance, R20Hz), anthropometrics (age and height), and asthma probability (wheezing patterns and therapeutic steps). Thus, PCA showed that the SAD markers were independent from clinical dimensions and were unable to differentiate wheezing phenotypes. CONCLUSIONS Lung function parameters obtained from impulse oscillometry and asthma probability were belonging to independent dimensions of the wheezing disease.
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Affiliation(s)
- Plamen Bokov
- Service de Physiologie Pédiatrique-Centre du Sommeil, INSERM NeuroDiderot, AP-HP, Hôpital Robert Debré, Université de Paris, Paris, France
| | - Donies Jallouli-Masmoudi
- Service de Physiologie Pédiatrique-Centre du Sommeil, AP-HP, Hôpital Robert Debré, Paris, France
| | - Flore Amat
- Service de Pneumopédiatrie, INSERM UMR S 1136, AP-HP, Hôpital Robert Debré, Paris, France
| | - Véronique Houdouin
- Service de Pneumopédiatrie, INSERM UMR S 976, AP-HP, Hôpital Robert Debré, Paris, France
| | - Christophe Delclaux
- Service de Physiologie Pédiatrique-Centre du Sommeil, INSERM NeuroDiderot, AP-HP, Hôpital Robert Debré, Université de Paris, Paris, France
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212
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Kouri A, Dandurand RJ, Usmani OS, Chow CW. Exploring the 175-year history of spirometry and the vital lessons it can teach us today. Eur Respir Rev 2021; 30:30/162/210081. [PMID: 34615699 DOI: 10.1183/16000617.0081-2021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/02/2021] [Indexed: 12/25/2022] Open
Abstract
175 years have elapsed since John Hutchinson introduced the world to his version of an apparatus that had been in development for nearly two centuries, the spirometer. Though he was not the first to build a device that sought to measure breathing and quantify the impact of disease and occupation on lung function, Hutchison coined the terms spirometer and vital capacity that are still in use today, securing his place in medical history. As Hutchinson envisioned, spirometry would become crucial to our growing knowledge of respiratory pathophysiology, from Tiffeneau and Pinelli's work on forced expiratory volumes, to Fry and Hyatt's description of the flow-volume curve. In the 20th century, standardization of spirometry further broadened its reach and prognostic potential. Today, spirometry is recognized as essential to respiratory disease diagnosis, management and research. However, controversy exists in some of its applications, uptake in primary care remains sub-optimal and there are concerns related to the way in which race is factored into interpretation. Moving forward, these failings must be addressed, and innovations like Internet-enabled portable spirometers may present novel opportunities. We must also consider the physiologic and practical limitations inherent to spirometry and further investigate complementary technologies such as respiratory oscillometry and other emerging technologies that assess lung function. Through an exploration of the storied history of spirometry, we can better contextualize its current landscape and appreciate the trends that have repeatedly arisen over time. This may help to improve our current use of spirometry and may allow us to anticipate the obstacles confronting emerging pulmonary function technologies.
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Affiliation(s)
- Andrew Kouri
- Division of Respirology, Dept of Medicine, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada
| | - Ronald J Dandurand
- Lakeshore General Hospital, Quebec, Canada.,Dept of Medicine, Respiratory Division, McGill University, Montreal, Quebec, Canada.,Montreal Chest Institute, Meakins-Christie Labs and Oscillometry Unit of the Centre for Innovative Medicine, McGill University Health Centre and Research Institute, Montreal, Canada
| | - Omar S Usmani
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, UK
| | - Chung-Wai Chow
- Dept of Medicine, University of Toronto, Toronto, Canada.,Division of Respirology and Multi-Organ Transplant Programme, Dept of Medicine, Toronto General Hospital, University Health Network, Toronto, Canada
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213
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Alamdari HH, Hacquebard L, Driscoll S, El-Sankary K, Roach DC, LeBlanc R, Lowe S, Oore S, Penzel T, Fietze I, Schmidt M, Morrison D. High Frequency-Low Amplitude Oscillometry: Continuous Unobtrusive Monitoring of Respiratory Function on PAP Machines. IEEE Trans Biomed Eng 2021; 69:2202-2211. [PMID: 34962859 DOI: 10.1109/tbme.2021.3138965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Oscillometry or Forced Oscillation Technique, traditionally used in intermittent clinical measurements, has recently gained substantial attention from its application as a continuous monitoring tool for large and small airways. However, low frequency (< 8 Hz) continuous oscillometry faces high breathing noise, and hence requires high oscillation amplitudes to maintain an acceptable signal-to-noise ratio. Therefore, PAP machines that utilize low frequency oscillometry do so intermittently to distinguish airway patency several seconds after a breathing pause has occurred. We hypothesized that high frequency and low amplitude (HFLA) oscillometry may be as sensitive and applicable for monitoring upper airway patency to distinguish between central and obstructive apnea and hypopnea events, and for monitoring respiratory impedance. An inline oscillometry prototype device was developed and connected to commercial PAP machines to test whether oscillometry at 17, 43, and 79 Hz are as sensitive to airway patency as oscillometry at 4 Hz. Analysis of 11 patients with 171 apneas and hypopneas showed that all frequency oscillometry inputs were equally sensitive in distinguishing between central and obstructive apneas, while 17 Hz and 43 Hz oscillometry were most sensitive in distinguishing between central and obstructive hypopneas. Observations during normal breathing also showed the same periodicity and cross-correlation between impedance measurements from HFLA oscillometry compared to 4 Hz. Our findings provide an unobtrusive means of distinguishing airway patency during sleep and a means of continuous monitoring of respiratory function, with the potential for detection and prediction of developing respiratory diseases and significantly richer context for data analytics.
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214
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McKenzie J, Nisha P, Cannon-Bailey S, Cain C, Kissel M, Stachel J, Proscyk C, Romano R, Hardy B, Calverley PMA. Overnight variation in tidal expiratory flow limitation in COPD patients and its correction: an observational study. Respir Res 2021; 22:319. [PMID: 34949190 PMCID: PMC8697433 DOI: 10.1186/s12931-021-01913-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 12/09/2021] [Indexed: 11/21/2022] Open
Abstract
Background Tidal expiratory flow limitation (EFLT) is common among COPD patients. Whether EFLT changes during sleep and can be abolished during home ventilation is not known. Methods COPD patients considered for noninvasive ventilation used a ventilator which measured within-breath reactance change at 5 Hz (∆Xrs) and adjusted EPAP settings to abolish EFLT. Participants flow limited (∆Xrs > 2.8) when supine underwent polysomnography (PSG) and were offered home ventilation for 2 weeks. The EPAP pressure that abolished EFLT was measured and compared to that during supine wakefulness. Ventilator adherence and subjective patient perceptions were obtained after home use. Results Of 26 patients with supine EFLT, 15 completed overnight PSG and 10 the home study. In single night and 2-week home studies, EFLT within and between participants was highly variable. This was unrelated to sleep stage or body position with only 14.6% of sleep time spent within 1 cmH2O of the awake screening pressure. Over 2 weeks, mean EPAP was almost half the mean maximum EPAP (11.7 vs 6.4 cmH2O respectively). Group mean ∆Xrs was ≤ 2.8 for 77.3% of their home use with a mean time to abolish new EFLT of 5.91 min. Adherence to the ventilator varied between 71 and 100% in prior NIV users and 36–100% for naïve users with most users rating therapy as comfortable. Conclusions Tidal expiratory flow limitation varies significant during sleep in COPD patients. This can be controlled by auto-titrating the amount of EPAP delivered. This approach appears to be practical and well tolerated by patients. Trial registration: The trial was retrospectively registered at CT.gov NCT04725500. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-021-01913-7.
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Affiliation(s)
- J McKenzie
- Philips Respironics, Monroeville, PA, USA
| | - P Nisha
- Philips Respironics, Monroeville, PA, USA
| | | | - C Cain
- Philips Respironics, Monroeville, PA, USA
| | - M Kissel
- Philips Respironics, Monroeville, PA, USA
| | - J Stachel
- Philips Respironics, Monroeville, PA, USA
| | - C Proscyk
- Philips Respironics, Monroeville, PA, USA
| | - R Romano
- Philips Respironics, Monroeville, PA, USA
| | - B Hardy
- Philips Respironics, Monroeville, PA, USA
| | - P M A Calverley
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK. .,University Hospital Aintree, Longmoor Lane, Liverpool, L23 8UE, UK.
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215
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Lavizzari A, Veneroni C, Beretta F, Ottaviani V, Fumagalli C, Tossici M, Colnaghi M, Mosca F, Dellacà RL. Oscillatory mechanics at birth for identifying infants requiring surfactant: a prospective, observational trial. Respir Res 2021; 22:314. [PMID: 34930247 PMCID: PMC8686669 DOI: 10.1186/s12931-021-01906-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/25/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Current criteria for surfactant administration assume that hypoxia is a direct marker of lung-volume de-recruitment. We first introduced an early, non-invasive assessment of lung mechanics by the Forced Oscillation Technique (FOT) and evaluated its role in predicting the need for surfactant therapy. OBJECTIVES To evaluate whether lung reactance (Xrs) assessment by FOT within 2 h of birth identifies infants who would need surfactant within 24 h; to eventually determine Xrs performance and a cut-off value for early detection of infants requiring surfactant. METHODS We conducted a prospective, observational, non-randomized study in our tertiary NICU in Milan. Eligible infants were born between 27+0 and 34+6 weeks' gestation, presenting respiratory distress after birth. EXCLUSION CRITERIA endotracheal intubation at birth, major malformations participation in other interventional trials, parental consent denied. We assessed Xrs during nasal CPAP at 5 cmH2O at 10 Hz within 2 h of life, recording flow and pressure tracing through a Fabian Ventilator for off-line analysis. Clinicians were blinded to FOT results. RESULTS We enrolled 61 infants, with a median [IQR] gestational age of 31.9 [30.3; 32.9] weeks and birth weight 1490 [1230; 1816] g; 2 infants were excluded from the analysis for set-up malfunctioning. 14/59 infants received surfactant within 24 h. Xrs predicted surfactant need with a cut-off - 33.4 cmH2O*s/L and AUC-ROC = 0.86 (0.76-0.96), with sensitivity 0.85 and specificity 0.83. An Xrs cut-off value of - 23.3 cmH2O*s/L identified infants needing surfactant or respiratory support > 28 days with AUC-ROC = 0.89 (0.81-0.97), sensitivity 0.86 and specificity 0.77. Interestingly, 12 infants with Xrs < - 23.3 cmH2O*s/L (i.e. de-recruited lungs) did not receive surfactant and subsequently required prolonged respiratory support. CONCLUSION Xrs assessed within 2 h of life predicts surfactant need and respiratory support duration in preterm infants. The possible role of Xrs in improving the individualization of respiratory management in preterm infants deserves further investigation.
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Affiliation(s)
- Anna Lavizzari
- NICU, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Via Commenda 12, 20135, Milan, Italy.
| | - Chiara Veneroni
- Dipartimento di Elettronica, Informazione e Bioingegneria-DEIB Laboratorio di Tecnologie Biomediche-TechRes Lab, Politecnico di Milano University, Milan, Italy
| | - Francesco Beretta
- NICU, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Via Commenda 12, 20135, Milan, Italy
| | - Valeria Ottaviani
- Dipartimento di Elettronica, Informazione e Bioingegneria-DEIB Laboratorio di Tecnologie Biomediche-TechRes Lab, Politecnico di Milano University, Milan, Italy
| | - Claudia Fumagalli
- NICU, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Via Commenda 12, 20135, Milan, Italy
| | - Marta Tossici
- Dipartimento di Elettronica, Informazione e Bioingegneria-DEIB Laboratorio di Tecnologie Biomediche-TechRes Lab, Politecnico di Milano University, Milan, Italy
| | - Mariarosa Colnaghi
- NICU, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Via Commenda 12, 20135, Milan, Italy
| | - Fabio Mosca
- NICU, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Via Commenda 12, 20135, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Raffaele L Dellacà
- Dipartimento di Elettronica, Informazione e Bioingegneria-DEIB Laboratorio di Tecnologie Biomediche-TechRes Lab, Politecnico di Milano University, Milan, Italy
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216
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Lopes AJ, Litrento PF, Provenzano BC, Carneiro AS, Monnerat LB, da Cal MS, Ghetti ATA, Mafort TT. Small airway dysfunction on impulse oscillometry and pathological signs on lung ultrasound are frequent in post-COVID-19 patients with persistent respiratory symptoms. PLoS One 2021; 16:e0260679. [PMID: 34843598 PMCID: PMC8629296 DOI: 10.1371/journal.pone.0260679] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background Thousands of people worldwide are suffering the consequences of coronavirus disease-2019 (COVID-19), and impulse oscillometry (IOS) and lung ultrasound (LUS) might be important tools for the follow-up of this population. Our objective was to prospectively evaluate abnormalities detected using these two methods in a cohort of COVID-19 survivors with respiratory symptoms. Methods In this follow-up study, 59 patients underwent clinical evaluations, spirometry, IOS and LUS in the 2nd (M1) and 5th (M2) months after diagnostic confirmation of COVID-19 by real-time reverse transcriptase–polymerase chain reaction. Aeration scores were obtained from the LUS exams based on the following findings: B-lines >2, coalescent B-lines, and subpleural consolidations. Results Fifty-nine (100%) participants had cough and/or dyspnea at M1, which decreased to 38 (64.4%) at M2 (p = 0.0001). Spirometry was abnormal in 26 (44.1%) and 20 (33.9%) participants at M1 and M2, respectively, although without statistical significance (p = 0.10). Normal examination, restrictive patterns, and obstructive patterns were observed in 33 (55.9%), 18 (30.5%), and 8 (13.6%) participants, respectively, at M1 and in 39 (66.1%), 13 (22%), and 7 (11.9%) participants at M2 (p = 0.14). Regarding IOS, considering changes in resistive and reactive parameters, abnormal exams were detected in 52 (88.1%) and 42 (71.2%) participants at M1 and M2, respectively (p = 0.002). Heterogeneity of resistance between 4 and 20 Hz >20% was observed in 38 (64.4%) and 33 (55.9%) participants at M1 and M2, respectively (p = 0.30). Abnormal LUS was observed in 46 (78%) and 36 (61%) participants at M1 and M2, respectively (p = 0.002), with a reduction in aeration scores between M1 and M2 [5 (2–8) vs. 3 (0–6) points, p<0.0001]. Conclusions IOS and LUS abnormalities are frequent in the first 5 months post-COVID-19 infection; however, when prospectively evaluated, significant improvement is evident in the parameters measured by these two methods.
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Affiliation(s)
- Agnaldo José Lopes
- Department of Pulmonology, Piquet Carneiro Policlinic, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
- Medical Sciences Post-Graduation Programme, School of Medical Sciences, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
- Rehabilitation Sciences Post-Graduation Programme, Augusto Motta University Center (UNISUAM), Rio de Janeiro/RJ, Brazil
- * E-mail:
| | - Patrícia Frascari Litrento
- Department of Pulmonology, Piquet Carneiro Policlinic, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Bruna Cuoco Provenzano
- Department of Pulmonology, Piquet Carneiro Policlinic, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Alícia Sales Carneiro
- Department of Pulmonology, Piquet Carneiro Policlinic, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Laura Braga Monnerat
- Department of Pulmonology, Piquet Carneiro Policlinic, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Mariana Soares da Cal
- Department of Pulmonology, Piquet Carneiro Policlinic, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Angelo Thomaz Abalada Ghetti
- Department of Pulmonology, Piquet Carneiro Policlinic, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Thiago Thomaz Mafort
- Department of Pulmonology, Piquet Carneiro Policlinic, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
- Medical Sciences Post-Graduation Programme, School of Medical Sciences, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
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217
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Jetmalani K, Brown NJ, Boustany C, Toelle BG, Marks GB, Abramson MJ, Johns DP, James AL, Hunter M, Musk AW, Berend N, Farah CS, Chapman DG, Thamrin C, King GG. Normal limits for oscillometric bronchodilator responses and relationships with clinical factors. ERJ Open Res 2021; 7:00439-2021. [PMID: 34761000 PMCID: PMC8573235 DOI: 10.1183/23120541.00439-2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction We aimed to determine normal thresholds for positive bronchodilator responses for oscillometry in an Australian general population sample aged ≥40 years, to guide clinical interpretation. We also examined relationships between bronchodilator responses and respiratory symptoms, asthma diagnosis, smoking and baseline lung function. Methods Subjects recruited from Sydney, Melbourne and Busselton, Australia, underwent measurements of spirometry, resistance (Rrs6) and reactance (Xrs6) at 6 Hz, before and after inhalation of salbutamol 200 μg. Respiratory symptoms and/or medication use, asthma diagnosis, and smoking were recorded. Threshold bronchodilator responses were defined as the fifth percentile of decrease in Rrs6 and 95th percentile increase in Xrs6 in a healthy subgroup. Results Of 1318 participants, 1145 (570 female) were analysed. The lower threshold for ΔRrs6 was −1.38 cmH2O·s·L−1 (−30.0% or −1.42 Z-scores) and upper threshold for ΔXrs6 was 0.57 cmH2O·s·L−1 (1.36 Z-scores). Respiratory symptoms and/or medication use, asthma diagnosis, and smoking all predicted bronchodilator response, as did baseline oscillometry and spirometry. When categorised into clinically relevant groups according to those predictors, ΔXrs6 was more sensitive than spirometry in smokers without current asthma or chronic obstructive pulmonary disease (COPD), ∼20% having a positive response. Using absolute or Z-score change provided similar prevalences of responsiveness, except in COPD, in which responsiveness measured by absolute change was twice that for Z-score. Discussion This study describes normative thresholds for bronchodilator responses in oscillometry parameters, including intra-breath parameters, as determined by absolute, relative and Z-score changes. Positive bronchodilator response by oscillometry correlated with clinical factors and baseline function, which may inform the clinical interpretation of oscillometry. Normative values for bronchodilator responses measured by oscillometry were derived. Responsiveness related to clinical factors and baseline function. Reactance was more sensitive in detecting bronchodilator response than spirometry mild airways disease.https://bit.ly/3wtWVeV
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Affiliation(s)
- Kanika Jetmalani
- The Woolcock Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Nathan J Brown
- The Woolcock Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Royal Brisbane and Women's Hospital, Emergency and Trauma Centre, Herston, QLD, Australia
| | - Chantale Boustany
- The Woolcock Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,School of Nursing, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Brett G Toelle
- The Woolcock Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
| | - Guy B Marks
- The Woolcock Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,Ingham Institute of Applied Medical Research, Sydney, NSW, Australia
| | - Michael J Abramson
- School of Population Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - David P Johns
- College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Alan L James
- Busselton Population Medical Research Institute, Busselton, WA, Australia.,School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia.,Dept of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Michael Hunter
- Busselton Population Medical Research Institute, Busselton, WA, Australia.,School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Arthur W Musk
- Busselton Population Medical Research Institute, Busselton, WA, Australia.,School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | - Norbert Berend
- The Woolcock Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Claude S Farah
- The Woolcock Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Dept of Thoracic Medicine, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - David G Chapman
- The Woolcock Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Dept of Respiratory Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Cindy Thamrin
- The Woolcock Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Gregory G King
- The Woolcock Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
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Virji MA, Cummings KJ, Cox-Ganser JM. A Strategy for Field Evaluations of Exposures and Respiratory Health of Workers at Small- to Medium-Sized Coffee Facilities. Front Public Health 2021; 9:705225. [PMID: 34858915 PMCID: PMC8631862 DOI: 10.3389/fpubh.2021.705225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
Coffee production is a global industry with roasteries throughout the world. Workers in this industry are exposed to complex mixtures of gases, dusts, and vapors including carbon monoxide, carbon dioxide, coffee dust, allergens, alpha-diketones, and other volatile organic compounds (VOCs). Adverse respiratory health outcomes such as respiratory symptoms, reduced pulmonary function, asthma, and obliterative bronchiolitis can occur among exposed workers. In response to health hazard evaluations requests received from 17 small- to medium-sized coffee facilities across the United States, the National Institute for Occupational Safety and Health conducted investigations during 2016-2017 to understand the burden of respiratory abnormalities, exposure characteristics, relationships between exposures and respiratory effects, and opportunities for exposure mitigation. Full-shift, task-based, and instantaneous personal and area air samples for diacetyl, 2,3-pentanedione and other VOCs were collected, and engineering controls were evaluated. Medical evaluations included questionnaire, spirometry, impulse oscillometry, and fractional exhaled nitric oxide. Exposure and health assessments were conducted using standardized tools and approaches, which enabled pooling data for aggregate analysis. The pooled data provided a larger population to better address the requestors' concern of the effect of exposure to alpha-diketones on the respiratory heath of coffee workers. This paper describes the rationale for the exposure and health assessment strategy, the approach used to achieve the study objectives, and its advantages and limitations.
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Affiliation(s)
| | | | - Jean M. Cox-Ganser
- Respiratory Health Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, WV, United States
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219
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Kilci F, Uyan ZS, Çelakıl ME, Doğan K, Bek K. Respiratory function in children with nephrotic syndrome: Comparative evaluation of impulse oscillometry and spirometry. Pediatr Pulmonol 2021; 56:3301-3309. [PMID: 34289254 DOI: 10.1002/ppul.25589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/01/2021] [Accepted: 07/15/2021] [Indexed: 11/09/2022]
Abstract
AIM To evaluate the respiratory functions of children with nephrotic syndrome (NS) by impulse oscillometry (IOS) and its correlation with spirometry. METHODS Fifty-five NS patients aged 3-18 years were included as the study group and 40 healthy children of the same age formed the control group. Patients were divided into nephrotic phase (first attack and relapse) and remission. Demographic, anthropometric, and laboratory data of the children were recorded. Respiratory functions were evaluated by IOS and spirometry. Children over 6-years old performed both IOS and spirometry while children under 6 years performed only IOS. RESULTS The R (R5%, R10%, R5-20), AX and Z5% values of IOS in patients with nephrotic phase were higher than remission patients and control group while spirometry indices of PEF% and MEF25-75% were lower. Z scores of MEF25-75 were significantly negatively correlated with z scores of R5, R10, Z5, and Fres while they were significantly positively correlated with z scores of X values (5, 10, 15, and 20 Hz). Z scores of forced expiratory volume in 1 /forced vital capacity significantly negatively correlated with z scores of R values (R5, R10), Z5 and AX and positively correlated with z scores of X values (X5, X10, X15 Hz). CONCLUSION Our study demonstrated that respiratory functions measured by IOS and spirometry were affected at the time of nephrotic phase in NS patients. IOS, a novel method easily applicable even in small children, is a potentially valuable tool to detect this condition; given its good correlation with spirometry.
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Affiliation(s)
- Fatih Kilci
- Department of Pediatrics, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Zeynep S Uyan
- Department of Pediatrics, Division of Pediatric Pulmonology, School of Medicine, Koç University, İstanbul, Turkey
| | - Mehtap E Çelakıl
- Department of Pediatrics, Division of Pediatric Nephrology, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Kenan Doğan
- Department of Pediatrics, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Kenan Bek
- Department of Pediatrics, Division of Pediatric Nephrology, School of Medicine, Kocaeli University, Kocaeli, Turkey
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220
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Forced Oscillation Technique for Monitoring the Respiratory Status of Children with Cystic Fibrosis: A Systematic Review. CHILDREN-BASEL 2021; 8:children8100857. [PMID: 34682122 PMCID: PMC8534643 DOI: 10.3390/children8100857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/13/2021] [Accepted: 09/23/2021] [Indexed: 11/17/2022]
Abstract
Spirometry is considered the gold standard method for monitoring lung function of patients with cystic fibrosis (CF) but it requires patients’ cooperation and therefore it is not useful for the majority of preschool-aged children. Oscillometry is an alternative modality for lung function monitoring that requires minimal cooperation and can be applied in children as young as 3 years of age. Furthermore, it generates lesser aerosol compared to spirometry, an issue that is of considerable importance in the COVID-19 era. The aim of this review was to present the existing clinical data regarding the application of oscillometry in children and adolescents with CF. The method seems to have acceptable feasibility and repeatability. However, there is conflicting data regarding the correlation of oscillometry values with the clinical symptoms of CF patients either in clinically stable or in exacerbation periods. Furthermore, it is not clear to what extent oscillometry measurements correlate with the spirometry indices. Based on current evidence, spirometry cannot be substituted by oscillometry in the monitoring of the respiratory status of children and adolescents with CF.
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221
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Artificial intelligence for quality control of oscillometry measures. Comput Biol Med 2021; 138:104871. [PMID: 34560503 DOI: 10.1016/j.compbiomed.2021.104871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/10/2021] [Accepted: 09/11/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The forced oscillation technique (FOT) allows non-invasive lung function testing during quiet breathing even without expert guidance. However, it still relies on an operator for excluding breaths with artefacts such as swallowing, glottis closure and coughing. This manual selection is operator-dependent and time-consuming. We evaluated supervised machine learning methods to exclude breaths with artefacts from data analysis automatically. METHODS We collected 932 FOT measurements (Resmon Pro Full, Restech) from 155 patients (6-87 years) following the European Respiratory Society (ERS) technical standards. Patients were randomly assigned to either a training (70%) or test set. For each breath, we computed 71 features (including anthropometric, pressure stimulus, breathing pattern, and oscillometry data). Univariate filter, multivariate filter and wrapper methods for feature selection combined with several classification models were considered. RESULTS Trained operators identified 4333 breaths with- and 10244 without artefacts. Features selection performed by a wrapper method combined with an AdaBoost tree model provided the best performance metrics on the test set: Balanced Accuracy = 85%; Sensitivity = 79%; Specificity = 91%; AUC-ROC = 0.93. Differences in FOT parameters computed after manual or automatic breath selection was less than ∼0.25 cmH2O*s/L for 95% of cases. CONCLUSION Supervised machine-learning techniques allow reliable artefact detection in FOT diagnostic tests. Automating this process is fundamental for enabling FOT for home monitoring, telemedicine, and point-of-care diagnostic applications and opens new scenarios for respiratory and community medicine.
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222
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Impact of bronchial wall thickness on airflow obstruction in bronchiectasis. Respir Physiol Neurobiol 2021; 295:103788. [PMID: 34555525 DOI: 10.1016/j.resp.2021.103788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/19/2021] [Indexed: 11/23/2022]
Abstract
The association between airflow obstruction and bronchial dilation has been researched in bronchiectasis. However, the impact of bronchial wall thickening on airflow obstruction has not been thoroughly investigated. This study assessed the underlying mechanism of airflow obstruction in bronchiectasis due to abnormal bronchial wall thickening using oscillometry. A total of 98 patients with bronchiectasis were retrospectively reviewed. At the time of diagnosis, spirometric and oscillometric parameters, high-resolution computed tomography scores, and clinical characteristics were collected. The bronchial diameter, bronchial wall thickness, and extent of emphysema were evaluated semi-quantitatively. Correlations between patient data and characteristics were analyzed. Thirty-three patients with airflow obstruction showed higher respiratory resistance, more negative respiratory reactance (Xrs) at 5 Hz (X5), and higher bronchial wall thickness score than those without airflow obstruction. The bronchial wall thickness score negatively affected forced expiration volume in 1 s /forced vital capacity and X5. Abnormal bronchial wall thickening might make Xrs more negative and progress airflow obstruction in bronchiectasis.
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223
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Boucher M, Henry C, Khadangi F, Dufour-Mailhot A, Bossé Y. Double-chamber plethysmography versus oscillometry to detect baseline airflow obstruction in a model of asthma in two mouse strains. Exp Lung Res 2021; 47:390-401. [PMID: 34541979 DOI: 10.1080/01902148.2021.1979693] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM OF THE STUDY The current gold standard to assess respiratory mechanics in mice is oscillometry, a technique from which several readouts of the respiratory system can be deduced, such as resistance and elastance. However, these readouts are often not altered in mouse models of asthma. This is in stark contrast with humans, where asthma is generally associated with alterations when assessed by either oscillometry or other techniques. In the present study, we have used double-chamber plethysmography (DCP) to evaluate the breathing pattern and the degree of airflow obstruction in a mouse model of asthma. MATERIALS AND METHODS Female C57BL/6 and BALB/c mice were studied at day 1 using DCP, as well as at day 11 using both DCP and oscillometry following a once-daily exposure to either house-dust mite (HDM) or saline for 10 consecutive days. RESULTS All DCP readouts used to describe either the breathing pattern (e.g., tidal volume and breathing frequency) or the degree of airflow obstruction (e.g., specific airway resistance) were different between mouse strains at day 1. Most of these strain differences persisted at day 11. Most oscillometric readouts (e.g., respiratory system resistance and elastance) were also different between strains. Changes caused by HDM were obvious with DCP, including decreases in tidal volume, minute ventilation, inspiratory time and mid-tidal expiratory flow and an increase in specific airway resistance. HDM also caused some strain specific alterations in breathing pattern, including increases in expiratory time and end inspiratory pause, which were only observed in C57BL/6 mice. Oscillometry also detected a small but significant increase in tissue elastance in HDM versus saline-exposed mice. CONCLUSIONS DCP successfully identified differences between C57BL/6 and BALB/c mice, as well as alterations in mice from both strains exposed to HDM. We conclude that, depending on the study purpose, DCP may sometimes outweigh oscillometry.
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Affiliation(s)
- Magali Boucher
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, Canada
| | - Cyndi Henry
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, Canada
| | - Fatemeh Khadangi
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, Canada
| | - Alexis Dufour-Mailhot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, Canada
| | - Ynuk Bossé
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, Canada
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224
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Principe S, Benfante A, Battaglia S, Maitland Van Der Zee AH, Scichilone N. The potential role of SP-D as an early biomarker of severity of asthma. J Breath Res 2021; 15. [PMID: 34428746 DOI: 10.1088/1752-7163/ac20c1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/24/2021] [Indexed: 11/12/2022]
Abstract
Surfactant decreases the surface tension of peripheral airways and modulates the immunological responses of the lung. The alterations of surfactant due to the airway inflammation suggest a role in the pathogenesis of asthma. We aim to test the hypothesis that serum levels of SP-A (Surfactant Protein A) and SP-D (Surfactant Protein-D) are altered in patients with mild asthma compared to healthy controls and those alterations are related to functional abnormalities of peripheral airways, which are an early marker of progression of asthma. In this pilot study, we recruited 20 mild asthmatics and 10 healthy controls. We measured serum SP-A and SP-D and all subjects underwent clinical, lung functional and biological assessments. Serum SP-D was significantly higher in asthmatics compared to healthy controls (mean (SD) values: 7.9(4.65) vs 3.31(1.71) ng ml-1,p-value: 0.008). In the asthmatic group, serum SP-D was significantly correlated to CalvNO (alveolar NO concentration) (R-squared: 0.26;p-value: 0.014). These preliminary findings suggest that serum SP-D could be used as a lung-specific biomarker of small airways damage thus predicting the progression to the most severe forms of asthma.
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Affiliation(s)
- Stefania Principe
- Dipartimento Universitario di Promozione della Salute, Materno Infantile, University of Palermo, Medicina Interna e Specialistica di Eccellenza 'G. D'Alessandro' (PROMISE) c/o Pneumologia, AOUP 'Policlinico Paolo Giaccone', 90127 Palermo, Italy.,Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Alida Benfante
- Dipartimento Universitario di Promozione della Salute, Materno Infantile, University of Palermo, Medicina Interna e Specialistica di Eccellenza 'G. D'Alessandro' (PROMISE) c/o Pneumologia, AOUP 'Policlinico Paolo Giaccone', 90127 Palermo, Italy
| | - Salvatore Battaglia
- Dipartimento Universitario di Promozione della Salute, Materno Infantile, University of Palermo, Medicina Interna e Specialistica di Eccellenza 'G. D'Alessandro' (PROMISE) c/o Pneumologia, AOUP 'Policlinico Paolo Giaccone', 90127 Palermo, Italy
| | - Anke H Maitland Van Der Zee
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Nicola Scichilone
- Dipartimento Universitario di Promozione della Salute, Materno Infantile, University of Palermo, Medicina Interna e Specialistica di Eccellenza 'G. D'Alessandro' (PROMISE) c/o Pneumologia, AOUP 'Policlinico Paolo Giaccone', 90127 Palermo, Italy
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225
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Ghita M, Copot D, Ionescu CM. Lung cancer dynamics using fractional order impedance modeling on a mimicked lung tumor setup. J Adv Res 2021; 32:61-71. [PMID: 34484826 PMCID: PMC8408337 DOI: 10.1016/j.jare.2020.12.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/28/2020] [Accepted: 12/31/2020] [Indexed: 12/23/2022] Open
Abstract
Introduction As pulmonary dysfunctions are prospective factors for developing cancer, efforts are needed to solve the limitations regarding applications in lung cancer. Fractional order respiratory impedance models can be indicative of lung cancer dynamics and tissue heterogeneity. Objective The purpose of this study is to investigate how the existence of a tumorous tissue in the lung modifies the parameters of the proposed models. The first use of a prototype forced oscillations technique (FOT) device in a mimicked lung tumor setup is investigated by comparing and interpreting the experimental findings. Methods The fractional order model parameters are determined for the mechanical properties of the healthy and tumorous lung. Two protocols have been performed for a mimicked lung tumor setup in a laboratory environment. A low frequency evaluation of respiratory impedance model and nonlinearity index were assessed using the forced oscillations technique. Results The viscoelastic properties of the lung tissue change, results being mirrored in the respiratory impedance assessment via FOT. The results demonstrate significant differences among the mimicked healthy and tumor measurements, (p-values < 0.05) for impedance values and also for heterogeneity index. However, there was no significant difference in lung function before and after immersing the mimicked lung in water or saline solution, denoting no structural changes. Conclusion Simulation tests comparing the changes in impedance support the research hypothesis. The impedance frequency response is effective in non-invasive identification of respiratory tissue abnormalities in tumorous lung, analyzed with appropriate fractional models.
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Affiliation(s)
- Maria Ghita
- Corresponding author at: Ghent University, Research Group on Dynamical Systems and Control (DySC), Tech Lane Science Park 125, Ghent 9052, Belgium.
| | - Dana Copot
- Ghent University, Research Group on Dynamical Systems and Control (DySC), Tech Lane Science Park 125, Ghent 9052, Belgium
- EEDT Core Group on Decision and Control in Flanders Make Consortium, Tech Lane Science Park 131, Ghent 9052, Belgium
| | - Clara M. Ionescu
- Ghent University, Research Group on Dynamical Systems and Control (DySC), Tech Lane Science Park 125, Ghent 9052, Belgium
- EEDT Core Group on Decision and Control in Flanders Make Consortium, Tech Lane Science Park 131, Ghent 9052, Belgium
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226
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Challenges in Diagnosing Occupational Chronic Obstructive Pulmonary Disease. MEDICINA-LITHUANIA 2021; 57:medicina57090911. [PMID: 34577834 PMCID: PMC8469547 DOI: 10.3390/medicina57090911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 11/16/2022]
Abstract
Occupational chronic obstructive pulmonary disease (oCOPD) represents 15–20% of the global burden of this disease. Even if industrial bronchitis has long been known, new occupational hazards continue to emerge and enlarge the number of people exposed to risk. This review discusses the challenges related to the early detection of oCOPD, in the context of new exposures and of limited usage of methods for an efficient disease occupational screening. It underlines that a better translation into clinical practice of the new methods for lung function impairment measurements, imaging techniques, or the use of serum or exhaled breath inflammation biomarkers could add significant value in the early detection of oCOPD. Such an approach would increase the chance to stop exposure at an earlier moment and to prevent or at least slow down the further deterioration of the lung function as a result of exposure to occupational (inhaled) hazards.
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227
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Durack T, Chapman DG, Rutting S, Thamrin C, King GG, Tonga KO. Dynamic compliance and reactance in older non-smokers with asthma and fixed airflow obstruction. Eur Respir J 2021; 58:13993003.04400-2020. [PMID: 33863745 DOI: 10.1183/13993003.04400-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/05/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Timothy Durack
- The Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, Australia.,Airway Physiology and Imaging Group and The Woolcock Emphysema Centre, The Woolcock Institute of Medical Research, Glebe, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - David G Chapman
- The Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, Australia.,Airway Physiology and Imaging Group and The Woolcock Emphysema Centre, The Woolcock Institute of Medical Research, Glebe, Australia.,Discipline of Medical Sciences, University of Technology Sydney, Broadway, Australia
| | - Sandra Rutting
- The Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, Australia.,Airway Physiology and Imaging Group and The Woolcock Emphysema Centre, The Woolcock Institute of Medical Research, Glebe, Australia.,NHMRC Centre of Excellence in Severe Asthma, New Lambton Heights, Australia
| | - Cindy Thamrin
- Airway Physiology and Imaging Group and The Woolcock Emphysema Centre, The Woolcock Institute of Medical Research, Glebe, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Gregory G King
- The Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, Australia.,Airway Physiology and Imaging Group and The Woolcock Emphysema Centre, The Woolcock Institute of Medical Research, Glebe, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,NHMRC Centre of Excellence in Severe Asthma, New Lambton Heights, Australia
| | - Katrina O Tonga
- The Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, Australia.,Airway Physiology and Imaging Group and The Woolcock Emphysema Centre, The Woolcock Institute of Medical Research, Glebe, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,The Department of Thoracic and Lung Transplant Medicine, St Vincent's Hospital, Darlinghurst, Australia.,Faculty of Medicine, St Vincent's Clinical School, The University of New South Wales, Sydney, Australia
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228
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González Vera R, Vidal Grell A, Yarur AM, Meneses CO, Castro-Rodriguez JA. "Reactance inversion" at low frequencies during lung function measurement by impulse oscillometry in children with persistent asthma . J Asthma 2021; 59:1597-1603. [PMID: 34255601 DOI: 10.1080/02770903.2021.1955376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Small airway dysfunction (SAD) in asthma can be measured by impulse oscillometry (IOS). Usually, the reactance should decrease with decreases in frequency oscillation. Sometimes an upward shift of the curve at low frequencies can be observed together with lower than expected reactance values. The actual value of the reactance at 5 Hz (X5) is calculated by the Sentry Suite application of the Jaeger Master screen iOS system™, providing the corrected X5 parameter (CX5). Our hypothesis is that correction of X5 is common in persistent asthma and it correlates better than X5 with the IOS parameters for evaluating SAD. METHODS In this transversal study, we evaluated 507 children (3-18 years old) using IOS-spirometry (Sentry Suite, Vyntus®). Resistance of all airways (R5), reactance area (AX), resonant frequency (Fres), X5, CX5, difference between R5 and R20 (D5-20), and spirometry parameters were analyzed. Reactance inversion and CX5 prevalence by age range was determined. The mean IOS-Spyrometry values in children with and without CX5 were compared, and correlations with each IOS-spirometry parameter in the age groups were performed. RESULTS CX5 was found in 83.5% of preschool children, 66.2% of schoolchildren, and 43.3% of adolescents (p < 0.001). The means of R5, AX, and D5-20 were significantly higher and FEV1 was significantly lower in children with CX5 (p < 0.05). In all ages, CX5 correlated better than X5 with IOS-spirometry parameters. CONCLUSION Reactance inversion and CX5 are frequent in asthmatic children, decrease with age, and correlate more closely than X5 with other IOS-spirometry parameters for evaluating SAD.
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Affiliation(s)
| | | | | | | | - Jose A Castro-Rodriguez
- Department of Pediatric Pulmonology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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229
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Holm S. Long-term changes to lung mechanics following smoke exposure are cause for concern. Respirology 2021; 26:830-831. [PMID: 34342090 DOI: 10.1111/resp.14127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Stephanie Holm
- Western States Pediatric Environmental Health Specialty Unit, University of California San Francisco, San Francisco, California, USA.,Division of Occupational and Environmental Medicine, University of California San Francisco, San Francisco, California, USA
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230
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Baumann P, Cannizzaro V. Lung function assessment in critically ill children: craving for standardisation. CURRENT OPINION IN PHYSIOLOGY 2021. [DOI: 10.1016/j.cophys.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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231
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Gray DM, Owusu SK, van der Zalm MM. Chronic lung disease in children: disease focused use of lung function. CURRENT OPINION IN PHYSIOLOGY 2021. [DOI: 10.1016/j.cophys.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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232
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Uysal P, Anik A, Anik A. School-Age Obese Asthmatic Children have Distinct Lung Function Measures From Lean Asthmatics and Obese Children. J Asthma 2021; 59:1548-1559. [PMID: 34328388 DOI: 10.1080/02770903.2021.1959925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: The lung functions of children with obese asthma seem to be distinct from those of obese children or lean asthmatics.Aim: To measure baseline lung function, exercise-induced bronchoconstriction (EIB), and bronchial hyperreactivity (BHR) in school-age obese asthmatics (OA group) and to compare the data with obese children (O group), lean asthmatics (A group), and healthy controls (H group).Methods: One hundred seventy school-age children were enrolled in this prospective cross-sectional study. Baseline fractionated exhaled nitric oxide (FeNO), and baseline, post-exercise (post-E), and post-bronchodilation (post-BD) impulse oscillometry (IOS) and spirometry tests were performed. EIB and BHR were evaluated based on the difference (Δ) in post-E - baseline, and post-BD - baseline values.Results: The mean FeNO level was higher in the OA group than in the other groups (p = 0.002). Baseline zR5 and R5-20 were higher (p = 0.013 and p = 0.044), but zFEF25-75 was lower (p < 0.01), in the OA group. ΔPost-E - baseline zFEV1 was lower in the A group (p = 0.003) but was higher in the OA group (p = 0.014) than the other groups. ΔPost-BD - baseline zFEV1 was lower in the H group compared to the other three groups (p = 0.004), but no significant difference was observed among the O, A, and OA groups (p > 0.05).Conclusion: A higher airway inflammation (high FeNO), peripheral airway resistance (high zR5 and zR5-20) and a lower peripheral airway flow (low FEF25-75) were observed at baseline measurement in school-age obese asthmatics compared to lean asthmatics and obese children. Obese asthmatics had no EIB but exhibited a similar BHR to that of asthmatics.
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Affiliation(s)
- Pinar Uysal
- Aydin Adnan Menderes University, School of Medicine, Department of Pediatrics, Division of Allergy and Immunology, Aydin, Turkey
| | - Ayse Anik
- Aydin Adnan Menderes University, School of Medicine, Department of Pediatrics, Division of Neonatology, Aydin, Turkey
| | - Ahmet Anik
- Aydin Adnan Menderes University, School of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Aydin, Turkey
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233
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Falvo MJ, Sotolongo AM, Osinubi OY, Helmer DA, Galvin JR, Franks TJ. Reply: Expected Disability From Isolated Small Airway Disease. Mil Med 2021; 186:205-206. [PMID: 33693748 DOI: 10.1093/milmed/usab097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael J Falvo
- Airborne Hazards and Burn Pits Center of Excellence, War Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, NJ 07018, USA.,New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, NJ 07101, USA
| | - Anays M Sotolongo
- Airborne Hazards and Burn Pits Center of Excellence, War Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, NJ 07018, USA
| | - Omowunmi Y Osinubi
- Airborne Hazards and Burn Pits Center of Excellence, War Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, NJ 07018, USA.,School of Public Health, Rutgers Biomedical and Health Sciences, Piscataway, NJ 08854, USA
| | - Drew A Helmer
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jeffrey R Galvin
- Department of Radiology and Nuclear Medicine (Chest Imaging), University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Teri J Franks
- Department of Pulmonary and Mediastinal Pathology, Department of Defense, The Joint Pathology Center, Silver Spring, MD 20910, USA
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234
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Usmani OS, Han MK, Kaminsky DA, Hogg J, Hjoberg J, Patel N, Hardin M, Keen C, Rennard S, Blé FX, Brown MN. Seven Pillars of Small Airways Disease in Asthma and COPD: Supporting Opportunities for Novel Therapies. Chest 2021; 160:114-134. [PMID: 33819471 DOI: 10.1016/j.chest.2021.03.047] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/05/2021] [Accepted: 03/10/2021] [Indexed: 12/29/2022] Open
Abstract
Identification of pathologic changes in early and mild obstructive lung disease has shown the importance of the small airways and their contribution to symptoms. Indeed, significant small airways dysfunction has been found prior to any overt airway obstruction being detectable by conventional spirometry techniques. However, most therapies for the treatment of obstructive lung disease target the physiological changes and associated symptoms that result from chronic lung disease, rather than directly targeting the specific underlying causes of airflow disruption or the drivers of disease progression. In addition, although spirometry is the current standard for diagnosis and monitoring of response to therapy, the most widely used measure, FEV1 , does not align with the pathologic changes in early or mild disease and may not align with symptoms or exacerbation frequency in the individual patient. Newer functional and imaging techniques allow more effective assessment of small airways dysfunction; however, significant gaps in our understanding remain. Improving our knowledge of the role of small airways dysfunction in early disease in the airways, along with the identification of novel end points to measure subclinical changes in this region (ie, those not captured as symptoms or identified through standard FEV1), may lead to the development of novel therapies that directly combat early airways disease processes with a view to slowing disease progression and reversing damage. This expert opinion paper discusses small airways disease in the context of asthma and COPD and highlights gaps in current knowledge that impede earlier identification of obstructive lung disease and the development and standardization of novel small airways-specific end points for use in clinical trials.
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Affiliation(s)
- Omar S Usmani
- National Heart and Lung Institute, Imperial College London & Royal Brompton Hospital, London, UK.
| | - MeiLan K Han
- Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI
| | - David A Kaminsky
- Pulmonary and Critical Care, University of Vermont Larner College of Medicine, Burlington, VT
| | - James Hogg
- James Hogg Research Centre, University of British Columbia and St. Paul's Hospital, Vancouver, BC, Canada
| | | | | | | | - Christina Keen
- Research and Early Development, Respiratory, Inflammation, and Autoimmune, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Stephen Rennard
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE; Translational Science and Experimental Medicine, Respiratory, Inflammation, and Autoimmune, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - François-Xavier Blé
- Translational Science and Experimental Medicine, Respiratory, Inflammation, and Autoimmune, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Mary N Brown
- Research and Early Development, Respiratory, Inflammation, and Autoimmune, BioPharmaceuticals R&D, AstraZeneca, Boston, MA
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235
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Ling Y, Si M, Niu Y, Han Y, Xu Y. The predictive value of impulse oscillometry for asthma exacerbations in childhood: A systematic review and meta-analyses. Pediatr Pulmonol 2021; 56:1850-1856. [PMID: 33756052 PMCID: PMC8251639 DOI: 10.1002/ppul.25374] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 02/08/2021] [Accepted: 03/01/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Several studies have explored the predictive value of impulse oscillometry (IOS) for asthma exacerbations in childhood, but its specific parameters are still unclear. Therefore, we designed this meta-analysis to determine the related indicators of acute asthma attacks. METHODS A comprehensive literature search was performed on July 9, 2020 based on PubMed, Embase, and Web of Science database. Weighted mean differences (WMDs) were calculated using fixed- or random-effects models. RESULTS A total of 615 patients from six trials were included in this analysis. IOS may be a useful tool to predict asthma exacerbations. And the results showed that R5 (WMD = -1.21, 95% CI: -1.55 to -0.87, p < .001), Fres (WMD = -1.34, 95% CI: -2.03 to -0.65, p = .018), and AX (WMD = -7.35, 95% CI: -9.94 to -4.76, p < .001) had significant correlation with asthma exacerbations. In addition, X5 may also predict the acute attack of asthma (WMD = 0.81, 95% CI: 0.56 to 1.01, p < .001). CONCLUSIONS R5, AX, Fres, and X5 may be able to identify the risk of an acute attack of asthma. Besides, our research further demonstrated that peripheral airway injury may play an important role in the acute attack of asthma.
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Affiliation(s)
- Yaoyao Ling
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Minghui Si
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Yufan Niu
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Yuqi Han
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Yongsheng Xu
- Department of Respiratory, The Children's Hospital of Tianjin (Children's Hospital of Tianjin University), Tianjin, China
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236
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Bickel S, Morton R, Eid N. Pulmonary Function Testing in the Coronavirus Disease Era: Lessons and Opportunities. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2021; 34:43-45. [PMID: 34143690 DOI: 10.1089/ped.2021.0059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Scott Bickel
- Division of Pediatric Pulmonology, Allergy and Immunology, Norton Children's and University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Ronald Morton
- Division of Pediatric Pulmonology, Allergy and Immunology, Norton Children's and University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Nemr Eid
- Division of Pediatric Pulmonology, Allergy and Immunology, Norton Children's and University of Louisville School of Medicine, Louisville, Kentucky, USA
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237
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Liang XL, Gao Y, Guan WJ, Du J, Chen L, Han W, Liu JM, Lu Y, Peng Y, Zhao BR, Wang T, Zheng JP. Reference values of respiratory impedance with impulse oscillometry in healthy Chinese adults. J Thorac Dis 2021; 13:3680-3691. [PMID: 34277060 PMCID: PMC8264702 DOI: 10.21037/jtd-20-3376] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 05/22/2021] [Indexed: 02/04/2023]
Abstract
Background Impulse oscillometry (IO) is a non-invasive pulmonary function test for measuring respiratory impedance. Available reference equations of IO indices for adults are limited. The aim of this study was to develop reference equations of IO indices for Chinese adults. Methods In a multicentral, cross-sessional study of IO in Chinese adults, IO data from healthy subjects were collected from 19 general hospitals across China between 2016 and 2018. Oscillometry measurements were conducted in accordance with recommendations of the European Respiratory Society (ERS). Multiple linear regression was performed to develop sex-specific reference equations of IO indices. Results IO measurements were performed in 1,318 subjects, of which 567 subjects were defined as healthy individuals with acceptable IO data and were included in the final analysis. Reference equations and limits of normal [lower limit of normal (LLN)/upper limit of normal (ULN)] of IO indices were developed separately for males and females. Height but not age was shown to be the most influential contributor to IO indices. The reference equations currently used in lung function laboratories predicted higher R5 and X5. Normal ranges of R5 and X5 recommended by the equipment manufacturer were clearly different from the ULN/LLN derived from the reference equations. Conclusions Reference equations of IO indices for Chinese adults from a wide region were provided in this study. It is necessary to update new IO reference equations and adopt ULN/LLN as normal ranges of IO indices. Trial Registration This study was registered at www.clinicaltrials.gov as part of a larger study NCT03467880.
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Affiliation(s)
- Xiao-Lin Liang
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yi Gao
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei-Jie Guan
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jing Du
- Department of Respiratory and Critical Care, West China Hospital, Sichuan University, Chengdu, China
| | - Li Chen
- Department of Respiratory Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Wen Han
- Department of Respiratory and Critical Care Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Jin-Ming Liu
- Department of Pulmonary Function Test, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yong Lu
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yi Peng
- Department of Respiratory Medicine, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bing-Rong Zhao
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
| | - Tao Wang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jin-Ping Zheng
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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238
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Gupta N, Sachdev A, Gupta S, Gupta D. COVID-19-A Sputnik Moment to Revitalize Oscillometry. Indian J Pediatr 2021; 88:613. [PMID: 33651304 PMCID: PMC7922720 DOI: 10.1007/s12098-021-03709-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/16/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Neeraj Gupta
- Department of Pediatrics, Institute of Child Health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110060, India.
| | - Anil Sachdev
- Department of Pediatrics, Institute of Child Health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110060, India
| | - Suresh Gupta
- Department of Pediatrics, Institute of Child Health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110060, India
| | - Dhiren Gupta
- Department of Pediatrics, Institute of Child Health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110060, India
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239
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Cottini M, Licini A, Lombardi C, Bagnasco D, Comberiati P, Berti A. Small airway dysfunction and poor asthma control: a dangerous liaison. Clin Mol Allergy 2021; 19:7. [PMID: 34051816 PMCID: PMC8164746 DOI: 10.1186/s12948-021-00147-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/22/2021] [Indexed: 01/05/2023] Open
Abstract
Asthma is a common chronic condition, affecting approximately 339 million people worldwide. The main goal of the current asthma treatment guidelines is to achieve clinical control, encompassing both the patient symptoms and limitations and the future risk of adverse asthma outcomes. Despite randomized controlled trials showing that asthma control is an achievable target, a substantial proportion of asthmatics remain poorly controlled in real life. The involvement of peripheral small airways has recently gained greater recognition in asthma, and many studies suggest that the persistent inflammation at these sites leads to small airway dysfunction (SAD), strongly contributing to a worse asthma control. Overall, the impulse oscillometry (IOS), introduced in the recent years, seems to be able to sensitively assess small airways, while conventional spirometry does not. Therefore, IOS may be of great help in characterizing SAD and guiding therapy choice. The aim of this article is to review the literature on SAD and its influence on asthma control, emphasizing the most recent evidence.
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Affiliation(s)
| | - Anita Licini
- Allergy and Pneumology Outpatient Clinic, Bergamo, Italy
| | - Carlo Lombardi
- Departmental Unit of Allergology, Immunology and Pulmonary Diseases, Fondazione Poliambulanza, Brescia, Italy
| | - Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genova, Italy.
| | - Pasquale Comberiati
- Section of Pediatrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alvise Berti
- Ospedale Santa Chiara and Department of Cellular, Computational and Integrative Biology (CIBIO), University of Trento, Trento, Italy.,Thoracic Disease Research Unit, Mayo Clinic, Rochester, MN, USA
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240
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Wollmer P, Tufvesson E, Wennersten A, Malmqvist U, Engström G, Olsson HK, Zaigham S, Frantz S, Nihlén U. Within-session reproducibility of forced oscillometry. Clin Physiol Funct Imaging 2021; 41:401-407. [PMID: 33914403 DOI: 10.1111/cpf.12706] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/23/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND The forced oscillation technique (FOT) provides detailed information about the mechanics of the respiratory system, while requiring minimal co-operation by the patient. FOT may be abnormal in subjects with normal spirometry and appears to be more closely related to airway symptoms. It is, therefore, attractive in epidemiological studies, where a large number of different examinations are made in each subjects in a short period of time. Current technical standards recommend the mean of three consecutive measurements to be used, but there is limited information regarding within-session variability of FOT measurements. OBJECTIVE The purpose of this study was to examine the within-session variability in FOT measurements in a large, population-based sample. METHODS We performed three consecutive FOT measurements in 700 subjects using the impulse oscillometry system. The first measurement was compared to the mean of three measurements for resistance at 5 and 20 Hz (R5 and R20, respectively), R5-R20, reactance at 5 Hz (X5) and resonant frequency (fres ). RESULTS The differences between the first and the mean of three measurements (median, interquartile range) were minimal, for example 0.002, -0.008 to 0.014 kPa L-1 s for R5 and -0.001, -0.008 to 0.005 kPa L-1 s for X5. Findings were numerically similar for men and women as well as for subjects with and without airflow obstruction at spirometry. CONCLUSIONS We conclude that, whereas in clinical situations, three FOT measurements are to be preferred, a single measurement may suffice in epidemiological studies.
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Affiliation(s)
- Per Wollmer
- Clinical Physiology and Nuclear Medicine Unit, Department of Translational Medicine, Lund University, Lund, Sweden
| | - Ellen Tufvesson
- Respiratory Medicine and Allergology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - André Wennersten
- Family Medicine and Community Medicine, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Ulf Malmqvist
- Division of Clinical Chemistry and Pharmacology, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Gunnar Engström
- Cardiovascular Research - Epidemiology, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Henric K Olsson
- Translational Science and Experimental Medicine, Research and Early Development, Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Suneela Zaigham
- Cardiovascular Research - Epidemiology, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Sophia Frantz
- Clinical Physiology and Nuclear Medicine Unit, Department of Translational Medicine, Lund University, Lund, Sweden
| | - Ulf Nihlén
- Respiratory Medicine and Allergology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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241
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Cottee AM, Seccombe LM, Thamrin C, King GG, Peters MJ, Farah CS. Response. Chest 2021; 158:1283-1284. [PMID: 32892864 DOI: 10.1016/j.chest.2020.03.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/27/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Alice M Cottee
- Department of Respiratory Medicine, Concord Repatriation General Hospital, NSW, Australia; Woolcock Emphysema Centre and Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, NSW, Australia; Faculty of Medicine and Health, University of Sydney, NSW, Australia.
| | - Leigh M Seccombe
- Department of Respiratory Medicine, Concord Repatriation General Hospital, NSW, Australia; Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Cindy Thamrin
- Woolcock Emphysema Centre and Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, NSW, Australia
| | - Gregory G King
- Woolcock Emphysema Centre and Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, NSW, Australia; Faculty of Medicine and Health, University of Sydney, NSW, Australia; Department of Respiratory Medicine, Royal North Shore Hospital, NSW, Australia
| | - Matthew J Peters
- Department of Respiratory Medicine, Concord Repatriation General Hospital, NSW, Australia; Faculty of Medicine and Health, University of Sydney, NSW, Australia; Faculty of Medicine and Health Sciences, Macquarie University, NSW, Australia
| | - Claude S Farah
- Department of Respiratory Medicine, Concord Repatriation General Hospital, NSW, Australia; Woolcock Emphysema Centre and Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, NSW, Australia; Faculty of Medicine and Health, University of Sydney, NSW, Australia; Faculty of Medicine and Health Sciences, Macquarie University, NSW, Australia
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242
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Johansson H, Wollmer P, Sundström J, Janson C, Malinovschi A. Bronchodilator response in FOT parameters in middle-aged adults from SCAPIS - normal values and relation to asthma and wheezing. Eur Respir J 2021; 58:13993003.00229-2021. [PMID: 33958428 DOI: 10.1183/13993003.00229-2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 04/22/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Henrik Johansson
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden.,Department of Medical Sciences, Respiratory-, Allergy- and Sleep Research, Uppsala University, Uppsala, Sweden.,Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden
| | - Per Wollmer
- Department of Translational Medicine, Clinical Physiology and Nuclear Medicine Unit, Lund University, Lund, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, and Uppsala Clinical Research Center, Uppsala, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory-, Allergy- and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
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243
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Siddiqui S. Moving closer to clinical application of the forced oscillation technique in asthma monitoring? Respirology 2021; 26:522-523. [PMID: 33955125 DOI: 10.1111/resp.14083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Salman Siddiqui
- Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre (Respiratory Theme), University of Leicester, Leicester, UK
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244
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Bayfield KJ, Douglas TA, Rosenow T, Davies JC, Elborn SJ, Mall M, Paproki A, Ratjen F, Sly PD, Smyth AR, Stick S, Wainwright CE, Robinson PD. Time to get serious about the detection and monitoring of early lung disease in cystic fibrosis. Thorax 2021; 76:1255-1265. [PMID: 33927017 DOI: 10.1136/thoraxjnl-2020-216085] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 02/24/2021] [Accepted: 03/10/2021] [Indexed: 12/26/2022]
Abstract
Structural and functional defects within the lungs of children with cystic fibrosis (CF) are detectable soon after birth and progress throughout preschool years often without overt clinical signs or symptoms. By school age, most children have structural changes such as bronchiectasis or gas trapping/hypoperfusion and lung function abnormalities that persist into later life. Despite improved survival, gains in forced expiratory volume in one second (FEV1) achieved across successive birth cohorts during childhood have plateaued, and rates of FEV1 decline in adolescence and adulthood have not slowed. This suggests that interventions aimed at preventing lung disease should be targeted to mild disease and commence in early life. Spirometry-based classifications of 'normal' (FEV1≥90% predicted) and 'mild lung disease' (FEV1 70%-89% predicted) are inappropriate, given the failure of spirometry to detect significant structural or functional abnormalities shown by more sensitive imaging and lung function techniques. The state and readiness of two imaging (CT and MRI) and two functional (multiple breath washout and oscillometry) tools for the detection and monitoring of early lung disease in children and adults with CF are discussed in this article.Prospective research programmes and technological advances in these techniques mean that well-designed interventional trials in early lung disease, particularly in young children and infants, are possible. Age appropriate, randomised controlled trials are critical to determine the safety, efficacy and best use of new therapies in young children. Regulatory bodies continue to approve medications in young children based on safety data alone and extrapolation of efficacy results from older age groups. Harnessing the complementary information from structural and functional tools, with measures of inflammation and infection, will significantly advance our understanding of early CF lung disease pathophysiology and responses to therapy. Defining clinical utility for these novel techniques will require effective collaboration across multiple disciplines to address important remaining research questions. Future impact on existing management burden for patients with CF and their family must be considered, assessed and minimised.To address the possible role of these techniques in early lung disease, a meeting of international leaders and experts in the field was convened in August 2019 at the Australiasian Cystic Fibrosis Conference. The meeting entitiled 'Shaping imaging and functional testing for early disease detection of lung disease in Cystic Fibrosis', was attended by representatives across the range of disciplines involved in modern CF care. This document summarises the proceedings, key priorities and important research questions highlighted.
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Affiliation(s)
- Katie J Bayfield
- Department of Respiratory Medicine, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Tonia A Douglas
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Tim Rosenow
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.,Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia.,Centre for Microscopy, Characterisation and Analysis, The University of Western Australia, Perth, Western Australia, Australia
| | - Jane C Davies
- National Heart and Lung Institute, Imperial College London, London, UK.,Department of Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Stuart J Elborn
- Centre for Infection and Immunity, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Marcus Mall
- Department of Pediatric Pulmonology, Immunology, and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,Department of Translational Pulmonology, German Center for Lung Research, Berlin, Germany
| | - Anthony Paproki
- The Australian e-Health Research Centre, CSIRO, Brisbane, Queensland, Australia
| | - Felix Ratjen
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Peter D Sly
- Children's Health and Environment Program, Child Health Research Centre, The University of Queenland, Herston, Queensland, Australia
| | - Alan R Smyth
- Division of Child Health, Obstetrics & Gynaecology. School of Medicine, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Stephen Stick
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.,Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia.,Department of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Claire E Wainwright
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Paul D Robinson
- Department of Respiratory Medicine, Children's Hospital at Westmead, Westmead, New South Wales, Australia .,Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, Glebe, New South Wales, Australia.,The Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales, Australia
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245
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Oda A, Otani T, Iwamoto H, Nishida M, Horibe Y, Yamaguchi K, Sakamoto S, Horimasu Y, Masuda T, Miyamoto S, Nakashima T, Fujitaka K, Hamada H, Takeno S, Hattori N. Vocal cord dysfunction detected by a three-dimensional image of dynamic change in respiratory resistance in a patient with difficult-to-treat asthma: a case report. J Asthma 2021; 59:1157-1161. [PMID: 33781154 DOI: 10.1080/02770903.2021.1910294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Vocal cord dysfunction (VCD) often coexists with asthma and exacerbates respiratory symptoms. A noninvasive method could be considered beneficial for the detection and follow-up of VCD complicated by asthma. Here, we report a case of VCD complicated by asthma, highlighting the effectiveness of colored three-dimensional (3-D) imaging of respiratory impedance using a broadband frequency forced oscillation technique (MostGraph). CASE STUDY A 74-year-old woman with difficult-to-treat asthma, in whom mepolizumab treatment was ineffective, was referred to our hospital. Stridulous sounds were loudest over the anterior neck. Pulmonary function tests' results were normal; however, a flattening of the inspiratory flow-volume curve was detected. RESULTS Remarkably, prominent spikes were observed in the inspiratory phase in the colored 3-D imaging of respiratory resistance, which was superimposed on increased respiratory resistance in the expiratory phase. Flexible laryngoscopy revealed the adduction of vocal cords on inspiration. The patient was diagnosed with asthma complicated by VCD. After successful treatment of VCD by speech therapy, inspiratory spikes of respiratory resistance disappeared, and normal vocal cord movement was observed on laryngoscopy. CONCLUSION The present case report indicates the effectiveness of forced oscillometry in evaluating dynamic changes in respiratory resistance for detecting and monitoring VCD complicated by asthma.
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Affiliation(s)
- Ayaka Oda
- Postgraduate Clinical Training Center, Hiroshima University, Hiroshima, Japan
| | - Toshihito Otani
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroshi Iwamoto
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Manabu Nishida
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuichiro Horibe
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Kakuhiro Yamaguchi
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shinjiro Sakamoto
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasushi Horimasu
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takeshi Masuda
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shintaro Miyamoto
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Taku Nakashima
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazunori Fujitaka
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hironobu Hamada
- Department of Physical Analysis and Therapeutic Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Sachio Takeno
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Noboru Hattori
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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246
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Roy GS, Daphtary N, Johnson O, Dixon AE, Kaminsky DA, Bates JHT. Measuring the mechanical input impedance of the respiratory system with breath-driven flow oscillations. J Appl Physiol (1985) 2021; 130:1064-1071. [PMID: 33571055 DOI: 10.1152/japplphysiol.00976.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In recent years, the mechanical input impedance of the respiratory system (Zrs) determined using the technique known as oscillometry has been gaining traction as a clinical diagnostic tool to complement conventional spirometry. Nevertheless, despite currently approved oscillometry devices being relatively compact and portable, they are still too heavy and bulky to be used in an ambulatory hands-free setting, mostly because of the mass of the motor and power supply. We therefore explored the possibility of using the subject's own respiratory musculature as the power source for creating flow oscillations at the mouth. We measured reference Zrs in 8 normal volunteers by having them breathe tidally into a piston-driven oscillator powered by an external motor. We fit the measured Zrs to the single-compartment model of the respiratory system characterized by the three parameters resistance (Rrs), elastance (Ers), and inertance (Irs). We then compared these parameter values to those obtained with two commercially available mucus-clearing devices that generate oscillations when expiratory flow drives a flapper valve. The estimates of Rrs agreed mostly within ±1 cmH2O·s·L-1, which is usefully accurate for most clinical needs. Ers and Irs agreed less well because the breath-driven oscillators provided data at essentially a single frequency close to the resonant frequency of the respiratory system. Nevertheless, we conclude that perturbing respiratory airflow and pressure with a breath-driven oscillator has the potential to provide measurements of Zrs, possibly serving as the basis for a lightweight ambulatory oscillometry system.NEW & NOTEWORTHY The technique of oscillometry for measuring the mechanical input impedance of the respiratory system is gaining traction as a clinical diagnostic tool, but the portability of existing commercially available devices is limited by the size and weight of oscillator motors and power supplies. We show that impedance can be measured by oscillations in mouth pressure and flow generated by mucus-clearing devices that are powered by the subject's own respiratory flow.
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Affiliation(s)
- Gregory S Roy
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Nirav Daphtary
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Olivia Johnson
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Anne E Dixon
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - David A Kaminsky
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Jason H T Bates
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont
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Cottee AM, Seccombe LM, Thamrin C, Badal T, King GG, Peters MJ, Farah CS. Longitudinal monitoring of asthma in the clinic using respiratory oscillometry. Respirology 2021; 26:566-573. [PMID: 33797141 DOI: 10.1111/resp.14053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 02/23/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND OBJECTIVE Asthma guidelines emphasize the importance of assessing lung function and symptoms. The forced oscillation technique (FOT) and its longitudinal relationship with spirometry and symptoms are unresolved. We examined concordance between longitudinal spirometry, FOT and symptom control, and determined FOT limits of agreement in stable asthma. METHODS Over a 3-year period, adults with asthma attending a tertiary clinic completed the asthma control test (ACT), fraction of exhaled nitric oxide (FeNO), FOT and spirometry. Analysis included between-visit concordance for significant change using Cohen's kappa (κ) and stable asthma FOT limits of agreement. RESULTS Data (n = 186) from 855 visits (mean ± SD 4.6 ± 3.0 visits), 114 ± 95 days apart, were analysed. Between-visit concordance was moderate between reactance at 5 Hz (X5) and forced expiratory volume in 1 s (FEV1 ) (κ = 0.34, p = 0.001), and weak between ACT and FEV1 (κ = 0.18, p = 0.001). Change in FeNO did not correlate with lung function or ACT (κ < 0.05, p > 0.1). Stable asthma between visits (n = 75; 132 visits) had reduced lung function variability, but comparable concordance to the entire cohort. Limits of agreement for FEV1 (0.42 L), resistance at 5 Hz (2.06 cm H2 O s L-1 ) and X5 (2.75 cm H2 O s L-1 ) in stable asthma were at least twofold greater than published values in health. CONCLUSION In adults with asthma, there is moderate concordance between longitudinal change in FOT and spirometry. Both tests relate poorly to changes in asthma control, highlighting the need for multi-modal assessment in asthma rather than symptoms alone. The derivation of longitudinal FOT limits of agreement will assist in its clinical interpretation.
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Affiliation(s)
- Alice M Cottee
- Department of Respiratory Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,Airway Physiology and Imaging Group and Woolcock Emphysema Centre, Woolcock Institute of Medical Research, Glebe, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Leigh M Seccombe
- Department of Respiratory Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Cindy Thamrin
- Airway Physiology and Imaging Group and Woolcock Emphysema Centre, Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
| | - Tanya Badal
- Department of Respiratory Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,Airway Physiology and Imaging Group and Woolcock Emphysema Centre, Woolcock Institute of Medical Research, Glebe, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Gregory G King
- Airway Physiology and Imaging Group and Woolcock Emphysema Centre, Woolcock Institute of Medical Research, Glebe, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Matthew J Peters
- Department of Respiratory Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Claude S Farah
- Department of Respiratory Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,Airway Physiology and Imaging Group and Woolcock Emphysema Centre, Woolcock Institute of Medical Research, Glebe, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, North Ryde, New South Wales, Australia
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248
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Lauhkonen E, Kaltsakas G, Sivagnanasithiyar S, Iles R. Comparison of forced oscillation technique and spirometry in paediatric asthma. ERJ Open Res 2021; 7:00202-2020. [PMID: 33816597 PMCID: PMC8005594 DOI: 10.1183/23120541.00202-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/25/2020] [Indexed: 11/21/2022] Open
Abstract
The Global Initiative for Asthma report emphasises the use of spirometry in diagnosing and monitoring asthma in children from 6 years of age onwards [1]. Spirometry requires good cooperation and younger children are sometimes unable to perform repeated forced expiratory blows [2]. Alternative pulmonary function measurements, such as the forced oscillation technique (FOT), are increasingly available for children at preschool age [3]. FOT measures lung function by imposing small soundwaves over tidal breathing through a mouthpiece, where pressure and flow changes in the airways are measured to derive respiratory system properties [4, 5]. The first study on bronchodilator responses by FOT in preschool-aged children was published already two decades ago [6]. Guidelines endorse the use of respiratory oscillometry in diagnosing and following up asthma in young children [3, 7], and it has shown potential in predicting loss of asthma control in older children and adolescents [8]. However, little is known of how FOT indices correlate with flow–volume indices when this technique is used in adjunct with conventional spirometry. Evaluation of airway obstruction with forced oscillation technique can be an adjunct to spirometry or even used as a primary method in those children unable to perform spirometryhttps://bit.ly/34rE6x2
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Affiliation(s)
- Eero Lauhkonen
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Hospital Trust, London, UK
| | - Georgios Kaltsakas
- Lane Fox Clinical Respiratory Physiology Research Centre, Centre for Human and Applied Physiological Science, School of Basic and Biomedical Science, King's College, London, UK
| | | | - Richard Iles
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Hospital Trust, London, UK
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249
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Berger KI, Wohlleber M, Goldring RM, Reibman J, Farfel MR, Friedman SM, Oppenheimer BW, Stellman SD, Cone JE, Shao Y. Respiratory impedance measured using impulse oscillometry in a healthy urban population. ERJ Open Res 2021; 7:00560-2020. [PMID: 33816605 PMCID: PMC8005688 DOI: 10.1183/23120541.00560-2020] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/02/2020] [Indexed: 11/12/2022] Open
Abstract
This study derives normative prediction equations for respiratory impedance in a healthy asymptomatic urban population using an impulse oscillation system (IOS). In addition, this study uses body mass index (BMI) in the equations to describe the effect of obesity on respiratory impedance. Data from an urban population comprising 472 healthy asymptomatic subjects that resided or worked in lower Manhattan, New York City were retrospectively analysed. This population was the control group from a previously completed case–control study of the health effects of exposure to World Trade Center dust. Since all subjects underwent spirometry and oscillometry, these previously collected data allowed a unique opportunity to derive normative prediction equations for oscillometry in an urban, lifetime non-smoking, asymptomatic population without underlying respiratory disease. Normative prediction equations for men and women were successfully developed for a broad range of respiratory oscillometry variables with narrow confidence bands. Models that used BMI as an independent predictor of oscillometry variables (in addition to age and height) demonstrated equivalent or better fit when compared with models that used weight. With increasing BMI, resistance and reactance increased compatible with lung and airway compression from mass loading. This study represents the largest cohort of healthy urban subjects assessed with an IOS device. Normative prediction equations were derived that should facilitate application of IOS in the clinical setting. In addition, the data suggest that modelling of lung function may be best performed using height and BMI as independent variables rather than the traditional approach of using height and weight. Prediction equations for respiratory impedance were derived in an urban cohort incorporating the effects of mass loading from obesity. Urban exposures had minimal effect on impedance allowing application of the equations to a broad range of populations.https://bit.ly/3a3zZvd
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Affiliation(s)
- Kenneth I Berger
- Dept of Medicine, NYU Grossman School of Medicine, New York, NY, USA.,André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA
| | - Margaret Wohlleber
- Dept of Medicine, NYU Grossman School of Medicine, New York, NY, USA.,André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA
| | - Roberta M Goldring
- Dept of Medicine, NYU Grossman School of Medicine, New York, NY, USA.,André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA
| | - Joan Reibman
- Dept of Medicine, NYU Grossman School of Medicine, New York, NY, USA.,Dept of Environmental Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Mark R Farfel
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Stephen M Friedman
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Beno W Oppenheimer
- Dept of Medicine, NYU Grossman School of Medicine, New York, NY, USA.,André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA
| | - Steven D Stellman
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, NY, USA.,Mailman School of Public Health, Columbia University, New York, NY, USA
| | - James E Cone
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Yongzhao Shao
- Dept of Population Health, NYU Grossman School of Medicine, New York, NY, USA
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250
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Andrade DSM, Ribeiro LM, Lopes AJ, Amaral JLM, Melo PL. Machine learning associated with respiratory oscillometry: a computer-aided diagnosis system for the detection of respiratory abnormalities in systemic sclerosis. Biomed Eng Online 2021; 20:31. [PMID: 33766046 PMCID: PMC7995797 DOI: 10.1186/s12938-021-00865-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/08/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The use of machine learning (ML) methods would improve the diagnosis of respiratory changes in systemic sclerosis (SSc). This paper evaluates the performance of several ML algorithms associated with the respiratory oscillometry analysis to aid in the diagnostic of respiratory changes in SSc. We also find out the best configuration for this task. METHODS Oscillometric and spirometric exams were performed in 82 individuals, including controls (n = 30) and patients with systemic sclerosis with normal (n = 22) and abnormal (n = 30) spirometry. Multiple instance classifiers and different supervised machine learning techniques were investigated, including k-Nearest Neighbors (KNN), Random Forests (RF), AdaBoost with decision trees (ADAB), and Extreme Gradient Boosting (XGB). RESULTS AND DISCUSSION The first experiment of this study showed that the best oscillometric parameter (BOP) was dynamic compliance, which provided moderate accuracy (AUC = 0.77) in the scenario control group versus patients with sclerosis and normal spirometry (CGvsPSNS). In the scenario control group versus patients with sclerosis and altered spirometry (CGvsPSAS), the BOP obtained high accuracy (AUC = 0.94). In the second experiment, the ML techniques were used. In CGvsPSNS, KNN achieved the best result (AUC = 0.90), significantly improving the accuracy in comparison with the BOP (p < 0.01), while in CGvsPSAS, RF obtained the best results (AUC = 0.97), also significantly improving the diagnostic accuracy (p < 0.05). In the third, fourth, fifth, and sixth experiments, different feature selection techniques allowed us to spot the best oscillometric parameters. They resulted in a small increase in diagnostic accuracy in CGvsPSNS (respectively, 0.87, 0.86, 0.82, and 0.84), while in the CGvsPSAS, the best classifier's performance remained the same (AUC = 0.97). CONCLUSIONS Oscillometric principles combined with machine learning algorithms provide a new method for diagnosing respiratory changes in patients with systemic sclerosis. The present study's findings provide evidence that this combination may help in the early diagnosis of respiratory changes in these patients.
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Affiliation(s)
- Domingos S M Andrade
- Electronic Engineering Post-Graduation Program, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luigi Maciel Ribeiro
- Electronic Engineering Post-Graduation Program, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Agnaldo J Lopes
- Pulmonary Function Laboratory, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jorge L M Amaral
- Department of Electronics and Telecommunications Engineering, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Pedro L Melo
- Biomedical Instrumentation Laboratory, Institute of Biology Roberto Alcantara Gomes and Laboratory of Clinical and Experimental Research in Vascular Biology (BioVasc), State University of Rio de Janeiro - Haroldo Lisboa da Cunha Pavilion, number 104 and 105, São Francisco Xavier Street 524 Maracanã, Rio de Janeiro, RJ, Zip Code: 20.550-013, Brazil.
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