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Riley M, Arigliani M, Davies G, Aurora P. Looking beyond LCI: Multiple breath washout phase III slope derived indices and their application in chronic respiratory disease in children. Pediatr Pulmonol 2024. [PMID: 39031489 DOI: 10.1002/ppul.27177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 06/17/2024] [Accepted: 07/06/2024] [Indexed: 07/22/2024]
Abstract
The multiple breath washout (MBW) test is widely reported in the context of Lung Clearance Index (LCI). LCI reflects global ventilation inhomogeneity but does not provide information regarding the localization of disease along the respiratory tree. The MBW-derived normalized phase III slope (SnIII) indices (Scond and Sacin), instead, can distinguish between convective-dependent and diffusion-convection-dependent ventilation inhomogeneity considered to occur within the conductive and acinar airways, respectively. In cystic fibrosis, Scond tends to become abnormal even earlier than LCI and spirometry. The value of Scond and Sacin in clinical practice has been recently explored in other respiratory conditions, including asthma, primary ciliary dyskinesia, bronchopulmonary dysplasia, bronchiolitis obliterans, and sickle cell disease. In this narrative review we offer an overview on the theoretical background, potentialities, and limitations of SnIII analysis in children, including challenges and feasibility aspects. Moreover, we summarize current evidence on the use of SnIII-derived indices across different groups of pediatric chronic respiratory disease and we highlight the gaps in knowledge that need to be addressed in future studies.
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Affiliation(s)
- Mollie Riley
- Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health (UCL GOS ICH), London, UK
- Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Michele Arigliani
- Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health (UCL GOS ICH), London, UK
- Department of Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | - Gwyneth Davies
- Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Population, Policy and Practice Research and Teaching Department, UCL GOS ICH, London, UK
| | - Paul Aurora
- Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health (UCL GOS ICH), London, UK
- Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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2
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Bayfield KJ, Weinheimer O, Middleton A, Boyton C, Fitzpatrick R, Kennedy B, Blaxland A, Jayasuriya G, Caplain N, Wielpütz MO, Yu L, Galban CJ, Robinson TE, Bartholmai B, Gustafsson P, Fitzgerald D, Selvadurai H, Robinson PD. Comparative sensitivity of early cystic fibrosis lung disease detection tools in school aged children. J Cyst Fibros 2024:S1569-1993(24)00075-4. [PMID: 38969602 DOI: 10.1016/j.jcf.2024.05.012] [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: 10/14/2023] [Revised: 05/05/2024] [Accepted: 05/20/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Effective detection of early lung disease in cystic fibrosis (CF) is critical to understanding early pathogenesis and evaluating early intervention strategies. We aimed to compare ability of several proposed sensitive functional tools to detect early CF lung disease as defined by CT structural disease in school aged children. METHODS 50 CF subjects (mean±SD 11.2 ± 3.5y, range 5-18y) with early lung disease (FEV1≥70 % predicted: 95.7 ± 11.8 %) performed spirometry, Multiple breath washout (MBW, including trapped gas assessment), oscillometry, cardiopulmonary exercise testing (CPET) and simultaneous spirometer-directed low-dose CT imaging. CT data were analysed using well-evaluated fully quantitative software for bronchiectasis and air trapping (AT). RESULTS CT bronchiectasis and AT occurred in 24 % and 58 % of patients, respectively. Of the functional tools, MBW detected the highest rates of abnormality: Scond 82 %, MBWTG RV 78 %, LCI 74 %, MBWTG IC 68 % and Sacin 51 %. CPET VO2peak detected slightly higher rates of abnormality (9 %) than spirometry-based FEV1 (2 %). For oscillometry AX (14 %) performed better than Rrs (2 %) whereas Xrs and R5-19 failed to detect any abnormality. LCI and Scond correlated with bronchiectasis (r = 0.55-0.64, p < 0.001) and AT (r = 0.73-0.74, p < 0.001). MBW-assessed trapped gas was detectable in 92 % of subjects and concordant with CT-assessed AT in 74 %. CONCLUSIONS Significant structural and functional deficits occur in early CF lung disease, as detected by CT and MBW. For MBW, additional utility, beyond that offered by LCI, was suggested for Scond and MBW-assessed gas trapping. Our study reinforces the complementary nature of these tools and the limited utility of conventional oscillometry and CPET in this setting.
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Affiliation(s)
- Katie J Bayfield
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Oliver Weinheimer
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg, German Center for Lung Research DZL, Heidelberg, Germany
| | - Anna Middleton
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Christie Boyton
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Rachel Fitzpatrick
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Brendan Kennedy
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Anneliese Blaxland
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Geshani Jayasuriya
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
| | - Neil Caplain
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Mark O Wielpütz
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg, German Center for Lung Research DZL, Heidelberg, Germany
| | - Lifeng Yu
- Division of Radiology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Craig J Galban
- Department of Radiology, Michigan Medicine, Ann Arbor, MI, USA
| | - Terry E Robinson
- Department of Pediatrics, Center of Excellence in Pulmonary Biology, Stanford University School of Medicine, Stanford, CA, USA
| | - Brian Bartholmai
- Division of Radiology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Per Gustafsson
- Department of Paediatrics, Central Hospital, Skövde, Sweden
| | - Dominic Fitzgerald
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia; The University of Sydney, Sydney, New South Wales, Australia
| | - Hiran Selvadurai
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia; The University of Sydney, Sydney, New South Wales, Australia
| | - Paul D Robinson
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Woolcock Institute of Medical Research, Sydney, New South Wales, Australia; The University of Sydney, Sydney, New South Wales, Australia; Children's Health and Environment Program, Child Health Research Centre, University of Queensland, South Brisbane, Australia.
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Britto CJ, Ratjen F, Clancy JP. Emerging Approaches to Monitor and Modify Care in the Era of Cystic Fibrosis Transmembrane Conductance Regulators. Clin Chest Med 2022; 43:631-646. [PMID: 36344071 DOI: 10.1016/j.ccm.2022.06.006] [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: 11/06/2022]
Abstract
As we characterize the clinical benefits of highly effective modulator therapy (HEMT) in the cystic fibrosis (CF) population, our paradigm for treating and monitoring disease continues to evolve. More sensitive approaches are necessary to detect early disease and clinical progression. This article reviews evolving strategies to assess disease control and progression in the HEMT era. This article also explores developments in pulmonary function monitoring, advanced respiratory imaging, tools for the collection of patient-reported outcomes, and their application to profile individual responses, guide therapeutic decisions, and improve the quality of life of people with CF.
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Affiliation(s)
- Clemente J Britto
- Yale Adult Cystic Fibrosis Program, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine.
| | - Felix Ratjen
- Division of Respiratory Medicine, Translational Medicine, University of Toronto Hospital for Sick Children, 555 University Avenue, Toronto Ontario M5G 1X8, Canada
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Whitfield CA, Horsley A, Jensen OE, Horn FC, Collier GJ, Smith LJ, Wild JM. Model-based Bayesian inference of the ventilation distribution in patients with cystic fibrosis from multiple breath washout, with comparison to ventilation MRI. Respir Physiol Neurobiol 2022; 302:103919. [PMID: 35562095 DOI: 10.1016/j.resp.2022.103919] [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: 12/22/2021] [Revised: 04/06/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Indices of ventilation heterogeneity (VH) from multiple breath washout (MBW) have been shown to correlate well with VH indices derived from hyperpolarised gas ventilation MRI. Here we report the prediction of ventilation distributions from MBW data using a mathematical model, and the comparison of these predictions with imaging data. METHODS We developed computer simulations of the ventilation distribution in the lungs to model MBW measurement with 3 parameters: σV, determining the extent of VH; V0, the lung volume; and VD, the dead-space volume. These were inferred for each individual from supine MBW data recorded from 25 patients with cystic fibrosis (CF) using approximate Bayesian computation. The fitted models were used to predict the distribution of gas imaged by 3He ventilation MRI measurements collected from the same visit. RESULTS The MRI indices measured (I1/3, the fraction of pixels below one-third of the mean intensity and ICV, the coefficient of variation of pixel intensity) correlated strongly with those predicted by the MBW model fits (r=0.93,0.88 respectively). There was also good agreement between predicted and measured MRI indices (mean bias ± limits of agreement: I1/3:-0.003±0.118 and ICV:-0.004±0.298). Fitted model parameters were robust to truncation of MBW data. CONCLUSION We have shown that the ventilation distribution in the lung can be inferred from an MBW signal, and verified this using ventilation MRI. The Bayesian method employed extracts this information with fewer breath cycles than required for LCI, reducing acquisition time required, and gives uncertainty bounds, which are important for clinical decision making.
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Affiliation(s)
- Carl A Whitfield
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK; Department of Mathematics, University of Manchester, Manchester, UK.
| | - Alexander Horsley
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Oliver E Jensen
- Department of Mathematics, University of Manchester, Manchester, UK
| | - Felix C Horn
- POLARIS, Imaging Sciences, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, UK
| | - Guilhem J Collier
- POLARIS, Imaging Sciences, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, UK
| | - Laurie J Smith
- POLARIS, Imaging Sciences, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, UK
| | - Jim M Wild
- POLARIS, Imaging Sciences, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, UK
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Cherrez-Ojeda I, Robles-Velasco K, Osorio MF, Calderon JC, Bernstein JA. Current Needs Assessment for Using Lung Clearance Index for Asthma in Clinical Practice. Curr Allergy Asthma Rep 2022; 22:13-20. [DOI: 10.1007/s11882-022-01025-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 11/03/2022]
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Safavi S, Dai R, Breton VL, Emmerson MN, Kowalik K, Lu Z, Lou W, Dubeau A, DeLorenzo S, Azad MB, Becker AB, Mandhane PJ, Turvey SE, Gustafsson P, Lefebvre DL, Sears MR, Moraes TJ, Subbarao P. Lung clearance index predicts persistence of preschool wheeze. Pediatr Allergy Immunol 2022; 33:e13713. [PMID: 34875116 DOI: 10.1111/pai.13713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/26/2021] [Accepted: 11/30/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The lung clearance index (LCI) is a measure of pulmonary function. Variable feasibility (50->80%) in preschool children has been reported. There are limited studies exploring its relationship to respiratory symptoms and how it predicts persistent wheeze. We aimed to assess the association with respiratory symptoms in preschool-aged children with LCI and determine its utility in predicting persistent wheeze. METHODS LCI was measured in a subcohort of the CHILD Cohort Study at age 3 years using SF6 multiple breath washout test mass spectrometry. Respiratory symptom phenotypes at age 3 were derived from children's respiratory symptoms reported by their parents. Responses were used to categorize children into 4 symptom groups: recurrent wheeze (3RW), recurrent cough (3RC), infrequent symptoms (IS), and no current symptoms (NCS). At age 5 years, these children were seen by a specialist clinician and assessed for persistent wheeze (PW). RESULTS At age 3 years, 69% (234/340) had feasible LCI. Excluding two children with missing data, 232 participants were categorized as follows: 33 (14%) 3RW; 28 (12%) 3RC; 17 (7%) IS; and 154 (66%) NCS. LCI z-score at age 3 years was highest in children with 3RW compared to 3RC (mean (SD): 1.14 (1.56) vs. 0.09 (0.95), p < .01), IS (mean (SD): -0.14 (0.59), p < .01), and NCS (mean (SD): -0.08 (1.06), p < .01). LCI z-score at age 3 was predictive of persistent wheeze at age 5 (PW) (AUROC: 0.87). CONCLUSIONS LCI at age 3 was strongly associated with recurrent wheeze at age 3, and predictive of its persistence to age 5.
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Affiliation(s)
- Shahideh Safavi
- Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children & Research Institute, Toronto, Ontario, Canada
| | - Ruixue Dai
- Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children & Research Institute, Toronto, Ontario, Canada
| | - Vanessa L Breton
- Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children & Research Institute, Toronto, Ontario, Canada
| | - Melanie N Emmerson
- Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children & Research Institute, Toronto, Ontario, Canada
| | - Krzysztof Kowalik
- Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children & Research Institute, Toronto, Ontario, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Zihang Lu
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Aimée Dubeau
- Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children & Research Institute, Toronto, Ontario, Canada
| | - Stephanie DeLorenzo
- Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children & Research Institute, Toronto, Ontario, Canada
| | - Meghan B Azad
- Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Allan B Becker
- Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Piush J Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Stuart E Turvey
- Department of Pediatrics, Child & Family Research Institute, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Per Gustafsson
- Department of Pediatrics, Central Hospital, Skövde, Sweden
| | - Diana L Lefebvre
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Malcolm R Sears
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Theo J Moraes
- Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children & Research Institute, Toronto, Ontario, Canada
| | - Padmaja Subbarao
- Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children & Research Institute, Toronto, Ontario, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Kieninger E, Willers C, Röthlisberger K, Yammine S, Pusterla O, Bauman G, Stranzinger E, Bieri O, Latzin P, Casaulta C. Effect of Salbutamol on Lung Ventilation in Children with Cystic Fibrosis: Comprehensive Assessment Using Spirometry, Multiple-Breath Washout, and Functional Lung Magnetic Resonance Imaging. Respiration 2021; 101:281-290. [PMID: 34808631 DOI: 10.1159/000519751] [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: 05/27/2021] [Accepted: 09/20/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Inhalation therapy is one of the cornerstones of the daily treatment regimen in patients with cystic fibrosis (CF). Recommendations regarding the addition of bronchodilators, especially salbutamol are conflicting due to the lack of evidence. New diagnostic measures such as multiple-breath washout (<underline>MBW)</underline> and functional magnetic resonance imaging (MRI) have the potential to reveal new insights into bronchodilator effects in patients with CF. OBJECTIVE The objective of the study was to comprehensively assess the functional response to nebulized inhalation with salbutamol in children with CF. METHODS Thirty children aged 6-18 years with stable CF performed pulmonary function tests, MBW, and matrix pencil-MRI before and after standardized nebulized inhalation of salbutamol. RESULTS Lung clearance index decreased (improved) by -0.24 turnover (95% confidence interval [CI]: -0.53 to 0.06; p = 0.111). Percentage of the lung volume with impaired fractional ventilation and relative perfusion decreased (improved) by -0.79% (CI: -1.99 to 0.42; p = 0.194) and -1.31% (CI: -2.28 to -0.35; p = 0.009), respectively. Forced expiratory volume (FEV1) increased (improved) by 0.41 z-score (CI: 0.24-0.58; p < 0.0001). We could not identify specific clinical factors associated with a more pronounced effect of salbutamol. CONCLUSIONS There is a positive short-term effect of bronchodilator inhalation on FEV1 in patients with CF, which is independent of ventilation inhomogeneity. Heterogeneous response between patients suggests that for prediction of a therapeutic effect this should be tested by spirometry in every patient individually.
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Affiliation(s)
- Elisabeth Kieninger
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Corin Willers
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland,
| | - Katrin Röthlisberger
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Physiotherapy, University Hospital of Bern, Bern, Switzerland
| | - Sophie Yammine
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Orso Pusterla
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Division of Radiological Physics, Department of Radiology, University of Basel Hospital, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Grzegorz Bauman
- Division of Radiological Physics, Department of Radiology, University of Basel Hospital, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Enno Stranzinger
- Department of Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Oliver Bieri
- Division of Radiological Physics, Department of Radiology, University of Basel Hospital, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Philipp Latzin
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carmen Casaulta
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Wawszczak M, Kulus M, Peradzyńska J. Peripheral airways involvement in children with asthma exacerbation. CLINICAL RESPIRATORY JOURNAL 2021; 16:97-104. [PMID: 34676678 PMCID: PMC9060097 DOI: 10.1111/crj.13456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022]
Abstract
Objective The literature provides some evidence of peripheral airways key role in the pathogenesis of asthma. However, the extent to which lung periphery including acinar zone contribute to asthma activity and control in pediatric population is unclear. Therefore, the aim of the study was to estimate peripheral airways involvement in children with asthma exacerbation and stable asthma simultaneously via different pulmonary function tests. Methods Children with asthma exacerbation (n = 20) and stable asthma (n = 22) performed spirometry, body plethysmography, exhaled nitric oxide, impulse oscillometry (IOS), and multiple‐breath washout (MBW). Results Peripheral airway's function indexes were increased in children with asthma, particularly in group with asthma exacerbation when compared with stable asthma group. The prevalence of abnormal results was significantly higher in asthma exacerbation. All children with asthma exacerbation had conductive ventilation inhomogeneity; 76% had acinar ventilation inhomogeneity. According to IOS measurements, resistance and reactance were within normal range, but other IOS parameters were significantly higher in children with asthma exacerbation compared with stable asthma group. The 36% of children with acute asthma had air trapping. Conclusion Significant involvement of peripheral airways was observed in children with asthma, particularly in asthma exacerbation, which determine lung periphery as important additional target for therapy and provide new insights into pathophysiological process of pediatric asthma.
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Affiliation(s)
- Maria Wawszczak
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Marek Kulus
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Peradzyńska
- Department of Epidemiology and Biostatistics, Medical University of Warsaw, Warsaw, Poland
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Comparison of Multiple Breath Washout and Spirometry in Children with Primary Ciliary Dyskinesia and Cystic Fibrosis and Healthy Controls. Ann Am Thorac Soc 2021; 17:1085-1093. [PMID: 32603187 DOI: 10.1513/annalsats.201905-375oc] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale: In cystic fibrosis (CF), the lung clearance index (LCI), derived from multiple breath washout (MBW), is more sensitive in detecting early lung disease than FEV1; MBW has been less thoroughly evaluated in young patients with primary ciliary dyskinesia (PCD).Objectives: Our objectives were 1) to evaluate the sensitivity of MBW and spirometry for the detection of mild lung disease in young children with PCD and CF compared with healthy control (HC) subjects and 2) to compare patterns of airway obstruction between disease populations.Methods: We used a multicenter, single-visit, observational study in children with PCD and CF with a forced expiratory volume in 1 second (FEV1) greater than 60% predicted and HC subjects, ages 3-12 years. Nitrogen MBW and spirometry were performed and overread for acceptability. χ2 and Kruskall-Wallis tests compared demographics and lung function measures between groups, linear regression evaluated the effect of disease state, and Spearman's rank correlation coefficient compared the LCI and spirometric measurements.Results: Twenty-five children with PCD, 49 children with CF, and 80 HC children were enrolled, among whom 17 children with PCD (68%), 36 children with CF (73%), and 53 (66%) HC children performed both acceptable spirometry and MBW; these children made up the analytic cohort. The median age was 9.0 years (interquartile range [IQR], 6.8-11.1). The LCI was abnormal (more than 7.8) in 10 of 17 (59%) patients with PCD and 21 of 36 (58%) patients with CF, whereas FEV1 was abnormal in three of 17 (18%) patients with PCD and six of 36 (17%) patients with CF. The LCI was significantly elevated in patients with PCD and CF compared with HC subjects (ratio of geometric mean vs. HC: PCD 1.27; 95% confidence interval [CI], 1.15-1.39; and CF 1.24; 95% CI, 1.15-1.33]). Children with PCD had lower midexpiratory-phase forced expiratory flow % predicted compared with children with CF (62% [IQR, 50-78%] vs. 85% [IQR, 68-99%]; P = 0.05). LCI did not correlate with FEV1.Conclusions: The LCI is more sensitive than FEV1 in detecting lung disease in young patients with PCD, similar to CF. LCI holds promise as a sensitive endpoint for the assessment of early PCD lung disease.
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Pleskova J, Koucky V, Medunova K, Vlckova B, Smolikova L, Pohunek P. Reflex zone stimulation reduces ventilation inhomogeneity in cystic fibrosis: A randomised controlled cross-over study. Pediatr Pulmonol 2021; 56:1558-1565. [PMID: 33656249 DOI: 10.1002/ppul.25350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 02/02/2021] [Accepted: 02/25/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND The reflex zone stimulation technique (RST) activates complex motor responses and has a positive impact on the locomotor system. This technique may also indirectly affect breathing; however, the use of this technique as adjunct of the treatment of cystic fibrosis (CF) has not yet been characterised. METHODS We performed a randomised controlled single-centre interventional trial to evaluate the short-term effects of RST on lung function in 21 paediatric CF patients with normal baseline spirometry. The effect of 30 min of RST was compared to that of sham therapy in a crossover design. The interventions were performed in random order and planned 6 months apart. The primary outcome was a change in global ventilation inhomogeneity after intervention, assessed by lung clearance index (LCI2.5 ) derived from a nitrogen multiple breath washout test. Secondary outcomes included changes in regional ventilation inhomogeneity (indices of acinar [Sacin*Vt] and conductive airway [Scond*Vt] inhomogeneity) and spirometry parameters (inspiratory capacity, forced vital capacity, and forced expiratory volume in 1 s). Trunk deformity was assessed by physiotherapists at study entry. RESULTS After the RST intervention, the LCI2.5 (p = .004) and Scond*Vt (p = .009) decreased significantly, while inspiratory capacity increased (p = .012). In the sham-therapy group, none of the parameters changed significantly. Trunk deformity was seen in 76.5% of all patients, and 92.9% of those with trunk deformity showed a decrease in LCI2.5 after RST. CONCLUSION RST has multiple positive short-term effects on lung function, especially in CF patients with trunk deformities.
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Affiliation(s)
- Jana Pleskova
- Department of Paediatrics, 2nd Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic.,Department of Rehabilitation and Sports Medicine, 2nd Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Vaclav Koucky
- Department of Paediatrics, 2nd Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Katerina Medunova
- Department of Rehabilitation and Sports Medicine, 2nd Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Blanka Vlckova
- Department of Rehabilitation and Sports Medicine, 2nd Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Libuse Smolikova
- Department of Rehabilitation and Sports Medicine, 2nd Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Petr Pohunek
- Department of Paediatrics, 2nd Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
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Walicka-Serzysko K, Postek M, Jeneralska N, Cichocka A, Milczewska J, Sands D. The effects of the addition of a new airway clearance device to chest physiotherapy in children with cystic fibrosis pulmonary exacerbations. JOURNAL OF MOTHER AND CHILD 2021; 24:16-24. [PMID: 33544556 PMCID: PMC8258837 DOI: 10.34763/jmotherandchild.20202403.2013.d-20-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Chest physiotherapy plays a crucial role in managing cystic fibrosis, especially during pulmonary exacerbations. This study evaluated the effects of adding a new airway clearance device to chest physiotherapy in subjects with cystic fibrosis hospitalised due to pulmonary exacerbations. METHODS This prospective open-label study was carried out at the Pediatric Cystic Fibrosis Centre in Poland between October 2017 and August 2018. Cystic fibrosis patients aged 10 to 18 years who were admitted to the hospital and required intravenous antibiotic therapy due to pulmonary exacerbations were consecutively allocated (1:1) to either chest physiotherapy alone or chest physiotherapy with a new airway clearance device (Simeox; PhysioAssist). Patients performed spirometry and multiple-breath nitrogen washout for lung clearance index assessment upon admission and prior to discharge. RESULTS Forty-eight cystic fibrosis patients were included (24 in each group). Spirometry parameters in both groups improved significantly after intravenous antibiotic therapy. A significant improvement in the maximum expiratory flow at 25% of forced vital capacity was observed only in the group with a new airway clearance device (p < 0.01 vs. baseline). Trends towards a lower lung clearance index ratio were similar in both groups. No adverse events were observed in either group. CONCLUSIONS Spirometry parameters increased significantly in cystic fibrosis patients treated for pulmonary exacerbations with intravenous antibiotic therapy and intensive chest physiotherapy. The new airway clearance device was safe and well tolerated when added to chest physiotherapy and may be another option for the treatment of pulmonary exacerbation in cystic fibrosis.
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Affiliation(s)
- Katarzyna Walicka-Serzysko
- Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland,Cystic Fibrosis Centre, Pediatric Hospital, Dziekanow Lesny, Poland, E-mail:
| | - Magdalena Postek
- Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland,Cystic Fibrosis Centre, Pediatric Hospital, Dziekanow Lesny, Poland
| | | | | | - Justyna Milczewska
- Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland,Cystic Fibrosis Centre, Pediatric Hospital, Dziekanow Lesny, Poland
| | - Dorota Sands
- Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland,Cystic Fibrosis Centre, Pediatric Hospital, Dziekanow Lesny, Poland
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12
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Hatziagorou E, Kampouras A, Avramidou V, Toulia I, Chrysochoou EA, Galogavrou M, Kirvassilis F, Tsanakas J. Toward the Establishment of New Clinical Endpoints for Cystic Fibrosis: The Role of Lung Clearance Index and Cardiopulmonary Exercise Testing. Front Pediatr 2021; 9:635719. [PMID: 33718306 PMCID: PMC7946844 DOI: 10.3389/fped.2021.635719] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/03/2021] [Indexed: 01/25/2023] Open
Abstract
As Cystic Fibrosis (CF) treatment advances, research evidence has highlighted the value and applicability of Lung Clearance Index and Cardiopulmonary Exercise Testing as endpoints for clinical trials. In the context of these new endpoints for CF trials, we have explored the use of these two test outcomes for routine CF care. In this review we have presented the use of these methods in assessing disease severity, disease progression, and the efficacy of new interventions with considerations for future research.
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Affiliation(s)
- Elpis Hatziagorou
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Asterios Kampouras
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasiliki Avramidou
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ilektra Toulia
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elisavet-Anna Chrysochoou
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Galogavrou
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fotios Kirvassilis
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - John Tsanakas
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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13
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Verger N, Arigliani M, Raywood E, Duncan J, Negreskul Y, Bush A, Aurora P. Limitations of regional ventilation inhomogeneity indices in children with cystic fibrosis. Pediatr Pulmonol 2020; 55:2315-2322. [PMID: 32441886 DOI: 10.1002/ppul.24863] [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: 11/29/2019] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Scond is a multiple breath washout (MBW) index that measures convection-dependent ventilation inhomogeneity (CDI) arising within conductive airways, but the calculation method is unreliable in subjects with advanced cystic fibrosis (CF) lung disease. A new CDI index, Scond *, has been proposed for use in adults with CF and moderate to severe ventilation inhomogeneity. We aimed to evaluate the most appropriate CDI index in children and adolescents with CF and various degrees of inhomogeneity, and from that the most appropriate diffusion-convection-interaction index (Sacin or Sacin *). METHODS Scond , Sacin and the alternative indices, Scond *, and Sacin * were retrospectively calculated in subjects with CF aged 3 to 18 years and age-matched controls, who underwent sulfur hexafluoride MBW between 2003 and 2015. The upper limit of normal was based on 95th percentile of the control population. RESULTS One hundred and twenty-seven subjects with CF (44% male; mean age ± SD: 7.5 years ± 4.9) and 94 controls (53% male; 7.9 years ± 5.1) were included in the final analysis. All measures of ventilation inhomogeneity were significantly higher in children with CF. As predicted, Scond reached a maximum value at lung clearance index (LCI) values of approximately 9. In subjects with LCI ≥ 9 Scond * showed good correlation with LCI, whilst Scond had no relationship with LCI (Spearman rank correlation Scond */LCI, 0.49; P < .01; Scond /LCI, -0.068; P = .46). In subjects with mild disease (LCI < 9) Scond was more frequently abnormal than Scond * (37% vs 16%; P = .01). CONCLUSIONS Scond and Sacin are sensitive indices of early regional inhomogeneity, but are of no value when LCI ≥ 9. In these subjects, Scond * & Sacin * are potential alternatives.
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Affiliation(s)
- Nicolas Verger
- Respiratory, Critical Care and Anaesthesia Section, Infection Inflammation and Immunity Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Michele Arigliani
- Division of Pediatrics, Department of Medicine, University Hospital of Udine, Udine, Italy
| | - Emma Raywood
- Respiratory, Critical Care and Anaesthesia Section, Infection Inflammation and Immunity Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Julie Duncan
- Respiratory, Critical Care and Anaesthesia Section, Infection Inflammation and Immunity Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Yulia Negreskul
- Respiratory, Critical Care and Anaesthesia Section, Infection Inflammation and Immunity Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Andrew Bush
- Respiratory Division, The National Heart and Lung Institute, Imperial College, London, UK
| | - Paul Aurora
- Respiratory, Critical Care and Anaesthesia Section, Infection Inflammation and Immunity Programme, UCL Great Ormond Street Institute of Child Health, London, UK.,Department of Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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14
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Franks LJ, Walsh JR, Hall K, Morris NR. Measuring airway clearance outcomes in bronchiectasis: a review. Eur Respir Rev 2020; 29:190161. [PMID: 32350088 PMCID: PMC9489113 DOI: 10.1183/16000617.0161-2019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 12/27/2019] [Indexed: 12/21/2022] Open
Abstract
While airway clearance techniques (ACTs) are recommended for individuals with bronchiectasis, many trials have demonstrated inconsistent benefits or failed to reach their primary outcome. This review determined the most common clinical and patient-reported outcome measures used to evaluate the efficacy of ACTs in bronchiectasis. A literature search of five databases using relevant keywords and filtering for studies published in English, up until the end of August 2019, was completed. Studies included randomised controlled trials, using crossover or any other trial design, and abstracts. Studies were included where the control was placebo, no intervention, standard care, usual care or an active comparator. Adults with bronchiectasis not related to cystic fibrosis were included. Extracted data comprised study authors, design, duration, intervention, outcome measures and results. The search identified 27 published studies and one abstract. The most common clinical outcome measures were sputum volume (n=23), lung function (n=17) and pulse oximetry (n=9). The most common patient-reported outcomes were health-related quality of life (measured with St George's Respiratory Questionnaire, n=4), cough-related quality of life (measured with Leicester Cough Questionnaire, n=4) and dyspnoea (measured with Borg/modified Borg scale, n=8). Sputum volume, lung function, dyspnoea and health- and cough-related quality of life appear to be the most common clinical and patient-reported measures of airway clearance treatment efficacy.
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Affiliation(s)
- Lisa J Franks
- Physiotherapy Dept, The Prince Charles Hospital, Chermside, Australia
- School of Allied Health Sciences and Menzies Health Institute, Griffith University, Brisbane, Australia
| | - James R Walsh
- Physiotherapy Dept, The Prince Charles Hospital, Chermside, Australia
- School of Allied Health Sciences and Menzies Health Institute, Griffith University, Brisbane, Australia
- Heart Lung Institute, The Prince Charles Hospital, Chermside, Australia
| | - Kathleen Hall
- Physiotherapy Dept, The Prince Charles Hospital, Chermside, Australia
- Physiotherapy, School of Allied Health, Australian Catholic University, Brisbane, Australia
| | - Norman R Morris
- School of Allied Health Sciences and Menzies Health Institute, Griffith University, Brisbane, Australia
- Heart Lung Institute, The Prince Charles Hospital, Chermside, Australia
- Allied Health Research Collaborative, Metro North Hospital and Health Service, The Prince Charles Hospital, Chermside, Australia
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15
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Chapman DG, King GG, Robinson PD, Farah CS, Thamrin C. The need for physiological phenotyping to develop new drugs for airways disease. Pharmacol Res 2020; 159:105029. [PMID: 32565310 DOI: 10.1016/j.phrs.2020.105029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/01/2020] [Accepted: 06/12/2020] [Indexed: 11/25/2022]
Abstract
Asthma and COPD make up the majority of obstructive airways diseases (OADs), which affects ∼11 % of the population. The main drugs used to treat OADs have not changed in the past five decades, with advancements mainly comprising variations on existing treatments. The recent biologics are beneficial to only specific subsets of patients. Part of this may lie in our inability to adequately characterise the tremendous heterogeneity in every aspect of OAD. The field is currently moving towards the concept of personalised medicine, based on a focus on treatable traits that are objective, measurable and modifiable. We propose extending this concept via the use of emerging clinical tools for comprehensive physiological phenotyping. We describe, based on published data, the evidence for the use of functional imaging, gas washout techniques and oscillometry, as well as potential future applications, to more comprehensively assess and predict treatment response in OADs. In this way, we hope to demonstrate how physiological phenotyping tools will improve the way in which drugs are prescribed, but most importantly, will facilitate development of new drugs for OADs.
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Affiliation(s)
- David G Chapman
- Airway Physiology and Imaging Group and Woolcock Emphysema Centre, The Woolcock Institute of Medical Research, The University of Sydney, Glebe NSW 2037, Australia; School of Life Sciences, Faculty of Science, University of Technology Sydney, Ultimo NSW 2007, Australia.
| | - G G King
- Airway Physiology and Imaging Group and Woolcock Emphysema Centre, The Woolcock Institute of Medical Research, The University of Sydney, Glebe NSW 2037, Australia; Department of Respiratory Medicine, Royal North Shore Hospital, St. Leonards, NSW 2065, Australia; NHMRC Centre of Excellence in Severe Asthma, New Lambton Heights NSW 2305, Australia; Faculty of Medicine and Health Sciences, The University of Sydney, NSW 2006, Australia
| | - Paul D Robinson
- Airway Physiology and Imaging Group and Woolcock Emphysema Centre, The Woolcock Institute of Medical Research, The University of Sydney, Glebe NSW 2037, Australia; Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia; Faculty of Medicine and Health Sciences, The University of Sydney, NSW 2006, Australia
| | - Claude S Farah
- Airway Physiology and Imaging Group and Woolcock Emphysema Centre, The Woolcock Institute of Medical Research, The University of Sydney, Glebe NSW 2037, Australia; Faculty of Medicine and Health Sciences, The University of Sydney, NSW 2006, Australia; Department of Thoracic Medicine, Concord Repatriation General Hospital, Concord, NSW 2137, Australia
| | - Cindy Thamrin
- Airway Physiology and Imaging Group and Woolcock Emphysema Centre, The Woolcock Institute of Medical Research, The University of Sydney, Glebe NSW 2037, Australia; Faculty of Medicine and Health Sciences, The University of Sydney, NSW 2006, Australia
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16
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Multiple Breath Washout for Diagnosing Asthma and Persistent Wheeze in Young Children. Ann Am Thorac Soc 2020; 16:599-605. [PMID: 30580555 DOI: 10.1513/annalsats.201807-503oc] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale: There is an unmet need for sensitive lung function tests for young children to aid in the diagnosis of asthma and wheezy disorders. We hypothesized that multiple breath washout (MBW) could be a valuable tool for such a purpose. Objectives: To compare the ability of MBW lung clearance index with traditional lung function measurements to discriminate between preschool children with well-controlled asthma/persistent wheeze and healthy children. Methods: We investigated 646 children from the COPSAC2010 (Copenhagen Prospective Studies on Asthma in Childhood 2010) mother-child cohort, who completed MBW testing with nitrogen, spirometry, and plethysmography before age 6 years. Asthma/persistent wheeze was prospectively diagnosed according to a validated symptom-based algorithm at the COPSAC clinic. Student's t tests and receiver operating characteristic curves were applied to analyze the discriminative ability of the lung function indices. Results: A total of 144 (22.3%) children were diagnosed with asthma/persistent wheeze during their first 6 years of life. Lung clearance index from MBW was not significantly different in children with versus those without asthma/persistent wheeze (mean standard deviation [SD] = 6.96 [1.14] vs. 6.95 [0.93], mean difference [95% confidence interval] = 0.02 [-0.18 to 0.22], P = 0.86, area under the curve [AUC] = 0.48), whereas significant differences were observed for specific airway resistance from plethysmography (1.21 kPa/s [0.31] vs. 1.14 kPa/s [0.25]; +0.07 kPa/s [0.02-0.13]; P < 0.01; AUC = 0.56) and spirometry forced expiratory volume in 1 second (FEV1) % predicted (99.4% [12.0] vs. 102.6% [12.5]; -3.2% [-5.6 to -0.9]; P < 0.01; AUC = 0.56) and forced expiratory flow at 25-75% (1.55 L/s [0.44] vs. 1.68 L/s [0.46]; -0.14 L/s [-0.22 to -0.05]; P < 0.01; AUC = 0.58). FEV1 (L/s) and FEV1/forced vital capacity ratio were not significantly different (P > 0.4). Conclusions: MBW, spirometry, and plethysmography are not sensitive tools for diagnosing mild asthmatic disease in young children.
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Irving S, Fleming L, Ahmad F, Biggart E, Bingham Y, Cook J, Hall P, Jamalzadeh A, Nagakumar P, Bossley C, Gupta A, Macleod K, Saglani S, Bush A. Lung clearance index and steroid response in pediatric severe asthma. Pediatr Pulmonol 2020; 55:890-898. [PMID: 32027471 DOI: 10.1002/ppul.24675] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 01/19/2020] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Lung clearance index (LCI) is a measure of airway disease that has been shown to be abnormal in asthma. We hypothesized that LCI would be higher (worse) in children with severe therapy-resistant asthma (STRA) compared with difficult asthma (DA) and healthy controls and that LCI would fall in response to parenteral steroids in STRA. METHODS Sixty-four children with asthma who were prescribed high-dose asthma therapy (GINA steps 4 or 5) performed LCI and spirometry. Forty-three had STRA and 21 DA. Thirty-nine of forty-three STRA patients attended for a clinically indicated bronchoscopy during which an intramuscular injection of triamcinolone was given. LCI, spirometry, and fractional exhaled nitric oxide (FeNO) were performed on the day of the bronchoscopy and repeated 4 weeks later. RESULTS LCI was more abnormal in STRA (median: 7.40, range: 5.58-12.34) than in DA (6.55, 5.77-7.75), P = .0006, and healthy controls (6.53, 5.57-7.35), P = .005. In contrast to the first second forced expired volume (FEV1 ), LCI improved following systemic steroids; of 20 STRA patients with an abnormal LCI at baseline, 13 improved following triamcinolone. LCI and FeNO responses were concordant. CONCLUSIONS There is a subgroup of children with STRA in whom LCI is elevated who improve following parenteral steroids. LCI may be a valuable additional domain in assessing steroid response in pediatric asthma.
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Affiliation(s)
- Samantha Irving
- Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Louise Fleming
- Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Fatima Ahmad
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Yvvone Bingham
- National Heart and Lung Institute, Imperial College London, London, UK
| | - James Cook
- Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Pippa Hall
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Prasad Nagakumar
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Cara Bossley
- King's College Hospital NHS Trust, London, UK.,Child Health Clinical Academic Group, King's College, London, UK
| | - Atul Gupta
- King's College Hospital NHS Trust, London, UK.,Child Health Clinical Academic Group, King's College, London, UK
| | | | - Sejal Saglani
- Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Andrew Bush
- Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
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18
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Almeida‐Junior A, Marson FAL, Almeida CCB, Ribeiro MÂGO, Paschoal IA, Moreira MM, Ribeiro JD. Volumetric capnography versus spirometry for the evaluation of pulmonary function in cystic fibrosis and allergic asthma. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2020. [DOI: 10.1016/j.jpedp.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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19
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Almeida-Junior A, Marson FAL, Almeida CCB, Ribeiro MÂGO, Paschoal IA, Moreira MM, Ribeiro JD. Volumetric capnography versus spirometry for the evaluation of pulmonary function in cystic fibrosis and allergic asthma. J Pediatr (Rio J) 2020; 96:255-264. [PMID: 30529075 PMCID: PMC9432330 DOI: 10.1016/j.jped.2018.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/11/2018] [Accepted: 10/14/2018] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To compare the values of the markers for volumetric capnography and spirometry and their ability to classify children and adolescents with asthma, cystic fibrosis (CF), and healthy controls. METHODS This was a cross-sectional study that included 103 patients with controlled persistent allergic asthma, 53 with CF and a healthy control group with 40 volunteers (aged 6 to 15 years), of both sexes. The individuals underwent volumetric capnography and spirometry. RESULTS Phase III slope (SIII), SIII standardized by exhaled tidal volume (SIII/TV) and capnographic index (SIII/SII)×100 (KPIv) were different among the three groups assessed, with highest values for CF. The relation between the forced expiratory volume in one second and the forced vital capacity (FEV1/FVC) was the only spirometric marker that presented difference on the three groups. On individuals with normal spirometry, KPIv and FEV1/FVC were different among the three groups. The ROC curve identified the individuals with asthma or CF from the control group, both through volumetric capnography (better to identify CF in relation to the control using KPIv) and through spirometry (better to identify asthma in relation to the control). KPIv was the best parameter to distinguish asthma from CF, even in individuals with normal spirometry. CONCLUSION Volumetric capnography and spirometry identified different alterations in lung function on asthma, CF, and healthy controls, allowing the three groups to be distinguished.
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Affiliation(s)
- Armando Almeida-Junior
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil
| | - Fernando Augusto Lima Marson
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Genética Médica e Medicina Genômica, Campinas, SP, Brazil; Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Laboratório de Fisiologia Pulmonar (LAFIP), Centro de Investigação em Pediatria (CIPED), Campinas, SP, Brazil.
| | - Celize Cruz Bresciani Almeida
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil
| | - Maria Ângela Gonçalves Oliveira Ribeiro
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil; Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Laboratório de Fisiologia Pulmonar (LAFIP), Centro de Investigação em Pediatria (CIPED), Campinas, SP, Brazil
| | - Ilma Aparecida Paschoal
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Clínica Médica, Campinas, SP, Brazil
| | - Marcos Mello Moreira
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Clínica Médica, Campinas, SP, Brazil
| | - José Dirceu Ribeiro
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil; Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Laboratório de Fisiologia Pulmonar (LAFIP), Centro de Investigação em Pediatria (CIPED), Campinas, SP, Brazil.
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Trinkmann F, Lenz SA, Schäfer J, Gawlitza J, Schroeter M, Gradinger T, Akin I, Borggrefe M, Ganslandt T, Saur J. Feasibility and clinical applications of multiple breath wash-out (MBW) testing using sulphur hexafluoride in adults with bronchial asthma. Sci Rep 2020; 10:1527. [PMID: 32001782 PMCID: PMC6992773 DOI: 10.1038/s41598-020-58538-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 01/15/2020] [Indexed: 11/17/2022] Open
Abstract
Ventilation heterogeneity is frequent in bronchial asthma and can be assessed using multiple breath wash-out testing (MBW). Most data is available in paediatric patients and using nitrogen as a tracer gas. We aimed to evaluate sulphur hexafluoride (SF6) MBW in adult asthmatics. Spirometry, whole-body plethysmography, impulse oscillometry and SF6-MBW were prospectively performed. MBW parameters reflecting global (lung clearance index, LCI), acinar (Sacin) and conductive (Scond) ventilation heterogeneity were derived from three consecutive wash-outs. LCI was calculated for the traditional 2.5% and an earlier 5% stopping point that has the potential to reduce wash-out times. 91 asthmatics (66%) and 47 non-asthmatic controls (34%) were included in final analysis. LCI2.5 and LCI5 were higher in asthmatics (p < 0.001). Likewise, Sacin and Scond were elevated (p < 0.001 and p < 0.01). Coefficient of variation was 3.4% for LCI2.5 and 3.5% for LCI5 in asthmatics. Forty-one asthmatic patients had normal spirometry. ROC analysis revealed an AUC of 0.906 for the differentiation from non-asthmatic controls exceeding diagnostic performance of individual and conventional parameters (AUC = 0.819, p < 0.05). SF6-MBW is feasible and reproducible in adult asthmatics. Ventilation heterogeneity is increased as compared to non-asthmatic controls persisting in asthmatic patients with normal spirometry. Diagnostic performance is not affected using an earlier LCI stopping point while reducing wash-out duration considerably.
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Affiliation(s)
- Frederik Trinkmann
- 1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany. .,Department of Biomedical Informatics of the Heinrich-Lanz-Centre, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.
| | - Steffi A Lenz
- 1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Julia Schäfer
- 1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Joshua Gawlitza
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Michele Schroeter
- 1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Tobias Gradinger
- Department of Biomedical Informatics of the Heinrich-Lanz-Centre, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Ibrahim Akin
- 1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Mannheim, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Martin Borggrefe
- 1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Mannheim, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Thomas Ganslandt
- Department of Biomedical Informatics of the Heinrich-Lanz-Centre, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Joachim Saur
- 1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
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Nuttall AGL, Velásquez W, Beardsmore CS, Gaillard EA. Lung clearance index: assessment and utility in children with asthma. Eur Respir Rev 2019; 28:28/154/190046. [PMID: 31748419 DOI: 10.1183/16000617.0046-2019] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/26/2019] [Indexed: 11/05/2022] Open
Abstract
There is increasing evidence that ventilation heterogeneity and small airway disease are significant factors in asthma, with evidence suggesting that the small airways are involved from an early stage in childhood asthma. Spirometry is commonly used to monitor lung function in asthmatics; however, it is not sensitive to small airway disease. There has been renewed interest in multibreath washout (MBW) tests, with recognition of the lung clearance index (LCI) as a global index of abnormality in gas mixing of the lungs that therefore also reflects small airway disease. This review summarises the technical and practical aspects of the MBW/LCI in children, and the differences between commercially available equipment. Children with severe asthma are more likely to have an abnormal LCI, whereas most children with mild-to-moderate asthma have an LCI within the normal range, but slightly higher than age-matched healthy controls. Monitoring children with asthma with MBW alongside standard spirometry may provide useful additional information.
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Affiliation(s)
- Amy G L Nuttall
- Institute for Lung Health, NIHR Leicester Respiratory Biomedical Research Unit and Dept of Infection Immunity and Inflammation, University of Leicester, Leicester, UK.,Children's Hospital, University Hospitals Leicester, Leicester, UK
| | - Werner Velásquez
- Hospital de Especialidades Rodolfo Robles, Quetzaltenango, Guatemala
| | - Caroline S Beardsmore
- Institute for Lung Health, NIHR Leicester Respiratory Biomedical Research Unit and Dept of Infection Immunity and Inflammation, University of Leicester, Leicester, UK.,Children's Hospital, University Hospitals Leicester, Leicester, UK
| | - Erol A Gaillard
- Institute for Lung Health, NIHR Leicester Respiratory Biomedical Research Unit and Dept of Infection Immunity and Inflammation, University of Leicester, Leicester, UK .,Children's Hospital, University Hospitals Leicester, Leicester, UK
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22
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Koucký V, Uhlík J, Hoňková L, Koucký M, Doušová T, Pohunek P. Ventilation Inhomogeneity and Bronchial Basement Membrane Changes in Chronic Neutrophilic Airway Inflammation. Chest 2019; 157:779-789. [PMID: 31711989 DOI: 10.1016/j.chest.2019.10.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 09/28/2019] [Accepted: 10/18/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Bronchial epithelial reticular basement membrane (RBM) thickening occurs in diseases with both eosinophilic (allergic bronchial asthma [BA]) and neutrophilic (cystic fibrosis [CF] and primary ciliary dyskinesia [PCD]) chronic airway inflammation; however, the lung function and airway remodeling relation remains unclear. The aim of this study was to test whether ventilation inhomogeneity is related to RBM thickening. METHODS Multiple breath washout test, endobronchial biopsy, and BAL were performed in 24 children with CF, 11 with PCD, 15 with BA, and in 19 control subjects. Lung clearance index at 2.5% (1/40th) of starting nitrogen concentration (LCI2.5), RBM thickness, and lavage fluid cytology were quantified; their mutual associations were studied by using Spearman rank correlations (r). RESULTS In asthma, ventilation inhomogeneity (mean ± SD) was mild (LCI2.5, 9.3 ± 1.4 vs 7.9 ± 0.9 in control subjects; P = .0391), and the RBM thickened (5.26 ± 0.98 μm vs 3.12 ± 0.62 μm in control subjects; P < .0001). No relation between RBM thickness and ventilation inhomogeneity or lavage cytology was found. In CF and PCD, RBM thickness was similar to that in asthma (4.54 ± 0.66 μm and 5.27 ± 1.11 μm, respectively), but ventilation inhomogeneity was significantly higher (LCI2.5, 12.5 ± 2.4 and 11.8 ± 2.5). Both in CF and PCD, RBM thickness correlated with LCI2.5 (r = 0.594, P = .015; r = 0.821, P = .023). In PCD only, RBM thickness was also related to the number of neutrophils in lavage fluid (r = 0.821; P = .023). CONCLUSIONS Lung function impairment in relation to RBM thickness was milder in BA than in CF and PCD. In asthma, ventilation inhomogeneity did not correlate with RBM thickness, whereas it did in CF and PCD. This outcome suggests a different structure-function relation in these diseases.
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Affiliation(s)
- Václav Koucký
- Department of Paediatrics, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic; Department of Histology and Embryology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Applied Mathematics, Faculty of Science, Humanities and Education, Technical University of Liberec, Liberec, Czech Republic.
| | - Jiří Uhlík
- Department of Histology and Embryology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lenka Hoňková
- Department of Paediatrics, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic; Department of Histology and Embryology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Miroslav Koucký
- Department of Applied Mathematics, Faculty of Science, Humanities and Education, Technical University of Liberec, Liberec, Czech Republic
| | - Tereza Doušová
- Department of Paediatrics, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Petr Pohunek
- Department of Paediatrics, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
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23
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Bayfield KJ, Horsley A, Alton E, Irving S, Bush A, Davies JC. Simultaneous sulfur hexafluoride and nitrogen multiple-breath washout (MBW) to examine inherent differences in MBW outcomes. ERJ Open Res 2019; 5:00234-2018. [PMID: 31720295 PMCID: PMC6826248 DOI: 10.1183/23120541.00234-2018] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 08/27/2019] [Indexed: 11/10/2022] Open
Abstract
Multiple-breath washout (MBW) can be performed with different gases (sulfur hexafluoride (SF6) and nitrogen (N2)) and different devices, all of which give discrepant results. This study aimed to confirm previously reported differences and explore factors influencing discrepant results; equipment factors or the physical properties of gases used. Inherent differences in simultaneous SF6 and N2 washout on the mass spectrometer show why results are never comparablehttp://bit.ly/34k52Oo
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Affiliation(s)
- Katie J Bayfield
- Imperial College London, London, UK.,Royal Brompton and Harefield NHS Foundation Trust, London, UK.,European Cystic Fibrosis Society Clinical Trials Network, Lung Clearance Index Core Facility, London, UK.,The Children's Hospital at Westmead, Sydney, Australia
| | - Alex Horsley
- Institute of Inflammation and repair, Education and Research centre, University of Manchester, University Hospital of South Manchester, Manchester, UK
| | - Eric Alton
- Imperial College London, London, UK.,Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Samantha Irving
- Imperial College London, London, UK.,Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Andrew Bush
- Imperial College London, London, UK.,Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Jane C Davies
- Imperial College London, London, UK.,Royal Brompton and Harefield NHS Foundation Trust, London, UK.,European Cystic Fibrosis Society Clinical Trials Network, Lung Clearance Index Core Facility, London, UK
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24
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Sensitivity of multiple breath washout to detect mild-to-moderate asthma in adolescence. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2052-2054.e5. [PMID: 30708145 DOI: 10.1016/j.jaip.2019.01.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 01/17/2019] [Accepted: 01/17/2019] [Indexed: 11/21/2022]
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25
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Poncin W, Lebecque P. [Lung clearance index in cystic fibrosis]. Rev Mal Respir 2019; 36:377-395. [PMID: 30686561 DOI: 10.1016/j.rmr.2018.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 03/28/2018] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Small airways' involvement in cystic fibrosis (CF) pulmonary disease is a very early event, which can progress sub-clinically and insidiously since it is poorly reflected by commonly used lung function tests. STATE OF ART Sensitive and discriminative tools are available to investigate small airways function. However their complexity and/or invasiveness has confined their use to research purposes and to some specialized research teams. By contrast, the multiple breath washout (MBW) test is more affordable and non-invasive. Lung clearance index (LCI), which is the most used derived parameter, is reproducible and much more sensitive than spirometry in detecting small airways disease. However, MBW is operator dependent. PERSPECTIVES The recent commercialization of devices assessing LCI launches MBW as a potential tool in routine clinical care, although its use currently remains mostly dedicated to research purposes. However, important differences in LCI between various equipment settings raise a number of theoretical questions. Specific algorithms should be refined and more transparent. Standardization of MBW is still an ongoing process. Whether other MBW derived indices can prove superior over LCI deserves further study. CONCLUSIONS In CF, LCI is now a well-established outcome in research settings to detect early lung function abnormalities and new treatment effects, especially in patients with mild lung disease. In these patients, LCI seems an attractive tool for clinicians too. Yet, further investigation is needed to define clinically significant changes in LCI and to which extent this index can be useful in guiding clinical decisions remains to be studied.
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Affiliation(s)
- W Poncin
- Pôle de pneumologie, ORL et dermatologie, université Catholique de Louvain, institut de recherche expérimentale et clinique (IREC), 1200 Bruxelles, Belgique; Service de médecine physique et réadaptation, cliniques universitaires Saint-Luc, 1200 Bruxelles, Belgique.
| | - P Lebecque
- Pneumologie pédiatrique & centre de référence pour la mucoviscidose, cliniques universitaires Saint-Luc, 1200 Bruxelles, Belgique
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26
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Nyilas S, Bigler A, Yammine S, Kieninger E, Rochat I, Ramsey K, Casaulta C, Moeller A, Latzin P, Singer F. Alternate gas washout indices: Assessment of ventilation inhomogeneity in mild to moderate pediatric cystic fibrosis lung disease. Pediatr Pulmonol 2018; 53:1485-1491. [PMID: 30168294 DOI: 10.1002/ppul.24149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 07/06/2018] [Accepted: 07/29/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Normalized phase III slope (SnIII ) indices from multiple breath washout (MBW) estimate ventilation inhomogeneity. Alternate (*) protocols for SnIII indices exist, however the utility of these outcomes in children with mild-to-moderate cystic fibrosis (CF) is unknown. METHODS We measured nitrogen MBW and spirometry in 135 children (43 controls) aged 4-18 years. We assessed validity, practicability, and reliability of SnIII protocols. Outcomes included the ability to detect abnormal lung function, test agreement, measurement duration, intra-test repeatability, and quality. RESULTS Lung clearance index (LCI) was abnormal in 80 (87%), Scond in 55 (60%), Scond* in 17 (19%), Sacin in 10 (11%), Sacin* in 11 (12%), and FEV1 in 28 (30%). Alternate protocols reduced measurement duration. Agreement of indices to detect abnormal lung function was poor. The quality of analysis and repeatability deteriorated with the alternate technique compared to standard. CONCLUSION In children with mild-to-moderate CF lung disease, alternate protocols seem practical but clinimetric properties of standard SnIII protocols are preferable.
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Affiliation(s)
- Sylvia Nyilas
- Division of Paediatric Pulmonology, University Children's Hospital Zurich, Zurich, Switzerland.,Division of Respiratory Medicine, Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Anja Bigler
- Division of Respiratory Medicine, Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Sophie Yammine
- Division of Respiratory Medicine, Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Elisabeth Kieninger
- Division of Respiratory Medicine, Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Isabelle Rochat
- Department of Paediatric Pulmonology, University Children's Hospital of Lausanne, Lausanne, Switzerland
| | - Kathryn Ramsey
- Division of Respiratory Medicine, Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Carmen Casaulta
- Division of Respiratory Medicine, Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Alexander Moeller
- Division of Paediatric Pulmonology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Philipp Latzin
- Division of Respiratory Medicine, Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Florian Singer
- Division of Paediatric Pulmonology, University Children's Hospital Zurich, Zurich, Switzerland.,Division of Respiratory Medicine, Department of Pediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
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27
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The CF Canada-Sick Kids Program in individual CF therapy: A resource for the advancement of personalized medicine in CF. J Cyst Fibros 2018; 18:35-43. [PMID: 29685812 DOI: 10.1016/j.jcf.2018.03.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/13/2018] [Accepted: 03/31/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Therapies targeting certain CFTR mutants have been approved, yet variations in clinical response highlight the need for in-vitro and genetic tools that predict patient-specific clinical outcomes. Toward this goal, the CF Canada-Sick Kids Program in Individual CF Therapy (CFIT) is generating a "first of its kind", comprehensive resource containing patient-specific cell cultures and data from 100 CF individuals that will enable modeling of therapeutic responses. METHODS The CFIT program is generating: 1) nasal cells from drug naïve patients suitable for culture and the study of drug responses in vitro, 2) matched gene expression data obtained by sequencing the RNA from the primary nasal tissue, 3) whole genome sequencing of blood derived DNA from each of the 100 participants, 4) induced pluripotent stem cells (iPSCs) generated from each participant's blood sample, 5) CRISPR-edited isogenic control iPSC lines and 6) prospective clinical data from patients treated with CF modulators. RESULTS To date, we have recruited 57 of 100 individuals to CFIT, most of whom are homozygous for F508del (to assess in-vitro: in-vivo correlations with respect to ORKAMBI response) or heterozygous for F508del and a minimal function mutation. In addition, several donors are homozygous for rare nonsense and missense mutations. Nasal epithelial cell cultures and matched iPSC lines are available for many of these donors. CONCLUSIONS This accessible resource will enable development of tools that predict individual outcomes to current and emerging modulators targeting F508del-CFTR and facilitate therapy discovery for rare CF causing mutations.
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28
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Horáček J, Koucký V, Hladík M. Novel approach to computerized breath detection in lung function diagnostics. Comput Biol Med 2018; 101:1-6. [PMID: 30081237 DOI: 10.1016/j.compbiomed.2018.07.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 07/28/2018] [Accepted: 07/28/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Breath detection, i.e. its precise delineation in time is a crucial step in lung function data analysis as obtaining any clinically relevant index is based on the proper localization of breath ends. Current threshold or smoothing algorithms suffer from severe inaccuracy in cases of suboptimal data quality. Especially in infants, the precise analysis is of utmost importance. The key objective of our work is to design an algorithm for accurate breath detection in severely distorted data. METHODS Flow and gas concentration data from multiple breath washout test were the input information. Based on universal physiological characteristics of the respiratory tract we designed an algorithm for breath detection. Its accuracy was tested on severely distorted data from 19 patients with different types of breathing disorders. Its performance was compared to the performance of currently used algorithms and to the breath counts estimated by human experts. RESULTS The novel algorithm outperformed the threshold algorithms with respect to their accuracy and had similar performance to human experts. It proved to be a highly robust and efficient approach in severely distorted data. This was demonstrated on patients with different pulmonary disorders. CONCLUSION Our newly proposed algorithm is highly robust and universal. It works accurately even on severely distorted data, where the other tested algorithms failed. It does not require any pre-set thresholds or other patient-specific inputs. Consequently, it may be used with a broad spectrum of patients. It has the potential to replace current approaches to the breath detection in pulmonary function diagnostics.
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Affiliation(s)
- Jaroslav Horáček
- Department of Applied Mathematics, Faculty of Mathematics and Physics, Charles University, Prague, Czech Republic.
| | - Václav Koucký
- Department of Paediatrics, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Milan Hladík
- Department of Applied Mathematics, Faculty of Mathematics and Physics, Charles University, Prague, Czech Republic.
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29
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Friedman NL, McDonough JM, Zhang X, Hysinger EB, Adams KM, Allen JL. Bronchodilator responsiveness assessed by forced oscillometry and multiple breath washout techniques in preschool children. Pediatr Investig 2018; 2:83-89. [PMID: 32851238 PMCID: PMC7331324 DOI: 10.1002/ped4.12034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/04/2018] [Indexed: 11/12/2022] Open
Abstract
IMPORTANCE The forced oscillation (FOT) and multiple breath washout (MBW) techniques are passive tests of lung function, and are reliable for preschool-age children. There has not been comparison testing to determine which test could more accurately differentiate between healthy controls and poorly controlled asthmatics, or differentiate a response to bronchodilator administration. OBJECTIVE To determine whether the MBW and/or FOT could differentiate between healthy controls and poorly controlled asthmatics, and whether the two tests could detect a response to bronchodilator administration. METHODS Twenty-eight healthy controls and 23 poorly controlled asthmatics 3-6 years of age participated. All subjects were administered the MBW followed by the FOT. A bronchodilator was then administered and testing was repeated. Wilcoxon Rank Sum tests were used to compare the difference between healthy controls and poorly controlled asthmatics. Wilcoxon Signed Rank tests were used to compare the pre- and post-bronchodilator values. RESULTS Neither MBW nor FOT differentiated healthy controls from poorly controlled asthmatics (pre-bronchodilator data); both groups had similar baseline gas mixing and airway mechanics. There was no improvement in any MBW outcomes post-bronchodilator administration. FOT detected a significant and similar degree of improvement in the airway mechanics in both groups. INTERPRETATION Neither MBW nor FOT differentiated between poorly controlled asthmatics (when well) and healthy controls. MBW did not detect a significant bronchodilator response in either subject group, whereas FOT detected a similar degree of bronchodilator responsiveness in both groups. This discrepancy may reflect differential changes in airway mechanics and gas mixing properties in response to bronchodilators.
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Affiliation(s)
- Nicholas L. Friedman
- Division of Pulmonary MedicineThe Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of PediatricsMadigan Army Medical CenterTacomaWAUSA
| | - Joseph M. McDonough
- Division of Pulmonary MedicineThe Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Xuemei Zhang
- Division of Pulmonary MedicineThe Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Erik B. Hysinger
- Division of Pulmonary MedicineCincinnati Children's Hospital Medical CenterCincinnatiOHUSA
| | - Kelly M. Adams
- Division of Pulmonary MedicineNorthwell Health SystemLake SuccessNYUSA
| | - Julian L. Allen
- Division of Pulmonary MedicineThe Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
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30
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Green K, Kongstad T, Skov M, Buchvald F, Rosthøj S, Marott JL, Gustafsson P, Pressler T, Nielsen KG. Variability of monthly nitrogen multiple-breath washout during one year in children with cystic fibrosis. J Cyst Fibros 2017; 17:242-248. [PMID: 29273421 DOI: 10.1016/j.jcf.2017.11.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 11/17/2017] [Accepted: 11/19/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Knowledge of between-session variability of nitrogen multiple-breath washout (N2MBW) indices is crucial when designing longitudinal interventional studies and in disease monitoring using N2MBW as end-point. Such information is currently sparse. METHODS Monthly triplets of N2MBW were prospectively obtained from 14 children with CF during one year. Linear mixed models were used to analyze variability. Our aim was to assess between-session variability of N2MBW indices from repeated measurements and compare LCI derived from different software packages currently in use (TestPoint® vs. Spiroware®). RESULTS Baseline LCI (median; range) was 9.37 (6.82; 12.08). Between-session differences in LCI measurements were up to 25%. Intra Class Correlation-Coefficient was 0.82. There was no systematic difference between LCI measurements derived from the two software packages (p=0.18); however, variability was significantly higher using Spiroware®. CONCLUSIONS We report between-session variability of LCI using N2MBW in school-age children and adolescents with CF. LCI changes exceeding 25% may be considered clinically relevant. TestPoint® and Spiroware® can be used interchangeably in longitudinal studies.
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Affiliation(s)
- Kent Green
- CF-Centre Copenhagen, Paediatric Pulmonary Service, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark; Research Unit on Women's and Children's Health, Copenhagen University Hospital, Rigshospitalet, Tagensvej 20, DK-2100 Copenhagen, Denmark.
| | - Thomas Kongstad
- CF-Centre Copenhagen, Paediatric Pulmonary Service, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark; Research Unit on Women's and Children's Health, Copenhagen University Hospital, Rigshospitalet, Tagensvej 20, DK-2100 Copenhagen, Denmark
| | - Marianne Skov
- CF-Centre Copenhagen, Paediatric Pulmonary Service, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Frederik Buchvald
- CF-Centre Copenhagen, Paediatric Pulmonary Service, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Susanne Rosthøj
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Entrance B, 2. floor, Postboks 2099, DK-1014 Copenhagen, Denmark
| | - Jacob Louis Marott
- The Copenhagen City Heart Study, Frederiksberg Hospital, University of Copenhagen, Nordre Fasanvej 57, DK-2000 Frederiksberg, Denmark
| | - Per Gustafsson
- Department of Paediatrics, Central Hospital, Lövängsvägen, 541 85 Skövde, Sweden
| | - Tacjana Pressler
- CF-Centre Copenhagen, Paediatric Pulmonary Service, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Kim Gjerum Nielsen
- CF-Centre Copenhagen, Paediatric Pulmonary Service, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
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31
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Vilmann L, Buchvald F, Green K, Nielsen KG. Fractional exhaled nitric oxide and multiple breath nitrogen washout in preschool healthy and asthmatic children. Respir Med 2017; 133:42-47. [PMID: 29173448 DOI: 10.1016/j.rmed.2017.10.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 10/05/2017] [Accepted: 10/31/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Objectively assessing pulmonary disease is challenging in preschool children with asthma. We evaluated the feasibility of measuring fractional exhaled nitrogen oxide (FeNO) and multiple breath nitrogen washout (N2MBW) in children. We compared their capacities for discriminating between children with asthma and healthy controls. METHODS We measured FeNO and N2MBW-derived indices of lung clearance (LCI2.5) and conductive and acinar ventilation heterogeneity (Scond and Sacin) in 65 preschool children; 35 with physician-diagnosed asthma and 30 healthy. FeNO was measured with a portable device (sampling time, 6 s). We employed data quality control guidelines on N2MBW. Feasibility was evaluated in a maximum of 8 attempts for both methods. Atopic co-morbidity and first-degree disposition were evaluated with the ISAAC-questionnaire. RESULTS FeNO and N2MBW testing were feasible in 45% and 91% of children, respectively. Feasibility was highly age-dependent. In children under 4 years old, FeNO was not feasible, but N2MBW was 85% feasible. Children with asthma had significantly elevated Scond values (median; 95% CI) (0.024; 0.020; 0.029) compared to healthy controls (0.019; 0.016; 0.023), but similar FeNO, LCI2.5 and Sacinvalues. CONCLUSION The feasibility of measuring FeNO was highly age-dependent and not applicable in children under age 4. N2MBW was feasible in the majority of preschool children. Scond, but not FeNO, could discriminate between children with asthma and healthy controls.
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Affiliation(s)
- Lea Vilmann
- Danish PCD & ChILD Centre, CF Centre Copenhagen, Pediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Frederik Buchvald
- Danish PCD & ChILD Centre, CF Centre Copenhagen, Pediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kent Green
- Danish PCD & ChILD Centre, CF Centre Copenhagen, Pediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kim Gjerum Nielsen
- Danish PCD & ChILD Centre, CF Centre Copenhagen, Pediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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32
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Steinbacher M, Pfleger A, Schwantzer G, Jauk S, Weinhandl E, Eber E. Small airway function before and after cold dry air challenge in pediatric asthma patients during remission. Pediatr Pulmonol 2017; 52:873-879. [PMID: 28486753 DOI: 10.1002/ppul.23724] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 04/12/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND We wanted to compare cold dry air challenge (CACh) induced changes in spirometric parameters with changes in nitrogen multiple breath washout (N2 MBW) parameters in pediatric asthma patients during clinical remission over the past year (ie, with "inactive asthma"). As N2 MBW assesses ventilation heterogeneity we expected to gain detailed information about peripheral airways contribution. METHODS In subjects with normal spirometry N2 MBW, spirometry and body plethysmography were performed at baseline, after CACh, and after salbutamol inhalation. An initial measurement of the fraction of exhaled nitric oxide (FeNO) was conducted. RESULTS Forty-three (20 female) subjects, mean age 13.7 years (range 6.5-18.6) performed reproducible N2 MBW measurements. Ten were tested hyperresponsive (23.3%) and 33 normoresponsive (76.7%). Baseline spirometry and body plethysmography as well as FRC (N2 MBW) were similar in both groups. Scond (0.031 vs 0.022), Sacin (0.057 vs 0.067), and FeNO (92.0 vs 28.5 ppb) were not statistically different between hyperresponsive and nomoresponsive subjects at baseline. Subjects with airway hyperresponsiveness (AHR) showed significant increases in lung clearance index (LCI, P = 0.011) and Scond (P = 0.008) after CACh, and significant decreases after salbutamol (LCI: P = 0.005; Scond: P = 0.005). In contrast, normoresponsive subjects showed no relevant changes after CACh, and only a decrease of Scond after salbutamol (P = 0.007). There were significant correlations between the CACh induced changes in FEV1 and changes in LCI (r = -0.45, P = 0.003), Scond (r = -0.30, P = 0.047), and Sacin (r = -0.47, P = 0.008), respectively. CONCLUSION Our study provides evidence of small airway involvement in children and adolescents with inactive asthma and airway hyperresponsiveness.
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Affiliation(s)
- Michael Steinbacher
- Division of Pediatric Pulmonology and Allergology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Andreas Pfleger
- Division of Pediatric Pulmonology and Allergology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Gerold Schwantzer
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Stefanie Jauk
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Elisabeth Weinhandl
- Division of Pediatric Pulmonology and Allergology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Ernst Eber
- Division of Pediatric Pulmonology and Allergology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
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Stafler P, Weinreb S, Mussaffi H, Mei-Zahav M, Prais D, Steuer G, Bar-On O, Hoshen M, Blau H. Feasibility of multiple breath washout measurements in infants with bronchiolitis: A pilot study. Pediatr Pulmonol 2017; 52:763-770. [PMID: 28221737 DOI: 10.1002/ppul.23674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/20/2016] [Accepted: 01/09/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Lung clearance index (LCI) reflects ventilation inhomogeneity and is raised in obstructive airway disease. Feasibility of multiple breath washout (MBW) measurement during acute lung disease in infants is unknown. As a further measure of disease, exhaled nitric oxide (eNO) may paradoxically decrease in acute bronchiolitis. We hypothesized that MBW measurements were attainable in infants with bronchiolitis and that LCI was raised and eNO reduced, compared to normal controls. METHODS Infants with acute bronchiolitis were tested with sulfur hexafluoride (SF6 ) MBW during hospitalization and compared to controls. Tidal breathing and eNO parameters were obtained. Measurements were performed during natural sleep. RESULTS Twenty-nine infants with bronchiolitis aged 3.7 ± 2.3 months (mean ± SD) and 23 controls aged 4.2 ± 2.5 months (P = 0.07) were evaluated. Fifteen of 29 (52%) infants with bronchiolitis and 19/23 (83%) controls achieved ≥2 valid MBW measurements. Reasons for test failure included waking up during facemask application and an irregular respiratory pattern. LCI was 8.4 ± 0.8 in the study group and 7.3 ± 0.7 in controls (P < 0.001). ENO was 2.3 ± 2.7 ppb in the study group and 7.9 ± 6.9 ppb in controls (P = 0.004). CONCLUSION MBW measurements during natural sleep are feasible but technically challenging in infants with acute bronchiolitis. LCI is raised compared to healthy controls. Larger trials, possibly using sedation protocols and shortened washout periods, are required to corroborate these findings. LCI can potentially serve as an objective indicator of severity and could be considered as a biomarker for future interventional trials.
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Affiliation(s)
- Patrick Stafler
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sigal Weinreb
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Huda Mussaffi
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meir Mei-Zahav
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dario Prais
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Steuer
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Ophir Bar-On
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | | | - Hannah Blau
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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34
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Port J, Tao Z, Junger A, Joppek C, Tempel P, Husemann K, Singer F, Latzin P, Yammine S, Nagel JH, Kohlhäufl M. A simple method to reconstruct the molar mass signal of respiratory gas to assess small airways with a double-tracer gas single-breath washout. Med Biol Eng Comput 2017; 55:1975-1987. [PMID: 28357624 DOI: 10.1007/s11517-017-1633-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 03/13/2017] [Indexed: 01/13/2023]
Abstract
For the assessment of small airway diseases, a noninvasive double-tracer gas single-breath washout (DTG-SBW) with sulfur hexafluoride (SF6) and helium (He) as tracer components has been proposed. It is assumed that small airway diseases may produce typical ventilation inhomogeneities which can be detected within one single tidal breath, when using two tracer components. Characteristic parameters calculated from a relative molar mass (MM) signal of the airflow during the washout expiration phase are analyzed. The DTG-SBW signal is acquired by subtracting a reconstructed MM signal without tracer gas from the signal measured with an ultrasonic sensor during in- and exhalation of the double-tracer gas for one tidal breath. In this paper, a simple method to determine the reconstructed MM signal is presented. Measurements on subjects with and without obstructive lung diseases including the small airways have shown high reliability and reproducibility of this method.
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Affiliation(s)
- Johannes Port
- Institut für Biomedizinische Technik, Universität Stuttgart, Stuttgart, Germany.
| | - Ziran Tao
- Institut für Biomedizinische Technik, Universität Stuttgart, Stuttgart, Germany
| | - Annika Junger
- Institut für Biomedizinische Technik, Universität Stuttgart, Stuttgart, Germany
| | - Christoph Joppek
- Institut für Biomedizinische Technik, Universität Stuttgart, Stuttgart, Germany
| | - Philipp Tempel
- Institut für Biomedizinische Technik, Universität Stuttgart, Stuttgart, Germany
| | - Kim Husemann
- Klinik Schillerhöhe, Zentrum für Pneumologie und Thoraxchirurgie, Robert-Bosch-Hospital, Gerlingen, Germany.,Internistische Facharztpraxis für Pneumologie, Allergologie, Thoraxonkologie, Bronchoskopie und Schlafmedizin, MVZ Klinikum Kempten GmbH, Kempten, Germany
| | - Florian Singer
- University Children's Hospital Zurich, Zurich, Switzerland
| | - Philipp Latzin
- University Children's Hospital Basel, Basel, Switzerland
| | - Sophie Yammine
- University Children's Hospital Basel, Basel, Switzerland
| | - Joachim H Nagel
- Institut für Biomedizinische Technik, Universität Stuttgart, Stuttgart, Germany
| | - Martin Kohlhäufl
- Klinik Schillerhöhe, Zentrum für Pneumologie und Thoraxchirurgie, Robert-Bosch-Hospital, Gerlingen, Germany
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35
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Foy BH, Kay D, Bordas R. Modelling responses of the inert-gas washout and MRI to bronchoconstriction. Respir Physiol Neurobiol 2017; 235:8-17. [DOI: 10.1016/j.resp.2016.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 09/18/2016] [Accepted: 09/20/2016] [Indexed: 10/20/2022]
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36
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Affiliation(s)
- Peter J Barry
- Manchester Adult Cystic Fibrosis Centre, University Hospital of South Manchester, Manchester, United Kingdom of Great Britain and Northern Ireland
- Institute of Inflammation and Repair, University of Manchester, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Patrick A Flume
- Departments of Medicine and Pediatrics, Medical University of South Carolina, Charleston, SC, USA
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37
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Physiologic endpoints for clinical studies for cystic fibrosis. J Cyst Fibros 2016; 15:416-23. [DOI: 10.1016/j.jcf.2016.05.014] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 05/27/2016] [Accepted: 05/28/2016] [Indexed: 11/20/2022]
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38
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Green K, Ejlertsen JS, Madsen A, Buchvald FF, Kongstad T, Kobbernagel H, Gustafsson PM, Nielsen KG. Abbreviation modalities of nitrogen multiple-breath washout tests in school children with obstructed lung disease. Pediatr Pulmonol 2016; 51:624-32. [PMID: 26595237 DOI: 10.1002/ppul.23339] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 10/07/2015] [Accepted: 10/29/2015] [Indexed: 11/12/2022]
Abstract
RATIONALE Nitrogen multiple-breath washout (N2 MBW) is a promising tool for assessing early lung damage in children with chronic obstructive pulmonary disease, but it can be a time-consuming procedure. We compared alternative test-shortening endpoints with the most commonly reported N2 MBW outcome, the lung clearance index, calculated as lung volume turnovers required to reach 2.5% of the starting N2 concentration (LCI2.5 ). METHODS Cross-sectional study of triplicate N2 MBW measurements obtained in cystic fibrosis (CF) patients (N = 60), primary ciliary dyskinesia (PCD) patients (N = 28), and matched healthy controls (N = 48) aged 5-18 years. Bland-Altman analysis was used to compare LCI2.5 with earlier LCI endpoints (3%, 4%, 5%, 7%, and 9% of starting N2 concentration), Cn@TO6 (defined as % of N2 starting concentration when reaching six lung volume turnovers), and LCI derived from only two N2 MBW runs in each session. N2 MBW endpoints were analyzed as z-scores calculated from healthy controls. RESULTS In PCD, Cn@TO6 and LCI2.5 exhibited similar values (mean [95%CI] difference: 0.33 [-0.24; 0.90] z-scores), reducing the test duration by one-third (5.4 min; 95%CI: 4.0; 6.8). All other tested alternative endpoints exhibited increasing disagreement with increasing LCI2.5 . With an average reduction in test duration of 40%, LCI2.5 derived from two runs exhibited good agreement in all children. CONCLUSIONS Cn@TO6 may be suggested as a potential test-shortening endpoint in school children with PCD. In CF, early test termination may reduce measurement power with advancing pulmonary disease, suggesting differences in underlying pathophysiology. Two technically acceptable N2 MBW runs may be sufficient in school children irrespective of diagnosis with CF or PCD. Pediatr Pulmonol. 2016;51:624-632. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Kent Green
- Department of Pediatric and Adolescent Medicine, Danish PCD and chILD Centre, CF Centre Copenhagen, Pediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Research Unit on Women's and Children's Health, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jacob S Ejlertsen
- Department of Pediatric and Adolescent Medicine, Danish PCD and chILD Centre, CF Centre Copenhagen, Pediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Astrid Madsen
- Department of Pediatric and Adolescent Medicine, Danish PCD and chILD Centre, CF Centre Copenhagen, Pediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Frederik F Buchvald
- Department of Pediatric and Adolescent Medicine, Danish PCD and chILD Centre, CF Centre Copenhagen, Pediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Kongstad
- Department of Pediatric and Adolescent Medicine, Danish PCD and chILD Centre, CF Centre Copenhagen, Pediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Research Unit on Women's and Children's Health, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Helene Kobbernagel
- Department of Pediatric and Adolescent Medicine, Danish PCD and chILD Centre, CF Centre Copenhagen, Pediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Research Unit on Women's and Children's Health, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Kim G Nielsen
- Department of Pediatric and Adolescent Medicine, Danish PCD and chILD Centre, CF Centre Copenhagen, Pediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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39
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Svenningsen S, Nair P, Guo F, McCormack DG, Parraga G. Is ventilation heterogeneity related to asthma control? Eur Respir J 2016; 48:370-9. [DOI: 10.1183/13993003.00393-2016] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 04/13/2016] [Indexed: 11/05/2022]
Abstract
In asthma patients, magnetic resonance imaging (MRI) and the lung clearance index (LCI) have revealed persistent ventilation heterogeneity, although its relationship to asthma control is not well understood. Therefore, our goal was to explore the relationship of MRI ventilation defects and the LCI with asthma control and quality of life in patients with severe, poorly controlled asthma.18 patients with severe, poorly controlled asthma (mean±sd 46±12 years, six males/12 females) provided written informed consent to an ethics board approved protocol, and underwent spirometry, LCI and 3He MRI during a single 2-h visit. Asthma control and quality of life were evaluated using the Asthma Control Questionnaire (ACQ) and Asthma Quality of Life Questionnaire (AQLQ). Ventilation heterogeneity was quantified using the LCI and 3He MRI ventilation defect percent (VDP).All participants reported poorly controlled disease (mean±sd ACQ score=2.3±0.9) and highly heterogeneous ventilation (mean±sd VDP=12±11% and LCI=10.5±3.0). While VDP and LCI were strongly correlated (r=0.86, p<0.0001), in a multivariate model that included forced expiratory volume in 1 s, VDP and LCI, VDP was the only independent predictor of asthma control (R2=0.38, p=0.01). There was also a significantly worse VDP, but not LCI in asthma patients with an ACQ score >2 (p=0.04) and AQLQ score <5 (p=0.04), and a trend towards worse VDP (p=0.053), but not LCI in asthma patients reporting ≥1 exacerbation in the past 6 months.In patients with poorly controlled, severe asthma MRI ventilation, but not LCI was significantly worse in those with worse ACQ and AQLQ.
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40
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Moeller A, Carlsen KH, Sly PD, Baraldi E, Piacentini G, Pavord I, Lex C, Saglani S. Monitoring asthma in childhood: lung function, bronchial responsiveness and inflammation. Eur Respir Rev 2016; 24:204-15. [PMID: 26028633 DOI: 10.1183/16000617.00003914] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
This review focuses on the methods available for measuring reversible airways obstruction, bronchial hyperresponsiveness (BHR) and inflammation as hallmarks of asthma, and their role in monitoring children with asthma. Persistent bronchial obstruction may occur in asymptomatic children and is considered a risk factor for severe asthma episodes and is associated with poor asthma outcome. Annual measurement of forced expiratory volume in 1 s using office based spirometry is considered useful. Other lung function measurements including the assessment of BHR may be reserved for children with possible exercise limitations, poor symptom perception and those not responding to their current treatment or with atypical asthma symptoms, and performed on a higher specialty level. To date, for most methods of measuring lung function there are no proper randomised controlled or large longitudinal studies available to establish their role in asthma management in children. Noninvasive biomarkers for monitoring inflammation in children are available, for example the measurement of exhaled nitric oxide fraction, and the assessment of induced sputum cytology or inflammatory mediators in the exhaled breath condensate. However, their role and usefulness in routine clinical practice to monitor and guide therapy remains unclear, and therefore, their use should be reserved for selected cases.
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Affiliation(s)
- Alexander Moeller
- Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland
| | - Kai-Hakon Carlsen
- Dept of Paediatrics, Women and Children's Division, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Peter D Sly
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia
| | - Eugenio Baraldi
- Women's and Children's Health Department, Unit of Respiratory Medicine and Allergy, University of Padova, Padova, Italy
| | - Giorgio Piacentini
- Paediatric Section, Dept of Life and Reproduction Sciences, University of Verona, Verona, Italy
| | - Ian Pavord
- Dept of Respiratory Medicine, University of Oxford, NDM Research Building, Oxford, UK
| | - Christiane Lex
- Dept of Paediatric Cardiology and Intensive Care Medicine, Division of Paediatric Respiratory Medicine, University Hospital Goettingen, Goettingen, Germany
| | - Sejal Saglani
- Leukocyte Biology and Respiratory Paediatrics, National Heart and Lung Institute, Imperial College London, London, UK
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41
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The single breath nitrogen test and mortality – A 38 years follow up. Respir Med 2016; 112:75-80. [DOI: 10.1016/j.rmed.2016.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 01/02/2016] [Accepted: 01/05/2016] [Indexed: 11/20/2022]
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42
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Ahmad F, Irving S, Alton E, Davies JC, Macleod K, Rosenthal M, Saunders C, Bush A, Saglani S, Fleming L. Multiple breath washouts in children can be shortened without compromising quality. Eur Respir J 2015; 46:1814-6. [PMID: 26453629 DOI: 10.1183/13993003.00791-2015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 07/27/2015] [Indexed: 11/05/2022]
Affiliation(s)
| | - Samantha Irving
- National Heart and Lung Institute, Imperial College London, London, UK Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Eric Alton
- Dept of Gene Therapy, Imperial College London, London, UK
| | - Jane C Davies
- Royal Brompton and Harefield NHS Foundation Trust, London, UK Dept of Gene Therapy, Imperial College London, London, UK
| | - Kenneth Macleod
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Mark Rosenthal
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Clare Saunders
- Dept of Gene Therapy, Imperial College London, London, UK
| | - Andrew Bush
- National Heart and Lung Institute, Imperial College London, London, UK Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Sejal Saglani
- National Heart and Lung Institute, Imperial College London, London, UK Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Louise Fleming
- National Heart and Lung Institute, Imperial College London, London, UK Royal Brompton and Harefield NHS Foundation Trust, London, UK
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43
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Bigler A, Yammine S, Singer F, Riedel T, Latzin P. Feasibility of automated slope III and Scond analysis in children. Pediatr Pulmonol 2015; 50:805-13. [PMID: 25056098 DOI: 10.1002/ppul.23080] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 05/08/2014] [Accepted: 05/28/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Multiple breath washout (MBW) derived Scond is an established index of ventilation inhomogeneity. Time-consuming post hoc calculations of the expirogram's slope of alveolar phase III (SIII) and the lack of available software hampered widespread application of Scond. METHODS Seventy-two school-aged children (45 with cystic fibrosis; CF) performed 3 nitrogen MBW. We tested a new automated algorithm for Scond analysis (Scondauto ) which comprised breath selection for SIII detection, calculation and reporting of test quality. We compared Scondauto to (i) standard Scond analysis (Scondmanual ) with manual breath selection and to (ii) pragmatic Scond analysis including all breaths (Scondall ). Primary outcomes were success rate and agreement between different Scond protocols, and Scond fitting quality (linear regression R(2) ). RESULTS Average Scondauto (0.06 for CF and 0.01 for controls) was not different from Scondmanual (0.06 for CF and 0.01 for controls) and showed comparable fitting quality (R(2) 0.53 for CF and 0.13 for controls vs. R(2) 0.54 for CF and 0.13 for controls). Scondall was similar in CF and controls but with inferior fitting quality compared to Scondauto and Scondmanual . CONCLUSIONS Automated Scond calculation is feasible and produces robust results comparable to the standard manual way of Scond calculation. This algorithm provides a valid, fast and objective tool for regular use, even in children.
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Affiliation(s)
- Anja Bigler
- University Children's Hospital Bern, Bern, Switzerland
| | - Sophie Yammine
- University Children's Hospital Bern, Bern, Switzerland.,University Children's Hospital Basel, UKBB, Basel, Switzerland
| | - Florian Singer
- University Children's Hospital Bern, Bern, Switzerland.,University Children's Hospital Zurich, Zurich, Switzerland
| | - Thomas Riedel
- University Children's Hospital Bern, Bern, Switzerland
| | - Philipp Latzin
- University Children's Hospital Bern, Bern, Switzerland.,University Children's Hospital Basel, UKBB, Basel, Switzerland
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44
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Sonneveld N, Stanojevic S, Amin R, Aurora P, Davies J, Elborn JS, Horsley A, Latzin P, O'Neill K, Robinson P, Scrase E, Selvadurai H, Subbarao P, Welsh L, Yammine S, Ratjen F. Lung clearance index in cystic fibrosis subjects treated for pulmonary exacerbations. Eur Respir J 2015; 46:1055-64. [PMID: 26160868 DOI: 10.1183/09031936.00211914] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 04/17/2015] [Indexed: 01/25/2023]
Abstract
Pulmonary exacerbations are important clinical events for cystic fibrosis (CF) patients. Studies assessing the ability of the lung clearance index (LCI) to detect treatment response for pulmonary exacerbations have yielded heterogeneous results. Here, we conduct a retrospective analysis of pooled LCI data to assess treatment with intravenous antibiotics for pulmonary exacerbations and to understand factors explaining the heterogeneous response.A systematic literature search was performed to identify prospective observational studies. Factors predicting the relative change in LCI and spirometry were evaluated while adjusting for within-study clustering.Six previously reported studies and one unpublished study, which included 176 pulmonary exacerbations in both paediatric and adult patients, were included. Overall, LCI significantly decreased by 0.40 units (95% CI -0.60- -0.19, p=0.004) or 2.5% following treatment. The relative change in LCI was significantly correlated with the relative change in forced expiratory volume in 1 s (FEV1), but results were discordant in 42.5% of subjects (80 out of 188). Higher (worse) baseline LCI was associated with a greater improvement in LCI (slope: -0.9%, 95% CI -1.0- -0.4%).LCI response to therapy for pulmonary exacerbations is heterogeneous in CF patients; the overall effect size is small and results are often discordant with FEV1.
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Affiliation(s)
- Nicole Sonneveld
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, ON, Canada Both authors contributed equally
| | - Sanja Stanojevic
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, ON, Canada Physiology and Experimental Medicine, Research Institute, Hospital for Sick Children, Toronto, ON, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada Both authors contributed equally
| | - Reshma Amin
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, ON, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | | | - J Stuart Elborn
- Centre for Infection and Immunity, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Alex Horsley
- Institute of Inflammation and Repair, University of Manchester, Manchester, UK
| | - Philipp Latzin
- University Children's Hospital Bern, Bern, Switzerland University Children's Hospital Basel (UKBB), Basel, Switzerland
| | - Katherine O'Neill
- Centre for Infection and Immunity, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Paul Robinson
- Dept of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | | | - Hiran Selvadurai
- Dept of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Padmaja Subbarao
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, ON, Canada Physiology and Experimental Medicine, Research Institute, Hospital for Sick Children, Toronto, ON, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Liam Welsh
- Royal Children's Hospital, Melbourne, Australia Murdoch Children's Research Institute, Melbourne, Australia
| | - Sophie Yammine
- University Children's Hospital Bern, Bern, Switzerland University Children's Hospital Basel (UKBB), Basel, Switzerland
| | - Felix Ratjen
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, ON, Canada Physiology and Experimental Medicine, Research Institute, Hospital for Sick Children, Toronto, ON, Canada Faculty of Medicine, Dept of Paediatrics, University of Toronto, Toronto, ON, Canada
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45
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Francisco B, Ner Z, Ge B, Hewett J, König P. Sensitivity of different spirometric tests for detecting airway obstruction in childhood asthma. J Asthma 2014; 52:505-11. [PMID: 25375906 DOI: 10.3109/02770903.2014.984842] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The objective of this study was to compare different measures of airflow obstruction by spirometry in childhood asthma. The objectives were; (a) to compare sensitivity of large airway tests (FEV1 and PEFR) with tests at low lung volumes (small airways) (FEF25-75, FEF50 and FEF75); (b) compare within each group which individual tests are more sensitive. METHODS This was a retrospective analysis of 2307 spirometry tests performed during outpatient visits on 821 doctor-diagnosed asthma patients aged 6-18. Tests were deemed acceptable if they were acceptable and repeatable by American Thoracic Society (ATS) criteria. RESULTS In mild obstruction, FEV1 detected 6.8% abnormal tests while FEF75 detected 33% (p < 0.0001). In more severe obstruction, the difference was more obvious (FEV1 14.8%; FEF75 71%). Tests at low lung volumes (small airway tests) were also more sensitive than PEFR. Within groups, FEV1 was more sensitive than PEFR in the large airway tests and FEF75 was more sensitive than FEF25-75 and FEF50 among the tests at low lung volumes (small airway tests). The FEV1/FVC ratio correlated more closely with tests at low lung volumes (small airway tests), than with large airway tests. CONCLUSIONS (1) Tests at low lung volumes (small airway tests) are more sensitive than large airway tests; (2) Within groups, the FEV1 is better than PEFR and FEF75 is better than FEF25-75 or FEF50.
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Affiliation(s)
- Benjamin Francisco
- Department of Child Health, University of Missouri-Columbia , Columbia, MO , USA and
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46
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Gustafsson PM, Robinson PD, Gilljam M, Lindblad A, Houltz BK. Slow and fast lung compartments in cystic fibrosis measured by nitrogen multiple-breath washout. J Appl Physiol (1985) 2014; 117:720-9. [DOI: 10.1152/japplphysiol.01274.2013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Imaging studies describe significant ventilation defects across a wide range of cystic fibrosis (CF) related lung disease severity. These are unfortunately poorly reflected by phase III slope analysis–derived Scond and Sacin from multiple-breath washout (MBW). Methodology extending previous two-lung compartment model-based analysis is presented describing size and function of fast- and slow-ventilating lung compartments from nitrogen (N2) MBW and correlation to obstructive lung disease severity. In 37 CF subjects (forced expiratory volume in 1 s [FEV1] mean [SD] 84.8 [19.9] % predicted; abnormal lung clearance index [LCI] in 36/37, range 7.28–18.9) and 74 matched healthy controls, volume and specific ventilation of both fast and slowly ventilated lung compartments were derived from N2-based MBW with commercial equipment. In healthy controls lung emptying was characterized by a large compartment constituting 75.6 (8.4)% of functional residual capacity (FRC) with a specific ventilation (regional alveolar tidal volume/regional lung volume) of 13.9 (3.7)% and a small compartment with high specific ventilation (48.4 [15.7]%). In CF the slowly ventilated lung compartment constituted 51.9(9.1)% of FRC, with low specific ventilation of 5.3 (2.4)%. Specific ventilation of the slowly ventilated lung compartment showed stronger correlation with LCI (r2 = 0.70, P < 0.001) vs. Sacin (r2 = 0.44, P < 0.001) or Scond (no significant correlation). Overventilation of the fast lung compartment was no longer seen in severe CF lung disease. Magnitude and function of under- and overventilated lung volumes can be derived from routine N2 MBW in CF. Reported values agree with previous modelling-derived estimates of impaired ventilation and offer improved correlation to disease severity, compared with SnIII analysis.
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Affiliation(s)
- P. M. Gustafsson
- Department of Pediatrics, Central Hospital, Skövde, Sweden
- The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - P. D. Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Australia
| | - M. Gilljam
- The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Chest Medicine and Allergology, The Sahlgrenska University Hospital, Gothenburg, Sweden
| | - A. Lindblad
- The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Queen Silvia Children's Hospital, Gothenburg, Sweden; and
| | - B. K. Houltz
- The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Physiology, The Sahlgrenska University Hospital/East, Gothenburg, Sweden
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47
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Zwitserloot A, Fuchs SI, Müller C, Bisdorf K, Gappa M. Clinical application of inert gas Multiple Breath Washout in children and adolescents with asthma. Respir Med 2014; 108:1254-9. [PMID: 25127180 DOI: 10.1016/j.rmed.2014.07.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 06/24/2014] [Accepted: 07/03/2014] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Children with asthma often have normal spirometry despite significant disease. The pathology of the small airways in asthma may be assessed using Multiple Breath Washout (MBW) and calculating the Lung Clearance Index (LCI). There are only few studies using MBW in children with asthma and existing data regarding bronchodilator effect are contradictory. The aim of the present pilot study was to compare LCI in asthma and controls and assess the effect of salbutamol in children with asthma on the LCI. METHODS Unselected patients with a diagnosis of asthma visiting the outpatient department of our hospital between 04-2010 and 03-2011 were recruited and compared to a healthy control group. MBW was performed as inert gas MBW using sulfurhexafluorid (SF6) as the tracer gas. Clinical data were documented and spirometry and MBW (EasyOne Pro, MBW module, NDD Switzerland) were performed before and after the use of salbutamol (200-400 μg). Healthy controls performed baseline MBW only. RESULTS 32 children diagnosed with asthma (4.7-17.4 years) and 42 controls (5.3-20.8) were included in the analysis. LCI differed between patients and controls, with a mean LCI (SD) of 6.48 (0.48) and 6.21 (0.38) (P = 0.008). Use of salbutamol had no significant effect on LCI for the group. CONCLUSION These pilot data show that clinically stable asthma patients and controls both have a LCI in the normal range. However, in patients the LCI is significantly higher indicating that MBW may have a role in assessing small airways disease in asthma.
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Affiliation(s)
- Annelies Zwitserloot
- Marien Hospital Wesel, Department of Paediatrics and Research Institute, Germany; Radboud University Medical Centre, Department of Paediatrics, Nijmegen, The Netherlands.
| | - Susanne I Fuchs
- Marien Hospital Wesel, Department of Paediatrics and Research Institute, Germany
| | - Christina Müller
- Marien Hospital Wesel, Department of Paediatrics and Research Institute, Germany
| | - Kornelia Bisdorf
- Marien Hospital Wesel, Department of Paediatrics and Research Institute, Germany
| | - Monika Gappa
- Marien Hospital Wesel, Department of Paediatrics and Research Institute, Germany
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48
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Kraemer R. Ventilation inhomogeneities in patients with cystic fibrosis: which target lung function parameters offer valuable evaluation? Respiration 2014; 87:459-61. [PMID: 24801562 DOI: 10.1159/000362675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Richard Kraemer
- Department of Clinical Research, University of Bern, Bern, Switzerland
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49
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Singer F, Abbas C, Yammine S, Casaulta C, Frey U, Latzin P. Abnormal small airways function in children with mild asthma. Chest 2014; 145:492-499. [PMID: 24091465 DOI: 10.1378/chest.13-0784] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Small airways disease is a hallmark in adults with persistent asthma, but little is known about small airways function in children with mild asthma and normal spirometry. We assessed ventilation heterogeneity, a marker of small airways function, with an easy tidal breath single-breath washout (SBW) technique in school-aged children with mild asthma and normal FEV1 and healthy age-matched control subjects. METHODS The primary outcome was the double-tracer gas phase III slope (SDTG), an index of ventilation heterogeneity in acinar airways derived from the tidal double-tracer gas SBW test. The second outcome was the nitrogen phase III slope (SN2), an index of global ventilation heterogeneity derived from the tidal nitrogen SBW test using pure oxygen. Triplicate SBW and spirometry tests were performed in healthy children (n=35) and children with asthma (n=31) at baseline and in children with asthma after bronchodilation. RESULTS Acinar (SDTG) but not global (SN2) ventilation heterogeneity was significantly increased in asthma despite normal FEV1. Of the 31 children with asthma, abnormal results were found for SDTG (≤-2 z scores) in 11; forced expiratory flow, midexpiratory phase (FEF25%-75%) in three; and FEV1 in zero. After bronchodilation, SDTG, SN2, FEF25%-75%, and FEV1 significantly changed (mean [95% CI] change from baseline, 36% [15%-56%], 38% [18%-58%], 17% [9-25%], and 6% [3%-9%], respectively). CONCLUSIONS Abnormal acinar ventilation heterogeneity in one-third of the children suggests that small airways disease may be present despite rare and mild asthma symptoms and normal spirometry. The easy tidal SBW technique has considerable potential as a clinical and research outcome in children with asthma.
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Affiliation(s)
- Florian Singer
- University Children's Hospital Zurich, Zurich; University Children's Hospital Bern, Bern
| | | | - Sophie Yammine
- University Children's Hospital Bern, Bern; University Children's Hospital Basel, Basel, Switzerland
| | | | - Urs Frey
- University Children's Hospital Zurich, Zurich; University Children's Hospital Basel, Basel, Switzerland
| | - Philipp Latzin
- University Children's Hospital Bern, Bern; University Children's Hospital Basel, Basel, Switzerland.
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50
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Kent L, Reix P, Innes JA, Zielen S, Le Bourgeois M, Braggion C, Lever S, Arets HGM, Brownlee K, Bradley JM, Bayfield K, O'Neill K, Savi D, Bilton D, Lindblad A, Davies JC, Sermet I, De Boeck K. Lung clearance index: evidence for use in clinical trials in cystic fibrosis. J Cyst Fibros 2013; 13:123-38. [PMID: 24315208 DOI: 10.1016/j.jcf.2013.09.005] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 09/10/2013] [Accepted: 09/23/2013] [Indexed: 02/09/2023]
Abstract
The ECFS-CTN Standardisation Committee has undertaken this review of lung clearance index as part of the group's work on evaluation of clinical endpoints with regard to their use in multicentre clinical trials in CF. The aims were 1) to review the literature on reliability, validity and responsiveness of LCI in patients with CF, 2) to gain consensus of the group on feasibility of LCI and 3) to gain consensus on answers to key questions regarding the promotion of LCI to surrogate endpoint status. It was concluded that LCI has an attractive feasibility and clinimetric properties profile and is particularly indicated for multicentre trials in young children with CF and patients with early or mild CF lung disease. This is the first article to collate the literature in this manner and support the use of LCI in clinical trials in CF.
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Affiliation(s)
- L Kent
- Centre for Health and Rehabilitation Technologies (CHaRT), Institute for Nursing and Health Research, University of Ulster, Newtownabbey, UK; Regional Cystic Fibrosis Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - P Reix
- Centre de Référence de la Mucoviscidose, Hospices Civils de Lyon, Lyon, France
| | - J A Innes
- Scottish Adult Cystic Fibrosis Service, Western General Hospital, Edinburgh, UK; Molecular and Clinical Medicine, University of Edinburgh, UK
| | - S Zielen
- Department of Paediatrics, J.W. Goethe-Universität Frankfurt, Germany
| | - M Le Bourgeois
- Centre de Référence de la Mucoviscidose, Hôpital Necker-Enfants Malades, Paris, France
| | - C Braggion
- Cystic Fibrosis Center, Pediatric Department, Meyer Children's Hospital, Florence, Italy
| | - S Lever
- Erasmus MC, Rotterdam, The Netherlands
| | - H G M Arets
- Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - K Brownlee
- Children's Cystic Fibrosis Centre, Leeds Teaching Hospitals, Leeds, UK
| | - J M Bradley
- Centre for Health and Rehabilitation Technologies (CHaRT), Institute for Nursing and Health Research, University of Ulster, Newtownabbey, UK; Regional Cystic Fibrosis Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - K Bayfield
- Department of Gene Therapy, Imperial College London, UK
| | - K O'Neill
- Centre for Infection and Immunity, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, UK
| | - D Savi
- Department of Pediatrics and Pediatric Neurology, Cystic Fibrosis Center, Sapienza University of Rome, Italy
| | - D Bilton
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - A Lindblad
- Gothenburg CF Centre, Queen Silvia Children's Hospital, Göteborg, Sweden
| | - J C Davies
- Department of Gene Therapy, Imperial College London, UK; Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - I Sermet
- Centre de Référence de la Mucoviscidose, Hôpital Necker-Enfants Malades, Paris, France; Université Paris Descartes, Paris, France
| | - K De Boeck
- Pediatric Pulmonology, University Hospitals Leuven and KU Leuven, Leuven, Belgium.
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