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Rutkove SB, McIlduff CE, Stommel E, Levy S, Smith C, Gutierrez H, Verga S, Samaan S, Yator C, Nanda A, Pastel L, Doussan A, Phipps K, Murphy E, Halter R. Assessing pulmonary function in ALS using electrical impedance tomography. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:581-588. [PMID: 38576194 PMCID: PMC11269030 DOI: 10.1080/21678421.2024.2334075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/14/2024] [Accepted: 03/18/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE We sought to determine whether thoracic electrical impedance tomography (EIT) could characterize pulmonary function in amyotrophic lateral sclerosis (ALS) patients, including those with facial weakness. Thoracic EIT is a noninvasive, technology in which a multi-electrode belt is placed across the chest, producing real-time impedance imaging of the chest during breathing. METHODS We enrolled 32 ALS patients and 32 age- and sex-matched healthy controls (HCs) without underlying lung disease. All participants had EIT measurements performed simultaneously with standard pulmonary function tests (PFTs), including slow and forced vital capacity (SVC and FVC) in upright and supine positions and maximal inspiratory and expiratory pressures (MIPs and MEPs, respectively). Intraclass correlation coefficients (ICCs) were calculated to assess the immediate reproducibility of EIT measurements and Pearson's correlations were used to explore the relationships between EIT and PFT values. RESULTS Data from 30 ALS patients and 27 HCs were analyzed. Immediate upright SVC reproducibility was very high (ICC 0.98). Correlations were generally strongest between EIT and spirometry measures, with R values ranging from 0.64 to 0.82 (p < 0.001) in the ALS cohort. There were less robust correlations between EIT values and both MIPs and MEPs in the ALS patients, with R values ranging from 0.33 to 0.44. There was no significant difference for patients with and without facial weakness. There were no reported adverse events. CONCLUSION EIT-based pulmonary measures hold the promise of providing an alternative approach for lung function assessment in ALS patients. Based on these early results, further development and study of this technology are warranted.
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Affiliation(s)
- Seward B. Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Courtney E. McIlduff
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Elijah Stommel
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Sean Levy
- Department of Medicine, Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Christy Smith
- Department of Medicine, Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Hilda Gutierrez
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sarah Verga
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Soleil Samaan
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Chebet Yator
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ajitesh Nanda
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Lisa Pastel
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Allaire Doussan
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Kathy Phipps
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Ethan Murphy
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Ryan Halter
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
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Lopes Vieira J, Miskovic A, Abel F. Interpretation of pulmonary function tests in children. BJA Educ 2023; 23:425-431. [PMID: 37876760 PMCID: PMC10591135 DOI: 10.1016/j.bjae.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 07/05/2023] [Accepted: 07/20/2023] [Indexed: 10/26/2023] Open
Affiliation(s)
- J.F. Lopes Vieira
- Chelsea and Westminster Hospital, London, UK
- Greate Ormond Stree Hospital, London, UK
| | | | - F. Abel
- Greate Ormond Stree Hospital, London, UK
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Hnaini M, Downs M, Miller MR, Campbell C, St-Laurent A. Duchenne muscular dystrophy respiratory profiles from real world registry data. Pediatr Pulmonol 2023; 58:2725-2732. [PMID: 37539841 DOI: 10.1002/ppul.26554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 05/16/2023] [Accepted: 06/03/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Understanding real-world profiles from neuromuscular databases is helpful for optimizing clinical care and planning research studies. The Canadian Neuromuscular Disease Registry (CNDR) has respiratory data from a population of boys with Duchenne Muscular Dystrophy (DMD). OBJECTIVES To describe cross-sectional respiratory profiles from a national DMD real-world dataset. To explore the relationship between forced vital capacity percent predicted (FVC%) and disease severity parameters: scoliosis, ambulation and ventilation status. METHODS Descriptive statistics summarized the respiratory profiles. The CNDR registry enrolls and collects DMD clinic data from 36 Canadian centers. RESULTS There were 414 participants enrolled. The age ranged from 2 to 36 years old. Pulmonary function test data were available for 323 participants. The use of ventilatory support was seen in a significant proportion (19.5%) of subjects by age 14-16 years and was used by the majority (69.2%) by age 20-22 years. FVC% declined at a rate of 3.19% per year with every 1-year increase in age. FVC% declined annually by 2.47% in nonambulatory participants versus by 0.96% in ambulatory participants. FVC% did not significantly change over age with the presence of scoliosis or use of ventilatory technology. CONCLUSIONS The data from this large cohort are valuable for understanding real-world patterns of clinical care and disease progression. There is a significant association between the loss of ambulation and the rate of FVC% decline. Further longitudinal studies are needed to better understand the impact of disease parameters on pulmonary function decline and the need for ventilatory support.
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Affiliation(s)
- Mona Hnaini
- Department of Pediatrics, Schulich School of Medicine & Dentistry Western University, London, Ontario, Canada
| | - Matt Downs
- Department of Pediatrics, Children's Hospital London Health Sciences Centre, London, Ontario, Canada
| | - Michael R Miller
- Division of Children's Health & Therapeutics, Department of Pediatrics, Children's Health Research Institute, Western University, London, Ontario, Canada
| | - Craig Campbell
- Department of Pediatrics, Schulich School of Medicine & Dentistry Western University, London, Ontario, Canada
- Department of Pediatrics, Children's Hospital London Health Sciences Centre, London, Ontario, Canada
- Division of Children's Health & Therapeutics, Department of Pediatrics, Children's Health Research Institute, Western University, London, Ontario, Canada
| | - Aaron St-Laurent
- Department of Pediatrics, Schulich School of Medicine & Dentistry Western University, London, Ontario, Canada
- Department of Pediatrics, Children's Hospital London Health Sciences Centre, London, Ontario, Canada
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Leon-Astudillo C, Okorie CUA, McCown MY, Dy FJ, Puranik S, Prero M, ElMallah MK, Treat L, Gross JE. ATS Core Curriculum 2022. Pediatric Pulmonary Medicine: Updates in pediatric neuromuscular disease. Pediatr Pulmonol 2023. [PMID: 37144867 DOI: 10.1002/ppul.26448] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/23/2023] [Indexed: 05/06/2023]
Abstract
The American Thoracic Society Core Curriculum updates clinicians annually in pediatric pulmonary disease. This is a concise review of the Pediatric Pulmonary Medicine Core Curriculum presented at the 2022 American Thoracic Society International Conference. Neuromuscular diseases (NMD) comprise a variety of conditions that commonly affect the respiratory system and cause significant morbidity including dysphagia, chronic respiratory failure, and sleep disordered breathing. Respiratory failure is the most common cause of mortality in this population. Substantial progress has been made in diagnosis, monitoring and treatment for NMD over the last decade. Pulmonary function testing (PFT) is utilized to objectively measure respiratory pump function and PFT milestones are utilized in NMD-specific pulmonary care guidelines. New disease modifying therapies are approved for the treatment of patients with Duchenne muscular dystrophy and spinal muscular atrophy (SMA), including the first ever approved systemic gene therapy, in the case of SMA. Despite extraordinary progress in the medical management of NMD, little is known regarding the respiratory implications and long-term outcomes for patients in the era of advanced therapeutics and precision medicine. The combination of technological and biomedical advancements has increased the complexity of the medical decision-making process for patients and families, thus emphasizing the importance of balancing respect for autonomy with the other foundational principles of medical ethics. This review features an overview of PFT, noninvasive ventilation strategies, novel and developing therapies, as well as the ethical considerations specific to the management of patients with pediatric NMD.
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Affiliation(s)
| | - Caroline U A Okorie
- Department of Pediatrics, Stanford Children's Health, Stanford, California, USA
| | - Michael Y McCown
- Department of Pediatrics, Inova Children's Hospital, Fairfax, Virginia, USA
| | - Fei J Dy
- Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Sandeep Puranik
- Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Moshe Prero
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Mai K ElMallah
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Lauren Treat
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jane E Gross
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Departments of Pediatrics and Medicine, National Jewish Health, Denver, Colorado, USA
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Alves RMR, Van Der Linden V, de Andrade LB. Comprehensive assessment model for patients with spinal muscular atrophy: proposal of tools for clinical practice and real-world studies. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:377-379. [PMID: 36820780 PMCID: PMC10004283 DOI: 10.1590/1806-9282.20221608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 12/15/2022] [Indexed: 02/22/2023]
Affiliation(s)
- Renalli Manuella Rodrigues Alves
- Instituto de Medicina Integral Professor Fernando Figueira, Pós-graduação em Saúde Integral – Recife (PE), Brazil
- Hospital Otávio de Freitas, Departamento de Reabilitação – Recife (PE), Brazil
- Corresponding author:
| | - Vanessa Van Der Linden
- Hospital Maria Lucinda/Raros, Serviço de Doenças Raras – Recife (PE), Brazil
- Universidade Federal de Pernambuco, Centro de Ciências da Saúde – Recife (PE), Brazil
| | - Lívia Barbosa de Andrade
- Instituto de Medicina Integral Professor Fernando Figueira, Pós-graduação em Saúde Integral – Recife (PE), Brazil
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Patel N, Chong K, Baydur A. Methods and Applications in Respiratory Physiology: Respiratory Mechanics, Drive and Muscle Function in Neuromuscular and Chest Wall Disorders. Front Physiol 2022; 13:838414. [PMID: 35774289 PMCID: PMC9237333 DOI: 10.3389/fphys.2022.838414] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
Individuals with neuromuscular and chest wall disorders experience respiratory muscle weakness, reduced lung volume and increases in respiratory elastance and resistance which lead to increase in work of breathing, impaired gas exchange and respiratory pump failure. Recently developed methods to assess respiratory muscle weakness, mechanics and movement supplement traditionally employed spirometry and methods to evaluate gas exchange. These include recording postural change in vital capacity, respiratory pressures (mouth and sniff), electromyography and ultrasound evaluation of diaphragmatic thickness and excursions. In this review, we highlight key aspects of the pathophysiology of these conditions as they impact the patient and describe measures to evaluate respiratory dysfunction. We discuss potential areas of physiologic investigation in the evaluation of respiratory aspects of these disorders.
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