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Gambazza S, Mariani A, Guarise R, Ferrari B, Carta F, Brivio A, Bizzarri S, Castellani C, Colombo C, Laquintana D. Short-term effects of positive expiratory pressure mask on ventilation inhomogeneity in children with cystic fibrosis: A randomized, sham-controlled crossover study. Pediatr Pulmonol 2024; 59:1354-1363. [PMID: 38362833 DOI: 10.1002/ppul.26915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 12/23/2023] [Accepted: 01/31/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Can physiotherapy with a positive expiratory pressure (PEP) mask improve peripheral ventilation inhomogeneity, a typical feature of children with cystic fibrosis (cwCF)? To answer this question, we used the nitrogen multiple-breath washout (N2MBW) test to measure diffusion-convection-dependent inhomogeneity arising within the intracinar compartment (Sacin*VT). METHODS For this randomized, sham-controlled crossover trial, two N2MBW tests were performed near the hospital discharge date: one before and the other after PEP mask therapy (1 min of breathing through a flow-dependent PEP device attached to a face mask, followed by three huffs and one cough repeated 10 times) by either a standard (10-15 cmH20) or a sham (<5 cmH20) procedure on two consecutive mornings. Deception entailed misinforming the subjects about the nature of the study; also the N2MBW operators were blinded to treatment allocation. Study outcomes were assessed with mixed-effect models. RESULTS The study sample was 19 cwCF (ten girls), aged 11.4 (2.7) years. The adjusted Sacin*VT mean difference between the standard and the sham procedure was -0.015 (90% confidence interval [CI]: -∞ to 0.025) L-1. There was no statistically significant difference in Scond*VT and lung clearance index between the two procedures: -0.005 (95% CI: -0.019 to 0.01) L-1 and 0.49 (95% CI: -0.05 to 1.03) turnovers, respectively. CONCLUSION Our findings do not support evidence for an immediate effect of PEP mask physiotherapy on Sacin*VT with pressure range 10-15 cmH20. Measurement with the N2MBW and the crossover design were found to be time-consuming and unsuitable for a short-term study of airway clearance techniques.
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Affiliation(s)
- Simone Gambazza
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Mariani
- Cystic Fibrosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo Guarise
- Cystic Fibrosis Centre, University Hospital of Verona, Verona, Italy
| | - Beatrice Ferrari
- Rehabilitation Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Federica Carta
- Cystic Fibrosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Brivio
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sofia Bizzarri
- Rehabilitation Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Chiara Castellani
- Rehabilitation Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Carla Colombo
- Cystic Fibrosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Dario Laquintana
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Kentgens AC, Kurz JM, Mozun R, Usemann J, Pedersen ESL, Kuehni CE, Latzin P, Moeller A, Singer F. Evaluation of the Double-Tracer Gas Single-Breath Washout Test in a Pediatric Field Study. Chest 2024; 165:396-404. [PMID: 37716474 PMCID: PMC10851274 DOI: 10.1016/j.chest.2023.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND The early life origins of chronic pulmonary diseases are thought to arise in peripheral small airways. Predictors of ventilation inhomogeneity, a proxy of peripheral airway function, are understudied in schoolchildren. RESEARCH QUESTION Is the double-tracer gas single-breath washout (DTG-SBW) measurement feasible in a pediatric field study setting? What are the predictors of the DTG-SBW-derived ventilation inhomogeneity estimate in unselected schoolchildren? STUDY DESIGN AND METHODS In this prospective cross-sectional field study, a mobile lung function testing unit visited participating schools in Switzerland. We applied DTG-SBW, fraction of exhaled nitric oxide (Feno), and spirometry measurements. The DTG-SBW is based on tidal inhalation of helium and sulfur-hexafluoride, and the phase III slope (SIIIHe-SF6) is derived. We assessed feasibility, repeatability, and associations of SIIIHe-SF6 with the potential predictors of anthropometrics, presence of wheeze (ie, parental report of one or more episode of wheeze in the prior year), Feno, FEV1, and FEV1/FVC. RESULTS In 1,782 children, 5,223 DTG-SBW trials were obtained. The DTG-SBW was acceptable in 1,449 children (81.3%); the coefficient of variation was 39.8%. SIIIHe-SF6 was independently but weakly positively associated with age and BMI. In 276 children (21.2%), wheeze was reported. SIIIHe-SF6 was higher by 0.049 g.mol.L-1 in children with wheeze compared with those without and remained associated with wheeze after adjusting for age and BMI in a multivariable linear regression model. SIIIHe-SF6 was not associated with Feno, FEV1, and FEV1/FVC. INTERPRETATION The DTG-SBW is feasible in a pediatric field study setting. On the population level, age, body composition, and wheeze are independent predictors of peripheral airway function in unselected schoolchildren. The variation of the DTG-SBW possibly constrains its current applicability on the individual level. TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT03659838; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Anne-Christianne Kentgens
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Johanna M Kurz
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Rebeca Mozun
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Department of Intensive Care and Neonatology and Children's Research Center, University Children`s Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jakob Usemann
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Respiratory Medicine, University Children`s Hospital Zurich, University of Zurich, Zurich, Switzerland; University Children's Hospital Basel (UKBB), Basel, Switzerland
| | - Eva S L Pedersen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Claudia E Kuehni
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Philipp Latzin
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alexander Moeller
- Department of Respiratory Medicine, University Children`s Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Florian Singer
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Respiratory Medicine, University Children`s Hospital Zurich, University of Zurich, Zurich, Switzerland; Division of Pediatric Pulmonology and Allergology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.
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Casaulta C, Messerli F, Rodriguez R, Klein A, Riedel T. Changes in ventilation distribution in children with neuromuscular disease using the insufflator/exsufflator technique: an observational study. Sci Rep 2022; 12:7009. [PMID: 35488044 PMCID: PMC9054802 DOI: 10.1038/s41598-022-11190-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 04/18/2022] [Indexed: 11/24/2022] Open
Abstract
Patients with neuromuscular disease often suffer from weak and ineffective cough resulting in mucus retention and increased risk for chest infections. Different airway clearance techniques have been proposed, one of them being the insufflator/exsufflator technique. So far, the immediate physiological effects of the insufflator/exsufflator technique on ventilation distribution and lung volumes are not known. We aimed to describe the immediate effects of the insufflator/exsufflator technique on different lung volumes, forced flows and ventilation distribution. Eight subjects (age 5.8–15.2 years) performed lung function tests including spirometry, multiple breath washout and electrical impedance tomography before and after a regular a chest physiotherapy session with an insufflator/exsufflator device. Forced lung volumes and flows as well as parameters of ventilation distribution derived from multiple breath washout and electrical impedance tomography were compared to assess the short-term effect of the therapy. In this small group of stable paediatric subjects with neuromuscular disease we could not demonstrate any short-term effects of insufflation/exsufflation manoeuvres on lung volumes, expiratory flows and ventilation distribution. With the currently used protocol of the insufflation/exsufflation manoeuvre, we cannot demonstrate any immediate changes in lung function.
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Affiliation(s)
- Carmen Casaulta
- Division of Paediatric Pulmonology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010, Bern, Switzerland.,Division of Paediatric Intensive Care, Department of Paediatrics, Inselspital, Bern University Hospital, Univeristy of Bern, Freiburgstrasse 15, 3010, Bern, Switzerland
| | - Florence Messerli
- Division of Paediatric Pulmonology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010, Bern, Switzerland
| | - Romy Rodriguez
- Division of Paediatric Pulmonology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010, Bern, Switzerland
| | - Andrea Klein
- Division of Paediatric Neurology, Department of Paediatrics, Inselspital, Bern University Hospital, Univeristy of Bern, Freiburgstrasse 15, 3010, Bern, Switzerland.,Paediatric Neurology, University Childrens Hospital Basel, UKBB, University of Basel, Spitalstrasse 33, 4056, Basel, Switzerland
| | - Thomas Riedel
- Division of Paediatric Intensive Care, Department of Paediatrics, Inselspital, Bern University Hospital, Univeristy of Bern, Freiburgstrasse 15, 3010, Bern, Switzerland. .,Department of Paediatrics, Cantonal Hospital Graubuenden, Loestrasse 170, 7000, Chur, Switzerland.
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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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Lauwers E, Ides K, Van Hoorenbeeck K, Verhulst S. Outcome measures for airway clearance techniques in children with chronic obstructive lung diseases: a systematic review. Respir Res 2020; 21:217. [PMID: 32807200 PMCID: PMC7433087 DOI: 10.1186/s12931-020-01484-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/11/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Airway clearance techniques (ACTs) are an important aspect of the treatment of children with chronic obstructive lung diseases. Unfortunately, a sound evidence base is lacking and airway clearance strategies are largely based on clinical expertise. One of the reasons for the limited evidence is the lack of appropriate outcome measures specifically related to the effectiveness of ACTs. This review discusses all outcome measures applied in previous research in the pediatric population to provide a baseline for future studies. DATA SOURCES A systematic literature search was performed in PubMed, Web of Science and EMBASE databases. Search terms included chronic obstructive lung diseases and ACTs. STUDY SELECTION Studies were independently selected by the investigators according to the eligibility criteria. After screening, 49 articles remained for further analysis. RESULTS AND CONCLUSIONS Data are summarized according to the type of outcome measure. 48 (98%) studies performed pulmonary function tests, 19 (39%) assessed expectorated sputum, 10 (20%) parameters related to disease exacerbation, 8 (16%) oxygenation, 8 (16%) patient-reported outcomes, 5 (10%) exercise capacity and 5 (10%) applied imaging techniques. The synthesis of results showed a high discrepancy between studies due to differences in study design, population and the application of techniques. Since no 'gold standard' method could be identified, a combination of different outcome measures is recommended to gain a better understanding and to identify the potential effects of ACTs. An overview of important considerations has been provided to assist researchers in their choice of outcomes in future studies.
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Affiliation(s)
- Eline Lauwers
- Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2160 Wilrijk, Antwerp, Belgium.
- Infla-Med Research Consortium of Excellence, University of Antwerp, Antwerp, Belgium.
| | - Kris Ides
- Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2160 Wilrijk, Antwerp, Belgium
- Infla-Med Research Consortium of Excellence, University of Antwerp, Antwerp, Belgium
| | - Kim Van Hoorenbeeck
- Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2160 Wilrijk, Antwerp, Belgium
- Infla-Med Research Consortium of Excellence, University of Antwerp, Antwerp, Belgium
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Stijn Verhulst
- Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2160 Wilrijk, Antwerp, Belgium
- Infla-Med Research Consortium of Excellence, University of Antwerp, Antwerp, Belgium
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
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O'Neill K, Elborn JS, Tunney MM, O'Neill P, Rowan S, Martin S, Bradley JM. Training in multiple breath washout testing for respiratory physiotherapists. Physiotherapy 2017; 104:61-66. [PMID: 28822601 DOI: 10.1016/j.physio.2017.04.003] [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: 07/26/2016] [Accepted: 04/13/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The development of multiple breath washout (MBW) testing in respiratory disease highlights the need for increased awareness amongst respiratory physiotherapists and a potential opportunity for professional development in the use of an important outcome measure for clinical trials. OBJECTIVES To rationalise how MBW may be a useful assessment tool for respiratory physiotherapists and to describe a local MBW training and certification programme for physiotherapists. RESULTS The respiratory Multidisciplinary Team in the Belfast Health and Social Care Trust (BHSCT) identified a need for MBW testing to be available to facilitate clinical research and assessment. A 2day training programme consisting of prereading preparation, self-directed learning, theory presentations, practical demonstrations and hands-on practice was developed and delivered. All participants underwent a certification process. CONCLUSION We have demonstrated the successful training and certification of clinical and research physiotherapists and encourage other respiratory physiotherapists to consider MBW test training.
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Affiliation(s)
- Katherine O'Neill
- Centre for Experimental Medicine, Queen's University Belfast, United Kingdom.
| | - J Stuart Elborn
- Centre for Experimental Medicine, Queen's University Belfast, United Kingdom
| | | | - Philip O'Neill
- Office for Digital Learning, Ulster University, United Kingdom
| | - Stephen Rowan
- South Eastern Health and Social Care Trust, United Kingdom
| | - Susan Martin
- Northern Ireland Clinical Trials Unit, Belfast Health and Social Care Trust, United Kingdom
| | - Judy M Bradley
- Northern Ireland Clinical Research Facility, Queen's University Belfast, United Kingdom
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Grosse-Onnebrink J, Mellies U, Olivier M, Werner C, Stehling F. Chest physiotherapy can affect the lung clearance index in cystic fibrosis patients. Pediatr Pulmonol 2017; 52:625-631. [PMID: 28125158 DOI: 10.1002/ppul.23670] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 11/12/2016] [Accepted: 12/28/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The lung clearance index (LCI) is determined by multiple-breath washout lung function (MBW). It is increasingly used as an endpoint in clinical trials. Chest physiotherapy (CP) is part of routine cystic fibrosis (CF) care. Whether the LCI is useful in detecting short-term treatment effects of CP has not been sufficiently investigated. We assessed the short-term influence of CP with highly standardized high-frequency chest wall oscillation (HFCWO) on the LCI in CF patients. METHODS In this randomized controlled study, the LCI was obtained in 20 CF patients (7-34 years) hospitalized for infective pulmonary exacerbation prior to and immediately after a single treatment of HFCWO. Twenty-one control group CF patients (7-51 years) received no treatment. We calculated the coefficient of repeatability (CR) to estimate the clinical relevance of possible treatment effects. RESULTS HFCWO improved (ie, decreased) the LCI by a median of 0.9 (range -0.45; 3.47; P = 0.002); the LCI decreased in 15 of 20 intervention group patients. In five patients the decrease in LCI exceeded the CR (2.15), indicating a clinically relevant treatment effect; in five patients the LCI increased but did not exceed the CR. The LCI did not change significantly in the control group patients. CONCLUSIONS HFCWO can have a short-term decreasing effect on the LCI, but the treatment response is heterogeneous. In future trials using LCI as an endpoint, the timing of CP in relation to MBW should be considered a possible bias.
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Affiliation(s)
- Joerg Grosse-Onnebrink
- Department of General Pediatrics, Pediatric Respiratory Medicine Unit, University Children's Hospital Muenster, Muenster, Germany
| | - Uwe Mellies
- Department of Pediatric Pulmonology, University of Duisburg-Essen, Children's Hospital, Essen, Germany
| | - Margarete Olivier
- Department of Pediatric Pulmonology, University of Duisburg-Essen, Children's Hospital, Essen, Germany
| | - Claudius Werner
- Department of General Pediatrics, Pediatric Respiratory Medicine Unit, University Children's Hospital Muenster, Muenster, Germany
| | - Florian Stehling
- Department of Pediatric Pulmonology, University of Duisburg-Essen, Children's Hospital, Essen, Germany
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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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Nyilas S, Schlegtendal A, Singer F, Goutaki M, Kuehni CE, Casaulta C, Latzin P, Koerner-Rettberg C. Alternative inert gas washout outcomes in patients with primary ciliary dyskinesia. Eur Respir J 2017; 49:49/1/1600466. [DOI: 10.1183/13993003.00466-2016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The lung clearance index (LCI) derived from a nitrogen multiple breath washout test (N2-MBW) is a promising tool to assess small airways disease in primary ciliary dyskinesia, but it is difficult to apply in routine clinical settings because of its long measuring time. In this study, we aimed to assess alternative indices derived from shorter washout protocols.49 patients with primary ciliary dyskinesia (mean age 14.7±6.6 years) and 37 controls (mean age 14.3±1.4 years) performed N2-MBW and double-tracer gas (DTG) single-breath washout tests. Global (LCI and moment ratio (M2/M0)), conductive (Scond) and acinar ventilation inhomogeneity (DTG Slope III (SIII-DTG)) were determined for each individual. The main outcomes were 1) the ability to detect abnormal lung function from washout indices (>1.64 z-scores) and 2) measurement duration.The prevalence of abnormal values for LCI2.5% was 37 out of 47 (79%), for LCI5% was 34 out of 47 (72%), for M2/M0 was 34 out of 47 (72%), for Scond was 36 out of 46 (78%) and for SIII-DTG was 12 out of 35 (34%). Mean±sd duration of measurement was 19.8±11.2 min for LCI2.5%, 10.8±4.6 min for LCI5% and 8.6±2.3 min for Scond.Compared to standard LCI2.5%, ventilation inhomogeneity was detected by LCI5%, moment ratio and Scond with comparable sensitivity while measurement duration was significantly shorter. Longitudinal studies will show which outcome is most suitable and practical in terms of sensitivity, duration and variability within the course of primary ciliary dyskinesia lung disease.
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Boeck L, Gensmer A, Nyilas S, Stieltjes B, Re TJ, Tamm M, Latzin P, Stolz D. Single-Breath Washout Tests to Assess Small Airway Disease in COPD. Chest 2016; 150:1091-1100. [DOI: 10.1016/j.chest.2016.05.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 04/18/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022] Open
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Short-term effects of physiotherapy on ventilation inhomogeneity in cystic fibrosis patients with a wide range of lung disease severity. J Cyst Fibros 2015; 14:627-31. [DOI: 10.1016/j.jcf.2014.12.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 12/29/2014] [Accepted: 12/30/2014] [Indexed: 01/10/2023]
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13
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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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Latzin P, Thompson B. Double tracer gas single-breath washout: promising for clinics or just a toy for research? Eur Respir J 2014; 44:1113-5. [DOI: 10.1183/09031936.00111114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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15
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Husemann K, Berg N, Engel J, Port J, Joppek C, Tao Z, Singer F, Schulz H, Kohlhäufl M. Double tracer gas single-breath washout: reproducibility in healthy subjects and COPD. Eur Respir J 2014; 44:1210-22. [PMID: 25102960 DOI: 10.1183/09031936.00085713] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The applicability and interpretation of inert tracer gas washout tests is hampered by the lack of feasible protocols and reproducibility data. We assessed feasibility, variability and reproducibility of a new easy to perform double tracer gas (DTG) single-breath washout (SBW) test and compared this with conventional nitrogen washouts. In 40 healthy nonsmokers and 20 patients with stable chronic obstructive pulmonary disease (COPD), we performed three N2 vital capacity SBWs, three N2 multiple-breath washouts and three tidal DTG-SBW tests. Follow-up was after 1 week, 1 month and 6 months. Main outcomes were the lung clearance index (LCI) (N2 multiple-breath washout), slope of phase III (dN2) (N2 vital capacity SBW) and slope of phase III (SIIIDTG) (DTG-SBW). In healthy subjects, mean±sd LCI at baseline was 6.94±0.61, dN2 0.99±0.42% N2 per litre and SIIIDTG -0.206±0.108 g·mol(-1)·L(-1). In COPD, LCI and dN2 were significantly higher (LCI 12.23±2.67, dN2 7.43±5.38% N2 per litre; p<0.001) and SIIIDTG significantly steeper (-0.653±0.428 g·mol(-1)·L(-1), p<0.001). Reproducibility was high for main outcome parameters: the intraclass correlation coefficient over 6 months was 0.77 (0.86 in COPD) for LCI, 0.82 (0.89) for dN2 and 0.83 (0.93) for SIIIDTG. The tidal DTG-SBW is a reproducible test in healthy and COPD subjects that seems attractive for use in routine clinical settings.
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Affiliation(s)
- Kim Husemann
- Klinik Schillerhöhe, Center for Respiratory Medicine and Thoracic Surgery, Robert-Bosch-Krankenhaus-GmbH, Stuttgart, Germany
| | - Nina Berg
- Klinik Schillerhöhe, Center for Respiratory Medicine and Thoracic Surgery, Robert-Bosch-Krankenhaus-GmbH, Stuttgart, Germany
| | - Jennifer Engel
- Klinik Schillerhöhe, Center for Respiratory Medicine and Thoracic Surgery, Robert-Bosch-Krankenhaus-GmbH, Stuttgart, Germany
| | - Johannes Port
- University of Stuttgart, Dept of Biomedical Engineering, Stuttgart, Germany
| | - Christoph Joppek
- University of Stuttgart, Dept of Biomedical Engineering, Stuttgart, Germany
| | - Ziran Tao
- University of Stuttgart, Dept of Biomedical Engineering, Stuttgart, Germany
| | | | - Holger Schulz
- Helmholtz Zentrum Munich, Institute of Epidemiology I, Neuherberg, Germany
| | - Martin Kohlhäufl
- Klinik Schillerhöhe, Center for Respiratory Medicine and Thoracic Surgery, Robert-Bosch-Krankenhaus-GmbH, Stuttgart, Germany
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Vanderhelst E, De Meirleir L, Schuermans D, Malfroot A, Vincken W, Verbanck S. Evidence of an Acinar Response following Treatment for Exacerbation in Adult Patients with Cystic Fibrosis. Respiration 2014; 87:492-8. [DOI: 10.1159/000360772] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 02/17/2014] [Indexed: 11/19/2022] Open
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17
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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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18
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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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