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Meißner M, Steinke E, Wielpütz MO, Joachim C, Sommerburg O, Mall MA, Stahl M. Impact of Reanalysis of Nitrogen Multiple-Breath Washout on its Relationship with Chest Magnetic Resonance Imaging Findings in Clinically Stable and Pulmonary Exacerbated Children with Cystic Fibrosis. KLINISCHE PADIATRIE 2024; 236:106-115. [PMID: 38109903 DOI: 10.1055/a-2214-7217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
RATIONALE Multiple-breath washout (MBW)-derived lung clearance index (LCI) detects lung disease in children with cystic fibrosis (CF). Correction of a cross-talk error in the software of the MBW device Exhalyzer D in a new software version has generated significant interest regarding its impact on previous MBW findings. Since LCI and chest magnetic resonance imaging (MRI) correlated before in CF children, this study aims to reassess previous MBW data after correction. PATIENTS/METHODS Reanalysis of the main findings from a previously published study comparing MBW and MRI in a pediatric CF cohort by reassessment of nitrogen (N2) MBW of 61 stable children with CF, 75 age-matched healthy controls (HC), and 15 CF children with pulmonary exacerbation (PEx) in the corrected software version. RESULTS The corrected LCI (N2LCIcor) decreased in the entire cohort (-17.0 (11.2)%), HC (-8.5 (8.2)%), stable CF children (-22.2 (11.1)%), and within the PEx group at baseline, at PEx and after antibiotic therapy (-21.5 (7.3)%; -22.5 (6.1)%; -21.4 (6.6)%; all P<0.01). N2LCIcor and N2LCIpre correlated with chest MRI scores in stable CF (r=0.70 to 0.84; all P<0.01) without a significant difference between N2LCIcor and N2LCIpre. Change in LCI from baseline to PEx and from PEx to after therapy decreased from N2LCIpre to N2LCIcor, but these changes remained significant (all P=0.001). DISCUSSION/CONCLUSIONS Our results indicate that N2LCIcor is significantly lower than N2LCIpre, but key results published in the original study demonstrating N2MBW and MRI as complementary methods for clinical surveillance in children with CF remain unaffected.
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Affiliation(s)
- Maria Meißner
- Dept. of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Eva Steinke
- Dept. of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
- associated partner site, German Center for Lung Research (DZL), Berlin, Germany
- Berlin Institute of Health (BIH) at Charité, Berlin Institute of Health (BIH) at Charité, Berlin, Germany
| | - Mark Oliver Wielpütz
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Cornelia Joachim
- Department of Pediatrics, Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, University of Heidelberg, Heidelberg, Germany
| | - Olaf Sommerburg
- Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Pediatrics, Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, University of Heidelberg, Heidelberg, Germany
| | - Marcus Alexander Mall
- Dept. of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
- associated partner site, German Center for Lung Research (DZL), Berlin, Germany
- Berlin Institute of Health (BIH) at Charité, Berlin Institute of Health (BIH) at Charité, Berlin, Germany
| | - Mirjam Stahl
- Dept. of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
- associated partner site, German Center for Lung Research (DZL), Berlin, Germany
- Berlin Institute of Health (BIH) at Charité, Berlin Institute of Health (BIH) at Charité, Berlin, Germany
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Steinke E, Wielpütz MO, Joachim C, Mall MA, Stahl M. Reanalysis of N 2-lung clearance index and the comparison to SF 6-lung clearance index and magnetic resonance imaging. J Cyst Fibros 2024; 23:150-154. [PMID: 37321911 DOI: 10.1016/j.jcf.2023.05.006] [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: 02/27/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 06/17/2023]
Abstract
Since the finding and correction of an error in previous spiroware software versions commonly used with the Exhalyzer D for multiple-breath washout (MBW) analysis, there has been an ongoing discussion about its impact on MBW results. In this study, we reanalyzed previously published findings with the corrected spiroware version 3.3.1. In total, 31 infants and preschool children with cystic fibrosis (CF) (mean age 2.3 ± 0.8 years) and 20 healthy controls (mean age 2.3 ± 1.1 years) underwent consecutive sulfure hexafluoride (SF6)- and nitrogen (N2)-MBW. In addition, children with CF underwent chest magnetic resonance imaging (MRI) on the same day. After reanalysis of MBW data, the corrected N2-lung clearance index (LCI) decreased by 10-15% in both groups (P = 0.001) but remained significantly higher than the SF6-LCI (P<0.01). Diagnostic agreement between the MBW results remained moderate with a persistent correlation between SF6- and N2-MBW. The corrected upper limit of normal of the N2-LCI changed classification of nine children with CF, eight of which were within the normal range after correction. The correlation between the different LCI values and the chest MRI scores remained significant with strongest correlation with the MRI perfusion score. Consequently, the corrected N2-LCI is significantly lower than the previous N2-LCI, but key results published before are not affected by the reanalysis.
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Affiliation(s)
- Eva Steinke
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany; German Center for Lung Research (DZL), associated partner site, Berlin, Germany; Berlin Institute of Health (BIH) at Charité, Berlin, Germany
| | - Mark O Wielpütz
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany; Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Cornelia Joachim
- Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Department of Pediatrics, University of Heidelberg, Heidelberg, Germany
| | - Marcus A Mall
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany; German Center for Lung Research (DZL), associated partner site, Berlin, Germany; Berlin Institute of Health (BIH) at Charité, Berlin, Germany
| | - Mirjam Stahl
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany; German Center for Lung Research (DZL), associated partner site, Berlin, Germany; Berlin Institute of Health (BIH) at Charité, Berlin, Germany.
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Lv Q, Gallardo-Estrella L, Andrinopoulou ER, Chen Y, Charbonnier JP, Sandvik RM, Caudri D, Nielsen KG, de Bruijne M, Ciet P, Tiddens H. Automatic analysis of bronchus-artery dimensions to diagnose and monitor airways disease in cystic fibrosis. Thorax 2023; 79:13-22. [PMID: 37734952 PMCID: PMC10803964 DOI: 10.1136/thorax-2023-220021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 08/11/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Cystic fibrosis (CF) lung disease is characterised by progressive airway wall thickening and widening. We aimed to validate an artificial intelligence-based algorithm to assess dimensions of all visible bronchus-artery (BA) pairs on chest CT scans from patients with CF. METHODS The algorithm fully automatically segments the bronchial tree; identifies bronchial generations; matches bronchi with the adjacent arteries; measures for each BA-pair bronchial outer diameter (Bout), bronchial lumen diameter (Bin), bronchial wall thickness (Bwt) and adjacent artery diameter (A); and computes Bout/A, Bin/A and Bwt/A for each BA pair from the segmental bronchi to the last visible generation. Three datasets were used to validate the automatic BA analysis. First BA analysis was executed on 23 manually annotated CT scans (11 CF, 12 control subjects) to compare automatic with manual BA-analysis outcomes. Furthermore, the BA analysis was executed on two longitudinal datasets (Copenhagen 111 CTs, ataluren 347 CTs) to assess longitudinal BA changes and compare them with manual scoring results. RESULTS The automatic and manual BA analysis showed no significant differences in quantifying bronchi. For the longitudinal datasets the automatic BA analysis detected 247 and 347 BA pairs/CT in the Copenhagen and ataluren dataset, respectively. A significant increase of 0.02 of Bout/A and Bin/A was detected for Copenhagen dataset over an interval of 2 years, and 0.03 of Bout/A and 0.02 of Bin/A for ataluren dataset over an interval of 48 weeks (all p<0.001). The progression of 0.01 of Bwt/A was detected only in the ataluren dataset (p<0.001). BA-analysis outcomes showed weak to strong correlations (correlation coefficient from 0.29 to 0.84) with manual scoring results for airway disease. CONCLUSION The BA analysis can fully automatically analyse a large number of BA pairs on chest CTs to detect and monitor progression of bronchial wall thickening and bronchial widening in patients with CF.
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Affiliation(s)
- Qianting Lv
- Department of Paediatric Pulmonology and Allergology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | | | - Yuxin Chen
- Department of Paediatric Pulmonology and Allergology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | - Rikke Mulvad Sandvik
- CF Center Copenhagen, Paediatric Pulmonary Service, Department of Paediatric and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- University of Copenhagen, Graduate School of Health and Medical Sciences, Copenhagen, Denmark
| | - Daan Caudri
- Department of Paediatric Pulmonology and Allergology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Kim Gjerum Nielsen
- CF Center Copenhagen, Paediatric Pulmonary Service, Department of Paediatric and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
| | - Marleen de Bruijne
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Pierluigi Ciet
- Department of Paediatric Pulmonology and Allergology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Pediatric Pulmonology, Erasmus Medical Center- Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Harm Tiddens
- Department of Paediatric Pulmonology and Allergology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Thirona, Nijmegen, The Netherlands
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Fouzas S, Kogias C, Gioulvanidou M, Bertzouanis A, Chrysochoou EA, Anthracopoulos MΒ, Tsanakas J, Hatziagorou E. Low-frequency oscillometry indices to assess ventilation inhomogeneity in CF patients. Pediatr Pulmonol 2023; 58:3147-3155. [PMID: 37555768 DOI: 10.1002/ppul.26635] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/21/2023] [Accepted: 07/29/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND The utility of the forced oscillations technique (FOT) in cystic fibrosis (CF) remains uncertain. The aim of this study was to explore the ability of lower-frequency FOT indices, alone and after adjustment for the lung volume, to assess the extent of ventilation inhomogeneity in CF patients with varying disease severity. METHODS Forty-five children, adolescents, and adults with CF (age 6.9-27 years) underwent spirometry, FOT, and nitrogen multiple-breath washout (N2-MBW) measurements. The respiratory resistance and reactance at 5 Hz (Rrs5 and Xrs5, respectively) were recorded, and a novel FOT index, the specific respiratory conductance (sGrs), was computed as the reciprocal of Rrs5 divided by the functional residual capacity. RESULTS The sGrs correlated well with the lung clearance index (LCI) (Spearman's r: -.797), whereas the correlation of Rrs5 and Xrs5 with the LCI, albeit significant, was weaker (r: .643 and -.631, respectively). The sGrs emerged as the most robust predictor of LCI regardless of the severity of lung disease, as reflected by patients' age and lung function measurements. Most importantly, the relationship between sGrs and LCI remained unaffected by lung hyperinflation, as opposed to that of the LCI with the spirometric and standard FOT indices. CONCLUSIONS In CF patients, the FOT indices at 5 Hz and the novel, volume-adjusted parameter sGrs, reflect the extent of lung involvement and the underlying ventilation inhomogeneity in a way comparable to N2-MBW. Future research should explore the role of lower-frequency FOT in assessing the severity and monitoring the progression of CF lung disease.
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Affiliation(s)
- Sotirios Fouzas
- Pediatric Respiratory Unit, Pediatric Department, University Hospital of Patras, Patras, Greece
| | - Christos Kogias
- Pediatric Respiratory and Cystic Fibrosis Unit, 3rd Paediatric Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Gioulvanidou
- Pediatric Respiratory and Cystic Fibrosis Unit, 3rd Paediatric Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aris Bertzouanis
- Pediatric Respiratory Unit, Pediatric Department, University Hospital of Patras, Patras, Greece
| | - Elisavet-Anna Chrysochoou
- Pediatric Respiratory and Cystic Fibrosis Unit, 3rd Paediatric Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - John Tsanakas
- Pediatric Respiratory and Cystic Fibrosis Unit, 3rd Paediatric Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elpis Hatziagorou
- Pediatric Respiratory and Cystic Fibrosis Unit, 3rd Paediatric Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Sandvik RM, Schmidt MN, Voldby CM, Buchvald FF, Olesen HV, Olsen J, Kragh MV, Rubak SL, Pressler T, Robinson PD, Gustafsson PM, Skov M, Nielsen KG. Nationwide lung function monitoring from infancy in newborn-screened children with cystic fibrosis. ERJ Open Res 2023; 9:00317-2023. [PMID: 37908398 PMCID: PMC10613974 DOI: 10.1183/23120541.00317-2023] [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: 05/16/2023] [Accepted: 08/01/2023] [Indexed: 11/02/2023] Open
Abstract
Background Cystic fibrosis (CF) lung disease starts in infancy and can be assessed for structural lung abnormalities using computed tomography or magnetic resonance scans, or for lung function impairment using multiple breath washout (MBW). However, in infancy these two methods are not well correlated. Trajectories of CF lung disease assessed by MBW in infants and toddlers remain poorly described, which is why we aimed to 1) describe the trajectory of lung function, 2) explore risk factors for progression and 3) explore the real-life effect of lumacaftor/ivacaftor. Methods This was a nationwide observational cohort study (2018-2021) using data collected as part of the routine clinical surveillance programme (including MBW and monthly endo-laryngeal suction sampling for bacterial pathogens) in children born after implementation of newborn screening for CF (May 2016). Lumacaftor/ivacaftor commenced from age 2 years in children homozygous for F508del. Ventilation distribution efficiency (VDE), recently described to have advantages over lung clearance index (LCI), was reported as the primary MBW outcome after z-score calculations based on published reference data. Mixed effect linear regression models were the main statistical analyses performed in this study. Results 59 children, aged 2-45 months, contributed with 211 MBW occasions (median (interquartile range (IQR)) 3 (2-5) MBW occasions per child) with a median (IQR) follow-up time of 10.8 (5.2-22.3) months. An overall mean annual deterioration rate of -0.50 (95% CI -0.78- -0.22) z-VDE was observed, starting from an estimated mean z-VDE of -1.68 (95% CI -2.15- -1.22) at age 0.0 years (intercept). Pseudomonas aeruginosa "ever" (n=14, MBWs 50) had a significantly worse z-VDE trajectory versus P. aeruginosa "never" (mean difference 0.53 (95% CI 0.16-0.89) per year; p=0.0047) and lumacaftor/ivacaftor treatment (n=22, MBWs 46) significantly improved the trajectory of z-VDE (mean difference 1.72 (95% CI 0.79-2.66) per year; p=0.0004), leading to a stable mean z-VDE trajectory after start of treatment. Conclusions Infants and toddlers with CF demonstrated progressive deterioration in z-VDE over the first years of life. P. aeruginosa isolation "ever" was associated with an accelerated deterioration in lung function, while lumacaftor/ivacaftor therapy significantly improved and stabilised the trajectory.
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Affiliation(s)
- Rikke M. Sandvik
- Department of Paediatric and Adolescent Medicine, Copenhagen University Hospital, Danish PCD and chILD Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, Copenhagen, Denmark
| | - Marika N. Schmidt
- Department of Paediatric and Adolescent Medicine, Copenhagen University Hospital, Danish PCD and chILD Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, Copenhagen, Denmark
| | - Christian M. Voldby
- Department of Paediatric and Adolescent Medicine, Copenhagen University Hospital, Danish PCD and chILD Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, Copenhagen, Denmark
| | - Frederik F. Buchvald
- Department of Paediatric and Adolescent Medicine, Copenhagen University Hospital, Danish PCD and chILD Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, Copenhagen, Denmark
| | - Hanne V. Olesen
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, CF Centre Aarhus, Danish Centre of Paediatric Pulmonology and Allergology, Aarhus, Denmark
| | - Jørgen Olsen
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, CF Centre Aarhus, Danish Centre of Paediatric Pulmonology and Allergology, Aarhus, Denmark
| | - Maja V. Kragh
- Department of Paediatric and Adolescent Medicine, Copenhagen University Hospital, Danish PCD and chILD Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, Copenhagen, Denmark
| | - Sune L.M. Rubak
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, CF Centre Aarhus, Danish Centre of Paediatric Pulmonology and Allergology, Aarhus, Denmark
| | - Tacjana Pressler
- Department of Paediatric and Adolescent Medicine, Copenhagen University Hospital, Danish PCD and chILD Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, Copenhagen, Denmark
| | - Paul D. Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia
- Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, Australia
- Airway Physiology and Imaging Group, The Woolcock Medical Research Institute, Sydney, Australia
| | - Per M. Gustafsson
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Children and Young Persons – Medical Clinic, Skaraborg Hospital, Skövde, Sweden
| | - Marianne Skov
- Department of Paediatric and Adolescent Medicine, Copenhagen University Hospital, Danish PCD and chILD Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, Copenhagen, Denmark
| | - Kim G. Nielsen
- Department of Paediatric and Adolescent Medicine, Copenhagen University Hospital, Danish PCD and chILD Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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McNally P, Linnane B, Williamson M, Elnazir B, Short C, Saunders C, Kirwan L, David R, Kemner-Van de Corput MPC, Tiddens HAWM, Davies JC, Cox DW. The clinical impact of Lumacaftor-Ivacaftor on structural lung disease and lung function in children aged 6-11 with cystic fibrosis in a real-world setting. Respir Res 2023; 24:199. [PMID: 37568199 PMCID: PMC10416528 DOI: 10.1186/s12931-023-02497-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Data from clinical trials of lumacaftor-ivacaftor (LUM-IVA) demonstrate improvements in lung clearance index (LCI) but not in FEV1 in children with Cystic Fibrosis (CF) aged 6-11 years and homozygous for the Phe508del mutation. It is not known whether LUM/IVA use in children can impact the progression of structural lung disease. We sought to determine the real-world impact of LUM/IVA on lung structure and function in children aged 6-11 years. METHODS This real-world observational cohort study was conducted across four paediatric sites in Ireland over 24-months using spirometry-controlled CT scores and LCI as primary outcome measures. Children commencing LUM-/IVA as part of routine care were included. CT scans were manually scored with the PRAGMA CF scoring system and analysed using the automated bronchus-artery (BA) method. Secondary outcome measures included rate of change of ppFEV1, nutritional indices and exacerbations requiring hospitalisation. RESULTS Seventy-one participants were recruited to the study, 31 of whom had spirometry-controlled CT performed at baseline, and after one year and two years of LUM/IVA treatment. At two years there was a reduction from baseline in trapped air scores (0.13 to 0.07, p = 0.016), but an increase from baseline in the % bronchiectasis score (0.84 to 1.23, p = 0.007). There was no change in overall % disease score (2.78 to 2.25, p = 0.138). Airway lumen to pulmonary artery ratios (AlumenA ratio) were abnormal at baseline and worsened over the course of the study. In 28 participants, the mean annual change from baseline LCI2.5 (-0.055 (-0.61 to 0.50), p = 0.85) measurements over two years were not significant. Improvements from baseline in weight (0.10 (0.06 to 0.15, p < 0.0001), height (0.05 (0.02 to 0.09), p = 0.002) and BMI (0.09 (0.03 to 0.15) p = 0.005) z-scores were seen with LUM/IVA treatment. The mean annual change from baseline ppFEV1 (-2.45 (-4.44 to 2.54), p = 0.66) measurements over two years were not significant. CONCLUSION In a real-world setting, the use of LUM/IVA over two years in children with CF aged 6-11 resulted in improvements in air trapping on CT but worsening in bronchiectasis scores. Our results suggest that LUM/IVA use in this age group improves air trapping but does not prevent progression of bronchiectasis over two years of treatment.
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Affiliation(s)
- Paul McNally
- Respiratory Department, Children's Health Ireland, Crumlin, Dublin, Ireland
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Barry Linnane
- University of Limerick School of Medicine, Limerick, Ireland
| | - Michael Williamson
- Respiratory Department, Children's Health Ireland, Crumlin, Dublin, Ireland
| | - Basil Elnazir
- Respiratory Department, Children's Health Ireland, Crumlin, Dublin, Ireland
- Trinity College, Dublin, Ireland
| | - Christopher Short
- NHLI, Imperial College, London, UK
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' Trust, London, UK
| | - Clare Saunders
- NHLI, Imperial College, London, UK
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' Trust, London, UK
| | - Laura Kirwan
- Cystic Fibrosis Registry of Ireland, Dublin, Ireland
| | - Rea David
- Respiratory Department, Children's Health Ireland, Crumlin, Dublin, Ireland
| | - Mariette P C Kemner-Van de Corput
- Department of Paediatric Pulmonology and Allergology, Department of Radiology and Nuclear Medicine, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Harm A W M Tiddens
- Respiratory Department, Children's Health Ireland, Crumlin, Dublin, Ireland
| | - Jane C Davies
- NHLI, Imperial College, London, UK
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' Trust, London, UK
| | - Des W Cox
- Respiratory Department, Children's Health Ireland, Crumlin, Dublin, Ireland.
- University College Dublin, Dublin, Ireland.
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7
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Sandvik RM, Lindblad A, Robinson PD, Nielsen KG, Gustafsson P. Turning lung clearance index on its head. Reference data for SF 6 multiple-breath washout derived ventilation distribution efficiency. J Appl Physiol (1985) 2023; 134:316-327. [PMID: 36548514 DOI: 10.1152/japplphysiol.00541.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/16/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
Cystic fibrosis (CF) lung disease is characterized by increased ventilation inhomogeneity (VI), as measured by multiple-breath washout (MBW). Lung clearance index (LCI) is the most reported VI outcome. This study aimed to evaluate historically published reference equations for sulfur hexafluoride (SF6) MBW outcomes, to data collected using updated commercial SF6MBW equipment, and to produce device-specific equations if necessary. SF6MBW was performed in 327 healthy children aged 0.1-18.4 yr [151 (46%) girls], 191 (58.4%) <3 yr. z-Scores were calculated from published reference equations (FRC and LCI) and multivariate linear regression was performed to produce device-specific reference equations. Due to increasing residual standard deviations with increasing LCI values, investigation of methods for improvement were investigated, based on the relationship between VI and dead space ventilation (VD/VT; dead space volume/tidal volume) in a cohort of 59 healthy children, 26 children with CF (n = 138 test occasions), and 49 adults with lung disease. Historical SF6MBW reference equations were unsuitable for EXHALYZER D data. In contrast to LCI and log10(LCI), 1/LCI (ventilation distribution efficiency; VDE) was linearly related to VD/VT, with z-scores linearly related to its absolute values. Reference equations were reported for VDE and log10(FRC). Significant predictors for VDE and log10(FRC), respectively, were log10(age) and sex, and log10(height), sex, and posture. VDE is potentially a better index of VI than LCI, particularly in more advanced CF lung disease and also for longitudinal monitoring. Further confirmatory clinical studies, particularly longitudinal imaging studies of structural or ventilatory changes, are warranted.NEW & NOTEWORTHY Lung clearance index (LCI) is the most used outcome from the multiple-breath washout test. As known for decades, the LCI is not linearly related to dead space ventilation, giving difficulties interpreting changes over time and in clinical trials. We present a new and improved outcome based on LCI, the ventilation distribution efficiency (VDE), which solves this problem by being linearly related to dead space ventilation. A pediatric age range reference equation for VDE is presented.
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Affiliation(s)
- Rikke Mulvad Sandvik
- Department of Paediatric and Adolescent Medicine, CF Centre Copenhagen, Danish Paediatric Pulmonary Service, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anders Lindblad
- Department of Pediatrics, Queen Silvia Children's Hospital, West Sweden CF Center, Gothenburg, Sweden
- The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Paul D Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- The Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales, Australia
- Airway Physiology and Imaging Group, The Woolcock Medical Research Institute, Sydney, New South Wales, Australia
| | - Kim G Nielsen
- Department of Paediatric and Adolescent Medicine, CF Centre Copenhagen, Danish Paediatric Pulmonary Service, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Per Gustafsson
- The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics, General Hospital, Skövde, Sweden
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Svedberg M, Imberg H, Gustafsson PM, Tiddens H, Davies G, Lindblad A. Longitudinal lung clearance index and association with structural lung damage in children with cystic fibrosis. Thorax 2023; 78:176-182. [PMID: 35277449 PMCID: PMC9872247 DOI: 10.1136/thoraxjnl-2021-218178] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/11/2022] [Indexed: 01/27/2023]
Affiliation(s)
- Marcus Svedberg
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Henrik Imberg
- Departmemt of Mathematical Science, Chalmers University of Technology, Gothenburg, Sweden
| | - Per Magnus Gustafsson
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Pediatrics, Central Hospital, Skoevde, Sweden
| | - Harm Tiddens
- Department of Pediatric Pulmonology and Allergology, ErasmusMC-Sophia Children's hospital, Rotterdam, Netherlands
| | - Gwyneth Davies
- UCL Great Ormond Street Institute of Child Health, UCL, London, UK.,Department of Respiratory Medicine, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Anders Lindblad
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Steinke E, Sommerburg O, Graeber SY, Joachim C, Labitzke C, Nissen G, Ricklefs I, Rudolf I, Kopp MV, Dittrich AM, Mall MA, Stahl M. TRACK-CF prospective cohort study: Understanding early cystic fibrosis lung disease. Front Med (Lausanne) 2023; 9:1034290. [PMID: 36687447 PMCID: PMC9853074 DOI: 10.3389/fmed.2022.1034290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/05/2022] [Indexed: 01/09/2023] Open
Abstract
Background Lung disease as major cause for morbidity in patients with cystic fibrosis (CF) starts early in life. Its large phenotypic heterogeneity is partially explained by the genotype but other contributing factors are not well delineated. The close relationship between mucus, inflammation and infection, drives morpho-functional alterations already early in pediatric CF disease, The TRACK-CF cohort has been established to gain insight to disease onset and progression, assessed by lung function testing and imaging to capture morpho-functional changes and to associate these with risk and protective factors, which contribute to the variation of the CF lung disease progression. Methods and design TRACK-CF is a prospective, longitudinal, observational cohort study following patients with CF from newborn screening or clinical diagnosis throughout childhood. The study protocol includes monthly telephone interviews, quarterly visits with microbiological sampling and multiple-breath washout and as well as a yearly chest magnetic resonance imaging. A parallel biobank has been set up to enable the translation from the deeply phenotyped cohort to the validation of relevant biomarkers. The main goal is to determine influencing factors by the combined analysis of clinical information and biomaterials. Primary endpoints are the lung clearance index by multiple breath washout and semi-quantitative magnetic resonance imaging scores. The frequency of pulmonary exacerbations, infection with pro-inflammatory pathogens and anthropometric data are defined as secondary endpoints. Discussion This extensive cohort includes children after diagnosis with comprehensive monitoring throughout childhood. The unique composition and the use of validated, sensitive methods with the attached biobank bears the potential to decisively advance the understanding of early CF lung disease. Ethics and trial registration The study protocol was approved by the Ethics Committees of the University of Heidelberg (approval S-211/2011) and each participating site and is registered at clinicaltrials.gov (NCT02270476).
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Affiliation(s)
- Eva Steinke
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité–Universitätsmedizin Berlin, Berlin, Germany,German Center for Lung Research (DZL), Associated Partner Site, Berlin, Germany,Berlin Institute of Health (BIH) at Charité, Berlin, Germany,*Correspondence: Eva Steinke ✉
| | - Olaf Sommerburg
- Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Department of Translational Pulmonology, University of Heidelberg, Heidelberg, Germany,Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Simon Y. Graeber
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité–Universitätsmedizin Berlin, Berlin, Germany,German Center for Lung Research (DZL), Associated Partner Site, Berlin, Germany,Berlin Institute of Health (BIH) at Charité, Berlin, Germany
| | - Cornelia Joachim
- Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Department of Translational Pulmonology, University of Heidelberg, Heidelberg, Germany,Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Christiane Labitzke
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Gyde Nissen
- Division of Pediatric Pneumology and Allergology, University of Lübeck, Lübeck, Germany,Airway Research Center North (ARCN), German Center for Lung Research (DZL), Lübeck, Germany
| | - Isabell Ricklefs
- Division of Pediatric Pneumology and Allergology, University of Lübeck, Lübeck, Germany,Airway Research Center North (ARCN), German Center for Lung Research (DZL), Lübeck, Germany
| | - Isa Rudolf
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany,Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Matthias V. Kopp
- Division of Pediatric Pneumology and Allergology, University of Lübeck, Lübeck, Germany,Airway Research Center North (ARCN), German Center for Lung Research (DZL), Lübeck, Germany,Division of Respiratory Medicine, Department of Pediatrics, University Children's Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Anna-Maria Dittrich
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany,Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Marcus A. Mall
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité–Universitätsmedizin Berlin, Berlin, Germany,German Center for Lung Research (DZL), Associated Partner Site, Berlin, Germany,Berlin Institute of Health (BIH) at Charité, Berlin, Germany
| | - Mirjam Stahl
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité–Universitätsmedizin Berlin, Berlin, Germany,German Center for Lung Research (DZL), Associated Partner Site, Berlin, Germany,Berlin Institute of Health (BIH) at Charité, Berlin, Germany
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10
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Tiddens HAWM, Chen Y, Andrinopoulou ER, Davis SD, Rosenfeld M, Ratjen F, Kronmal RA, Hinckley Stukovsky KD, Dasiewicz A, Stick SM. The effect of inhaled hypertonic saline on lung structure in children aged 3-6 years with cystic fibrosis (SHIP-CT): a multicentre, randomised, double-blind, controlled trial. THE LANCET. RESPIRATORY MEDICINE 2022; 10:669-678. [PMID: 35286860 DOI: 10.1016/s2213-2600(21)00546-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND In the Saline Hypertonic in Preschoolers (SHIP) study, inhaled 7% hypertonic saline improved the lung clearance index in children aged 3-6 years with cystic fibrosis, but it remained unclear whether improvement is also seen in structural lung disease. We aimed to assess the effect of inhaled hypertonic saline on chest CT imaging in children aged 3-6 years with cystic fibrosis. METHODS Children with cystic fibrosis were enrolled in this multicentre, randomised, double-blind, controlled study at 23 cystic fibrosis centres in Spain, Denmark, the Netherlands, Italy, France, Belgium, the USA, Canada, and Australia. Eligible participants were children aged 3-6 years who were able to cooperate with chest CT imaging and comply with daily nebuliser treatment. Participants were randomly assigned 1:1 to receive inhaled 2 puffs of 100 μg salbutamol followed by 4mL of either 7% hypertonic saline or 0·9% isotonic saline twice per day for 48 weeks. Randomisation was stratified by age in North America and Australia, and by age and country in Europe. Chest CTs were obtained at baseline and 48 weeks and scored using the Perth-Rotterdam Annotated Grid Morphometric Analysis for Cystic Fibrosis (PRAGMA-CF) method. The primary outcome was the difference between groups in the percentage of total lung volume occupied by abnormal airways (PRAGMA-CF %Disease) measured by chest CT at 48 weeks. Analysis was by intention-to-treat. This study is registered with Clinicaltrials.gov, NCT02950883. FINDINGS Between May 24, 2016, and Dec 18, 2019, 134 children were assessed for inclusion. 18 patients were excluded (nine had incomplete or unsuccessful chest CT at enrolment visit, two could not comply with CT training, two had acute respiratory infection, two withdrew consent, two for reasons unknown, and one was already on hypertonic saline). 116 participants were enrolled and randomly assigned to hypertonic saline (n=56) or isotonic saline (n=60). 12 patients dropped out of the study (seven in the hypertonic saline group and five in the isotonic saline group). Mean PRAGMA-CF %Disease at 48 weeks was 0·88% (95% CI 0·60-1·16) in the hypertonic saline group and 1·55% (1·25-1·84) in the isotonic saline group (mean difference 0·67%, 95% CI 0·26-1·08; p=0·0092) based on a linear regression model adjusted for baseline %Disease values and baseline age. Most adverse events in both groups were rated as mild, and the most common adverse event in both groups was cough. INTERPRETATION Inhaled hypertonic saline for 48 weeks had a positive effect on structural lung changes in children aged 3-6 years with cystic fibrosis relative to isotonic saline. This is the first demonstration of an intervention that alters structural lung disease in children aged 3-6 years with cystic fibrosis. FUNDING Cystic Fibrosis Foundation.
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Affiliation(s)
- Harm A W M Tiddens
- Department of Paediatrics, Division of Respiratory Medicine and Allergology, Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands.
| | - Yuxin Chen
- Department of Paediatrics, Division of Respiratory Medicine and Allergology, Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands
| | | | - Stephanie D Davis
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Felix Ratjen
- Division of Respiratory Medicine, Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - Richard A Kronmal
- Collaborative Health Studies Coordinating Center, University of Washington, Seattle, WA USA
| | | | - Alison Dasiewicz
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
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11
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Svedberg M, Imberg H, Gustafsson P, Brink M, Caisander H, Lindblad A. Chest X-rays are less sensitive than multiple breath washout examinations when it comes to detecting early cystic fibrosis lung disease. Acta Paediatr 2022; 111:1253-1260. [PMID: 35181935 PMCID: PMC9306859 DOI: 10.1111/apa.16302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/30/2022]
Abstract
AIM Annual chest X-ray is recommended as routine surveillance to track cystic fibrosis (CF) lung disease. The aim of this study was to investigate the clinical utility of chest X-rays to track CF lung disease. METHODS Children at Gothenburg's CF centre who underwent chest X-rays, multiple breath washouts and chest computed tomography examinations between 1996 and 2016 were included in the study. Chest X-rays were interpreted with Northern Score (NS). We compared NS to lung clearance index (LCI) and structural lung damage measured by computed tomography using a logistic regression model. RESULTS A total of 75 children were included over a median period of 13 years (range: 3.0-18.0 years). The proportion of children with abnormal NS was significantly lower than the proportion of abnormal LCI up to the age of 4 years (p < 0.05). A normal NS and a normal LCI at age 6 years were associated with a median (10-90th percentile) total airway disease of 1.8% (0.4-4.7%) and bronchiectasis of 0.2% (0.0-1.5%). CONCLUSION Chest X-rays were less sensitive than multiple breath washout examinations to detect early CF lung disease. The combined results from both methods can be used as an indicator to perform chest computed tomography less frequently.
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Affiliation(s)
- Marcus Svedberg
- Department of Pediatrics Institute of Clinical Science at The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Pediatrics Queen Silvia's Children Hospital Gothenburg Sweden
| | - Henrik Imberg
- Department of Mathematical Sciences Chalmers University of Technology and University of Gothenburg Gothenburg Sweden
- Statistiska Konsultgruppen Gothenburg Sweden
| | - Per Gustafsson
- Department of Pediatrics Institute of Clinical Science at The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Pediatrics Central Hospital Skoevde Sweden
| | - Mela Brink
- Department of Pediatric Radiology Queen Silvia's Children Hospital Gothenburg Sweden
| | - Håkan Caisander
- Department of Pediatric Radiology Queen Silvia's Children Hospital Gothenburg Sweden
| | - Anders Lindblad
- Department of Pediatrics Institute of Clinical Science at The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Pediatrics Queen Silvia's Children Hospital Gothenburg Sweden
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12
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Gambazza S, Ambrogi F, Carta F, Moroni L, Russo M, Brivio A, Colombo C. Lung clearance index to characterize clinical phenotypes of children and adolescents with cystic fibrosis. BMC Pulm Med 2022; 22:122. [PMID: 35365111 PMCID: PMC8976307 DOI: 10.1186/s12890-022-01903-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/11/2022] [Indexed: 12/31/2022] Open
Abstract
Background Lung clearance index (LCI) is accepted as an early marker of lung disease in cystic fibrosis (CF), however the utility of LCI to identify subgroups of CF disease in the paediatric age group has never been explored. The aim of the study was to characterize phenotypes of children with CF using LCI as a marker of ventilation inhomogeneity and to investigate whether these phenotypes distinguished patients based on time to pulmonary exacerbation (PE).
Methods Data were collected on patients with CF aged < 18 years old, attending the CF Center of Milan during outpatient follow-up visits between October 2014 and September 2019. Cluster analysis using agglomerative nesting hierarchical method was performed to generate distinct phenotypes. Time-to-recurrent event analysis investigated association of phenotypes with PE. Results We collected 313 multiple breath washout tests on 125 children aged 5.5–16.8 years. Cluster analysis identified two divergent phenotypes in children and adolescents of same age, presenting with almost normal FEV1 but with substantial difference in markers of ventilation inhomogeneity (mean LCI difference of 3.4, 95% Confidence Interval [CI] 2.6–4.2). A less severe phenotype was associated with a lower risk of PE relapse (Hazard Ratio 0.45, 95% CI 0.34–0.62). Conclusions LCI is useful in clinical practice to characterize distinct phenotypes of children and adolescents with mild/normal FEV1. A less severe phenotype translates into a lower risk of PE relapse. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01903-5.
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Affiliation(s)
- Simone Gambazza
- Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Biometry and Epidemiology "G. A. Maccacaro", University of Milan, Milan, Italy. .,Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Federico Ambrogi
- Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Biometry and Epidemiology "G. A. Maccacaro", University of Milan, Milan, Italy
| | - Federica Carta
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Cystic Fibrosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Moroni
- Cystic Fibrosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Russo
- 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.,Cystic Fibrosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carla Colombo
- Cystic Fibrosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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13
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Sandvik RM, Gustafsson PM, Lindblad A, Buchvald F, Olesen HV, Olsen JH, Skov M, Schmidt MN, Thellefsen MR, Robinson PD, Rubak S, Pressler T, Nielsen KG. Contemporary N 2 and SF 6 multiple breath washout in infants and toddlers with cystic fibrosis. Pediatr Pulmonol 2022; 57:945-955. [PMID: 35029068 DOI: 10.1002/ppul.25830] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/20/2021] [Accepted: 01/12/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Multiple breath washout (MBW) is used for early detection of cystic fibrosis (CF) lung disease, with SF6 MBW commonly viewed as the reference method. The use of N2 MBW in infants and toddlers has been questioned for technical and physiological reasons, but a new correction of the N2 signal has minimized the technical part. The present study aimed to assess the remaining differences and the contributing mechanisms for the differences between SF6 and N2 MBW,corrected-such as tidal volume reduction during N2 washout with pure O2 . METHOD This was a longitudinal multicenter cohort study. SF6 MBW and N2 MBW were performed prospectively at three CF centers in the same visits on 154 test occasions across 62 children with CF (mean age: 22.7 months). Offline analysis using identical algorithms to the commercially available program provided outcomes of N2,original and N2,corrected for comparison with SF6 MBW. RESULTS Mean functional residual capacity, FRCN2,corrected was 14.3% lower than FRCN2, original , and 1.0% different from FRCSF6 . Lung clearance index, LCIN2,corrected was 25.2% lower than LCIN2,original , and 7.3% higher than LCISF6 . Mean (SD) tidal volume decreased significantly during N2 MBWcorrected , compared to SF6 MBW (-13.1 ml [-30.7; 4.6], p < 0.0001, equal to -12.0% [-25.7; 1.73]), but this tidal volume reduction did not correlate to the differences between LCIN2,corrected and LCISF6 . The absolute differences in LCI increased significantly with higher LCISF6 (0.63/LCISF6 ) and (0.23/LCISF6 ), respectively, for N2,original and N2,corrected , but the relative differences were stable across disease severity for N2,corrected , but not for N2,original . CONCLUSION Only minor residual differences between FRCN2,corrected and FRCSF6 remained to show that the two methods measure gas volumes very similar in this age range. Small differences in LCI were found. Tidal volume reduction during N2 MBW did not affect differences. The corrected N2 MBW can now be used with confidence in young children with CF, although not interchangeably with SF6 .
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Affiliation(s)
- Rikke M Sandvik
- Danish Paediatric Pulmonary Service, CF Centre Copenhagen, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Per M Gustafsson
- Department of Paediatrics, Central Hospital, Skövde, Sweden.,Institute of Clinical Science, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Lindblad
- Institute of Clinical Science, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Pediatrics, CF Center, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Frederik Buchvald
- Danish Paediatric Pulmonary Service, CF Centre Copenhagen, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hanne V Olesen
- Department of Paediatrics and Adolescent Medicine, Danish Center of Pediatric Pulmonology and Allergology, Cystic Fibrosis Centre Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen H Olsen
- Department of Paediatrics and Adolescent Medicine, Danish Center of Pediatric Pulmonology and Allergology, Cystic Fibrosis Centre Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Marianne Skov
- Danish Paediatric Pulmonary Service, CF Centre Copenhagen, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marika N Schmidt
- Danish Paediatric Pulmonary Service, CF Centre Copenhagen, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mette R Thellefsen
- Danish Paediatric Pulmonary Service, CF Centre Copenhagen, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Paul D Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Sune Rubak
- Department of Paediatrics and Adolescent Medicine, Danish Center of Pediatric Pulmonology and Allergology, Cystic Fibrosis Centre Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Tacjana Pressler
- Danish Paediatric Pulmonary Service, CF Centre Copenhagen, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kim G Nielsen
- Danish Paediatric Pulmonary Service, CF Centre Copenhagen, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Ciet P, Bertolo S, Ros M, Casciaro R, Cipolli M, Colagrande S, Costa S, Galici V, Gramegna A, Lanza C, Lucca F, Macconi L, Majo F, Paciaroni A, Parisi GF, Rizzo F, Salamone I, Santangelo T, Scudeller L, Saba L, Tomà P, Morana G. State-of-the-art review of lung imaging in cystic fibrosis with recommendations for pulmonologists and radiologists from the "iMAging managEment of cySTic fibROsis" (MAESTRO) consortium. Eur Respir Rev 2022; 31:31/163/210173. [PMID: 35321929 DOI: 10.1183/16000617.0173-2021] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/20/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Imaging represents an important noninvasive means to assess cystic fibrosis (CF) lung disease, which remains the main cause of morbidity and mortality in CF patients. While the development of new imaging techniques has revolutionised clinical practice, advances have posed diagnostic and monitoring challenges. The authors aim to summarise these challenges and make evidence-based recommendations regarding imaging assessment for both clinicians and radiologists. STUDY DESIGN A committee of 21 experts in CF from the 10 largest specialist centres in Italy was convened, including a radiologist and a pulmonologist from each centre, with the overall aim of developing clear and actionable recommendations for lung imaging in CF. An a priori threshold of at least 80% of the votes was required for acceptance of each statement of recommendation. RESULTS After a systematic review of the relevant literature, the committee convened to evaluate 167 articles. Following five RAND conferences, consensus statements were developed by an executive subcommittee. The entire consensus committee voted and approved 28 main statements. CONCLUSIONS There is a need for international guidelines regarding the appropriate timing and selection of imaging modality for patients with CF lung disease; timing and selection depends upon the clinical scenario, the patient's age, lung function and type of treatment. Despite its ubiquity, the use of the chest radiograph remains controversial. Both computed tomography and magnetic resonance imaging should be routinely used to monitor CF lung disease. Future studies should focus on imaging protocol harmonisation both for computed tomography and for magnetic resonance imaging. The introduction of artificial intelligence imaging analysis may further revolutionise clinical practice by providing fast and reliable quantitative outcomes to assess disease status. To date, there is no evidence supporting the use of lung ultrasound to monitor CF lung disease.
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Affiliation(s)
- Pierluigi Ciet
- Radiology and Nuclear Medicine Dept, Erasmus MC, Rotterdam, The Netherlands .,Pediatric Pulmonology and Allergology Dept, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands.,Depts of Radiology and Medical Science, University of Cagliari, Cagliari, Italy
| | - Silvia Bertolo
- Radiology Dept, Ca'Foncello S. Maria Hospital, Treviso, Italy
| | - Mirco Ros
- Dept of Pediatrics, Ca'Foncello S. Maria Hospital, Treviso, Italy
| | - Rosaria Casciaro
- Dept of Pediatrics, IRCCS Institute "Giannina Gaslini", Cystic Fibrosis Centre, Genoa, Italy
| | - Marco Cipolli
- Regional Reference Cystic Fibrosis center, University hospital of Verona, Verona, Italy
| | - Stefano Colagrande
- Dept of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence- Careggi Hospital, Florence, Italy
| | - Stefano Costa
- Dept of Pediatrics, Gaetano Martino Hospital, Messina, Italy
| | - Valeria Galici
- Cystic Fibrosis Centre, Dept of Paediatric Medicine, Anna Meyer Children's University Hospital, Florence, Italy
| | - Andrea Gramegna
- Respiratory Disease and Adult Cystic Fibrosis Centre, Internal Medicine Dept, IRCCS Ca' Granda, Milan, Italy.,Dept of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Cecilia Lanza
- Radiology Dept, University Hospital Ospedali Riuniti, Ancona, Italy
| | - Francesca Lucca
- Regional Reference Cystic Fibrosis center, University hospital of Verona, Verona, Italy
| | - Letizia Macconi
- Radiology Dept, Tuscany Reference Cystic Fibrosis Centre, Meyer Children's Hospital, Florence, Italy
| | - Fabio Majo
- Dept of Pediatrics, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Giuseppe Fabio Parisi
- Pediatric Pulmonology Unit, Dept of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Francesca Rizzo
- Radiology Dept, IRCCS Institute "Giannina Gaslini", Cystic Fibrosis Center, Genoa, Italy
| | | | - Teresa Santangelo
- Dept of Radiology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Luigia Scudeller
- Clinical Epidemiology, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy
| | - Luca Saba
- Depts of Radiology and Medical Science, University of Cagliari, Cagliari, Italy
| | - Paolo Tomà
- Dept of Radiology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Giovanni Morana
- Radiology Dept, Ca'Foncello S. Maria Hospital, Treviso, Italy
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15
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Stanojevic S, Davis SD, Perrem L, Shaw M, Retsch-Bogart G, Davis M, Jensen R, Clem CC, Isaac SM, Guido J, Jara S, France L, McDonald N, Solomon M, Sweezey N, Grasemann H, Waters V, Sanders DB, Ratjen FA. Determinants of lung disease progression measured by lung clearance index in children with cystic fibrosis. Eur Respir J 2021; 58:13993003.03380-2020. [PMID: 33542049 DOI: 10.1183/13993003.03380-2020] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/11/2020] [Indexed: 02/06/2023]
Abstract
The lung clearance index (LCI) measured by the multiple breath washout (MBW) test is sensitive to early lung disease in children with cystic fibrosis. While LCI worsens during the preschool years in cystic fibrosis, there is limited evidence to clarify whether this continues during the early school age years, and whether the trajectory of disease progression as measured by LCI is modifiable.A cohort of children (healthy and cystic fibrosis) previously studied for 12 months as preschoolers were followed during school age (5-10 years). LCI was measured every 3 months for a period of 24 months using the Exhalyzer D MBW nitrogen washout device. Linear mixed effects regression was used to model changes in LCI over time.A total of 582 MBW measurements in 48 healthy subjects and 845 measurements in 64 cystic fibrosis subjects were available. The majority of children with cystic fibrosis had elevated LCI at the first preschool and first school age visits (57.8% (37 out of 64)), whereas all but six had normal forced expiratory volume in 1 s (FEV1) values at the first school age visit. During school age years, the course of disease was stable (-0.02 units·year-1 (95% CI -0.14-0.10). LCI measured during preschool years, as well as the rate of LCI change during this time period, were important determinants of LCI and FEV1, at school age.Preschool LCI was a major determinant of school age LCI; these findings further support that the preschool years are critical for early intervention strategies.
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Affiliation(s)
- Sanja Stanojevic
- Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, ON, Canada.,Dept of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Stephanie D Davis
- Dept of Pediatrics; Division of Pediatric Pulmonology, University of North Carolina at Chapel Hill, UNC Children's, Chapel Hill, NC, USA
| | - Lucy Perrem
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Michelle Shaw
- Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - George Retsch-Bogart
- Dept of Pediatrics; Division of Pediatric Pulmonology, University of North Carolina at Chapel Hill, UNC Children's, Chapel Hill, NC, USA
| | - Miriam Davis
- Dept of Pediatrics; Division of Pediatric Pulmonology, University of North Carolina at Chapel Hill, UNC Children's, Chapel Hill, NC, USA
| | - Renee Jensen
- Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - Charles C Clem
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Dept of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sarah M Isaac
- Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - Julia Guido
- Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - Sylvia Jara
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Dept of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lisa France
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Dept of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nancy McDonald
- Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - Melinda Solomon
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Neil Sweezey
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Hartmut Grasemann
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Valerie Waters
- Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, ON, Canada.,Division of Infectious Diseases, Hospital for Sick Children, Toronto, ON, Canada
| | - D B Sanders
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Dept of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Felix A Ratjen
- Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, ON, Canada.,Division of Respiratory Medicine, Hospital for Sick Children, Toronto, ON, Canada
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16
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Spano J, Milla CE. Defining the Clinical Utility of the Lung Clearance Index. Are We There Yet? Am J Respir Crit Care Med 2021; 203:937-939. [PMID: 33181036 PMCID: PMC8048751 DOI: 10.1164/rccm.202010-3899ed] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jacquelyn Spano
- Center for Excellence in Pulmonary Biology Stanford University Palo Alto, California
| | - Carlos E Milla
- Center for Excellence in Pulmonary Biology Stanford University Palo Alto, California
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