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Baglyas S, Valkó L, Móró V, Podmaniczky E, Czövek D, Makan G, Gingl Z, Gál J, Hantos Z, Lorx A. Using intra-breath oscillometry in obesity hypoventilation syndrome to detect tidal expiratory flow limitation: a potential marker to optimize CPAP therapy. BMC Pulm Med 2023; 23:477. [PMID: 38017501 PMCID: PMC10685591 DOI: 10.1186/s12890-023-02777-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/21/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) therapy has profound effects in obesity hypoventilation syndrome (OHS). Current therapy initiation focuses on upper airway patency rather than the assessment of altered respiratory mechanics due to increased extrapulmonary mechanical load. METHODS We aimed to examine the viability of intra-breath oscillometry in optimizing CPAP therapy for OHS. We performed intra-breath oscillometry at 10 Hz in the sitting and supine positions, followed by measurements at increasing CPAP levels (none-5-10-15-20 cmH2O) in awake OHS patients. We plotted intra-breath resistance and reactance (Xrs) values against flow (V') and volume (V) to identify tidal expiratory flow limitation (tEFL). RESULTS Thirty-five patients (65.7% male) completed the study. We found a characteristic looping of the Xrs vs V' plot in all patients in the supine position revealing tEFL: Xrs fell with decreasing flow at end-expiration. Intra-breath variables representing expiratory decrease of Xrs became more negative in the supine position [end-expiratory Xrs (mean ± SD): -1.9 ± 1.8 cmH2O·s·L- 1 sitting vs. -4.2 ± 2.2 cmH2O·s·L- 1 supine; difference between end-expiratory and end-inspiratory Xrs: -1.3 ± 1.7 cmH2O·s·L- 1 sitting vs. -3.6 ± 2.0 cmH2O·s·L- 1 supine, p < 0.001]. Increasing CPAP altered expiratory Xrs values and loop areas, suggesting diminished tEFL (p < 0.001). 'Optimal CPAP' value (able to cease tEFL) was 14.8 ± 4.1 cmH2O in our cohort, close to the long-term support average of 13.01(± 2.97) cmH2O but not correlated. We found no correlation between forced spirometry values, patient characteristics, apnea-hypopnea index and intra-breath oscillometry variables. CONCLUSIONS tEFL, worsened by the supine position, can be diminished by stepwise CPAP application in most patients. Intra-breath oscillometry is a viable method to detect tEFL during CPAP initiation in OHS patients and tEFL is a possible target for optimizing therapy in OHS patients.
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Affiliation(s)
- Szabolcs Baglyas
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1082 Üllői út 78/B, Budapest, Hungary.
| | - Luca Valkó
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1082 Üllői út 78/B, Budapest, Hungary
| | - Vivien Móró
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1082 Üllői út 78/B, Budapest, Hungary
| | - Eszter Podmaniczky
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1082 Üllői út 78/B, Budapest, Hungary
| | - Dorottya Czövek
- Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Gergely Makan
- Department of Technical Informatics, University of Szeged, Szeged, Hungary
| | - Zoltán Gingl
- Department of Technical Informatics, University of Szeged, Szeged, Hungary
| | - János Gál
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1082 Üllői út 78/B, Budapest, Hungary
| | - Zoltán Hantos
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1082 Üllői út 78/B, Budapest, Hungary
| | - András Lorx
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1082 Üllői út 78/B, Budapest, Hungary
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Gonzalez-Uribe V, Romero-Tapia SJ, Castro-Rodriguez JA. Asthma Phenotypes in the Era of Personalized Medicine. J Clin Med 2023; 12:6207. [PMID: 37834850 PMCID: PMC10573947 DOI: 10.3390/jcm12196207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Asthma is a widespread disease affecting approximately 300-million people globally. This condition leads to significant morbidity, mortality, and economic strain worldwide. Recent clinical and laboratory research advancements have illuminated the immunological factors contributing to asthma. As of now, asthma is understood to be a heterogeneous disease. Personalized medicine involves categorizing asthma by its endotypes, linking observable characteristics to specific immunological mechanisms. Identifying these endotypic mechanisms is paramount in accurately profiling patients and tailoring therapeutic approaches using innovative biological agents targeting distinct immune pathways. This article presents a synopsis of the key immunological mechanisms implicated in the pathogenesis and manifestation of the disease's phenotypic traits and individualized treatments for severe asthma subtypes.
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Affiliation(s)
- Victor Gonzalez-Uribe
- Alergia e Inmunología Clínica, Hospital Infantil de México Federico Gómez, Ciudad de Mexico 06720, Mexico;
- Facultad Mexicana de Medicina, Universidad La Salle México, Ciudad de Mexico 14000, Mexico
| | - Sergio J. Romero-Tapia
- Health Sciences Academic Division (DACS), Universidad Juárez Autónoma de Tabasco, Villahermosa 86040, Mexico;
| | - Jose A. Castro-Rodriguez
- Department of Pediatric Pulmonology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile
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Sharpe AL, Reibman J, Oppenheimer BW, Goldring RM, Liu M, Shao Y, Bohart I, Kwok B, Weinstein T, Addrizzo-Harris D, Sterman DH, Berger KI. Role of small airway dysfunction in unexplained exertional dyspnoea. ERJ Open Res 2023; 9:00603-2022. [PMID: 37284422 PMCID: PMC10240305 DOI: 10.1183/23120541.00603-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/01/2023] [Indexed: 06/08/2023] Open
Abstract
Background Isolated small airway abnormalities may be demonstrable at rest in patients with normal spirometry; however, the relationship of these abnormalities to exertional symptoms remains uncertain. This study uses an augmented cardiopulmonary exercise test (CPET) to include evaluation of small airway function during and following exercise to unmask abnormalities not evident with standard testing in individuals with dyspnoea and normal spirometry. Methods Three groups of subjects were studied: 1) World Trade Center (WTC) dust exposure (n=20); 2) Clinical Referral (n=15); and Control (n=13). Baseline evaluation included respiratory oscillometry. Airway function during an incremental workload CPET was assessed by: 1) tidal flow versus volume curves during exercise to assess for dynamic hyperinflation and expiratory flow limitation; and 2) post-exercise spirometry and oscillometry to evaluate for airway hyperreactivity. Results All subjects demonstrated normal baseline forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC). Dyspnoea was reproduced during CPET in WTC and Clinical Referral groups versus Control without abnormality in respiratory pattern and minute ventilation. Tidal flow-volume curves uncovered expiratory flow limitation and/or dynamic hyperinflation with increased prevalence in WTC and Clinical Referral versus Control (55%, 87% versus 15%; p<0.001). Post-exercise oscillometry uncovered small airway hyperreactivity with increased prevalence in WTC and Clinical Referral versus Control (40%, 47% versus 0%, p<0.05). Conclusions We uncovered mechanisms for exertional dyspnoea in subject with normal spirometry that was attributable to either small airway dysfunction during exercise and/or small airway hyperreactivity following exercise. The similarity of findings in WTC environmentally exposed and clinically referred cohorts suggests broad relevance for these evaluations.
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Affiliation(s)
- Alexis L. Sharpe
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
- André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA
| | - Joan Reibman
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Beno W. Oppenheimer
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
- André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA
| | - Roberta M. Goldring
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
- André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA
| | - Mengling Liu
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Yongzhao Shao
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Isaac Bohart
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
- André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA
| | - Benjamin Kwok
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
- André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA
| | - Tatiana Weinstein
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
- André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA
| | - Doreen Addrizzo-Harris
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Daniel H. Sterman
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Kenneth I. Berger
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
- André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA
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4
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Shah NM, Kaltsakas G. Respiratory complications of obesity: from early changes to respiratory failure. Breathe (Sheff) 2023. [DOI: 10.1183/20734735.0263-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Obesity is a significant and increasingly common cause of respiratory compromise. It causes a decrease in static and dynamic pulmonary volumes. The expiratory reserve volume is one of the first to be affected. Obesity is associated with reduced airflow, increased airway hyperresponsiveness, and an increased risk of developing pulmonary hypertension, pulmonary embolism, respiratory tract infections, obstructive sleep apnoea and obesity hypoventilation syndrome. The physiological changes caused by obesity will eventually lead to hypoxic or hypercapnic respiratory failure. The pathophysiology of these changes includes a physical load of adipose tissue on the respiratory system and a systemic inflammatory state. Weight loss has clear, well-defined benefits in improving respiratory and airway physiology in obese individuals.
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Jörres RA, Scholl N, Dressel H, Kauffmann-Guerrero D, Karrasch S, Ochmann U, Kneidinger N, Alter P, Magnussen H, Behr J, Nowak D, Kahnert K. A new approach for the detection of obesity-related airway obstruction in lung-healthy individuals. Respir Med 2022; 205:107025. [PMID: 36399895 DOI: 10.1016/j.rmed.2022.107025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/16/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Subjects with obesity show an increased prevalence of airway obstruction but it is not clear in each case whether this reflects genuine lung disease. Via intentional increase in end-expiratory lung volume we studied the detection of obesity-induced airway obstruction in lung-healthy obese subjects. METHODS The primary study population comprised 66 lung-healthy obese subjects and 23 normal weight subjects. Measurements were performed in a body plethysmograph allowing for recording and quantification of breathing loops in terms of specific airway resistance at both normal and intentionally elevated end-expiratory lung volume. The change in volume was documented by a shutter maneuver. RESULTS The voluntary increase of lung volume led to a significant reduction of expiratory airway resistance in 11 of the 66 obese subjects. This reduction could be quantified by a change of total expiratory resistance (sRtEX) of >1 kPa*s but was also clearly visible in the breathing loops. sRtEX showed the largest change among all resistance parameters. The loops of normal weight subjects remained virtually unaffected by the change in lung volume. Moreover, those of 5 obese patients with COPD who were measured for comparison partially showed a reduction of resistance but airway obstruction remained. CONCLUSION The proposed breathing maneuver was simple to perform and allowed for a quantitative and qualitative detection of obesity-induced airway obstruction. This might help in reducing the likelihood of misdiagnosis and overtreatment of obese patients.
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Affiliation(s)
- Rudolf A Jörres
- Institute and Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ludwig-Maximilians-Universität München, LMU Munich, Munich, Germany
| | - Nicola Scholl
- Institute and Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ludwig-Maximilians-Universität München, LMU Munich, Munich, Germany
| | - Holger Dressel
- Division of Occupational and Environmental Medicine, Epidemiology, Biostatistics and Prevention Institute, University of Zurich and University Hospital Zurich, Zurich, Switzerland; Department of Medicine V, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ludwig-Maximilians-Universität München, LMU Munich, Munich, Germany
| | - Diego Kauffmann-Guerrero
- Department of Medicine V, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ludwig-Maximilians-Universität München, LMU Munich, Munich, Germany
| | - Stefan Karrasch
- Institute and Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ludwig-Maximilians-Universität München, LMU Munich, Munich, Germany
| | - Uta Ochmann
- Institute and Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ludwig-Maximilians-Universität München, LMU Munich, Munich, Germany
| | - Nikolaus Kneidinger
- Department of Medicine V, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ludwig-Maximilians-Universität München, LMU Munich, Munich, Germany
| | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, Member of the German Center for Lung Research (DZL), University Medical Center Giessen and Marburg, Philipps-University Marburg (UMR), Marburg, Germany
| | - Helgo Magnussen
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Grosshansdorf, Germany
| | - Jürgen Behr
- Department of Medicine V, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ludwig-Maximilians-Universität München, LMU Munich, Munich, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ludwig-Maximilians-Universität München, LMU Munich, Munich, Germany
| | - Kathrin Kahnert
- Department of Medicine V, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ludwig-Maximilians-Universität München, LMU Munich, Munich, Germany.
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Kaminsky DA, Simpson SJ, Berger KI, Calverley P, de Melo PL, Dandurand R, Dellacà RL, Farah CS, Farré R, Hall GL, Ioan I, Irvin CG, Kaczka DW, King GG, Kurosawa H, Lombardi E, Maksym GN, Marchal F, Oostveen E, Oppenheimer BW, Robinson PD, van den Berge M, Thamrin C. Clinical significance and applications of oscillometry. Eur Respir Rev 2022; 31:31/163/210208. [PMID: 35140105 PMCID: PMC9488764 DOI: 10.1183/16000617.0208-2021] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/29/2021] [Indexed: 12/28/2022] Open
Abstract
Recently, “Technical standards for respiratory oscillometry” was published, which reviewed the physiological basis of oscillometric measures and detailed the technical factors related to equipment and test performance, quality assurance and reporting of results. Here we present a review of the clinical significance and applications of oscillometry. We briefly review the physiological principles of oscillometry and the basics of oscillometry interpretation, and then describe what is currently known about oscillometry in its role as a sensitive measure of airway resistance, bronchodilator responsiveness and bronchial challenge testing, and response to medical therapy, particularly in asthma and COPD. The technique may have unique advantages in situations where spirometry and other lung function tests are not suitable, such as in infants, neuromuscular disease, sleep apnoea and critical care. Other potential applications include detection of bronchiolitis obliterans, vocal cord dysfunction and the effects of environmental exposures. However, despite great promise as a useful clinical tool, we identify a number of areas in which more evidence of clinical utility is needed before oscillometry becomes routinely used for diagnosing or monitoring respiratory disease. This paper provides a current review of the interpretation, clinical significance and application of oscillometry in respiratory medicine, with special emphasis on limitations of evidence and suggestions for future research.https://bit.ly/3GQPViA
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Affiliation(s)
- David A Kaminsky
- Dept of Medicine, Pulmonary and Critical Care Medicine, University of Vermont, Larner College of Medicine, Burlington, VT, USA.,These authors have contributed equally to this manuscript
| | - Shannon J Simpson
- Children's Lung Health, Telethon Kids Institute, School of Allied Health, Curtin University, Perth, Australia.,These authors have contributed equally to this manuscript
| | - Kenneth I Berger
- Division of Pulmonary, Critical Care, and Sleep Medicine, NYU School of Medicine and André Cournand Pulmonary Physiology Laboratory, Belleuve Hospital, New York, NY, USA
| | - Peter Calverley
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Pedro L de Melo
- Dept of Physiology, Biomedical Instrumentation Laboratory, Institute of Biology and Faculty of Engineering, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ronald Dandurand
- Lakeshore General Hospital, Pointe-Claire, QC, Canada.,Montreal Chest Institute, Meakins-Christie Labs, Oscillometry Unit of the Centre for Innovative Medicine, McGill University Health Centre and Research Institute, and McGill University, Montreal, QC, Canada
| | - Raffaele L Dellacà
- Dipartimento di Elettronica, Informazione e Bioingegneria - DEIB, Politecnico di Milano University, Milan, Italy
| | - Claude S Farah
- Dept of Respiratory Medicine, Concord Repatriation General Hospital, Sydney, Australia
| | - Ramon Farré
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona-IDIBAPS, Barcelona, Spain.,CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Graham L Hall
- Children's Lung Health, Telethon Kids Institute, School of Allied Health, Curtin University, Perth, Australia
| | - Iulia Ioan
- Dept of Paediatric Lung Function Testing, Children's Hospital, Vandoeuvre-lès-Nancy, France.,EA 3450 DevAH - Laboratory of Physiology, Faculty of Medicine, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Charles G Irvin
- Dept of Medicine, Pulmonary and Critical Care Medicine, University of Vermont, Larner College of Medicine, Burlington, VT, USA
| | - David W Kaczka
- Depts of Anaesthesia, Biomedical Engineering and Radiology, University of Iowa, Iowa City, IA, USA
| | - Gregory G King
- Dept of Respiratory Medicine and Airway Physiology and Imaging Group, Royal North Shore Hospital, St Leonards, Australia.,Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Hajime Kurosawa
- Dept of Occupational Health, Tohoku University School of Medicine, Sendai, Japan
| | - Enrico Lombardi
- Paediatric Pulmonary Unit, Meyer Paediatric University Hospital, Florence, Italy
| | - Geoffrey N Maksym
- School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
| | - François Marchal
- Dept of Paediatric Lung Function Testing, Children's Hospital, Vandoeuvre-lès-Nancy, France.,EA 3450 DevAH - Laboratory of Physiology, Faculty of Medicine, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Ellie Oostveen
- Dept of Respiratory Medicine, Antwerp University Hospital and University of Antwerp, Belgium
| | - Beno W Oppenheimer
- Division of Pulmonary, Critical Care, and Sleep Medicine, NYU School of Medicine and André Cournand Pulmonary Physiology Laboratory, Belleuve Hospital, New York, NY, USA
| | - Paul D Robinson
- Woolcock Institute of Medical Research, Children's Hospital at Westmead, Sydney, Australia
| | - Maarten van den Berge
- Dept of Pulmonary Diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Cindy Thamrin
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
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Lee H, Choi S, Park JY, Jo DS, Choi UY, Lee H, Jung YT, Chung IH, Choe YJ, Kim JY, Park YJ, Choi EH. Analysis of Critical COVID-19 Cases Among Children in Korea. J Korean Med Sci 2022; 37:e13. [PMID: 34981683 PMCID: PMC8723896 DOI: 10.3346/jkms.2022.37.e13] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/13/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is generally asymptomatic or mild in otherwise healthy children, however, severe cases may occur. In this study, we report the clinical characteristics of children classified as critical COVID-19 in Korea to provide further insights into risk factors and management in children. METHODS This study was a retrospective case series of children < 18 years of age classified as critical COVID-19. Cases were identified by the Korea Disease Control and Prevention Agency surveillance system and medical records were reviewed. Critical COVID-19 was defined as cases with severe illness requiring noninvasive (high flow nasal cannula, continuous positive airway pressure, or bilevel positive airway pressure) or invasive mechanical ventilation, extracorporeal membrane oxygenation (ECMO) or continuous renal replacement therapy (CRRT), between January 20, 2020 and October 7, 2021. RESULTS Among 39,146 cases diagnosed with COVID-19 in subjects < 18 years of age, eight cases (0.02%) were identified as critical COVID-19. The median age was 13 years (range 10 month-17 years) and male-to-female ratio was 1:1. Three children had underlying diseases; one child has asthma and major depressive disorder, one child had Lennox-Gastaut syndrome and one child had mental retardation and was newly diagnosed with type 2 diabetes mellitus with the diagnosis of COVID-19. Among the eight children, seven were obese (body mass index range [BMI] median 29.3, range 25.9-38.2, weight-for-length > 97% for infant) and one was overweight (BMI 21.3). All patients had fever, six patients had dyspnea or cough and other accompanied symptoms included sore throat, headache, lethargy and myalgia. Radiologic findings showed pneumonia within 1-8 days after symptom onset. Pneumonia progressed in these children for 2-6 days and was improved within 5-32 days after diagnosis. Among the eight critical cases, remdesivir was administered in six cases. Steroids were provided for all cases. Inotropics were administered in one case. Six cases were treated with noninvasive mechanical ventilator and three required mechanical ventilator. One case required ECMO due to acute respiratory distress syndrome. All cases were admitted to the intensive care unit and admission period ranged from 9-39 days. Among all critical COVID-19 cases < 18 years of age, there were no fatal cases. CONCLUSION To develop appropriate policies for children in the COVID-19 pandemic, it is important to monitor and assess the clinical burden in this population.
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Affiliation(s)
- Hyunju Lee
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Sujin Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Young Park
- Department of Pediatrics, Chung-Ang University Hospital, Seoul, Korea
| | - Dae Sun Jo
- Department of Pediatrics, Jeonbuk National University Medical School, Jeonju, Korea
| | - Ui Yoon Choi
- Department of Pediatrics, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Heayon Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yun Tae Jung
- Department of Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - In Hyuk Chung
- Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Young June Choe
- Department of Pediatrics, Korea University Anam Hospital, Seoul, Korea
| | - Jin Yong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Incheon Medical Center, Incheon, Korea
| | - Young-Joon Park
- Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Eun Hwa Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
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8
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Jaleel I, Ahamed H. Analysis of spirometric variables with increasing body mass index in normal and overweight healthy individuals. JOURNAL OF CLINICAL SCIENCES 2022. [DOI: 10.4103/jcls.jcls_41_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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9
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Al-Ahmad M, Nurkic J, Othman Y, Jusufovic E, Maher A. Severe asthma in Kuwait population: Phenotype-based approach. Respir Med 2021; 187:106586. [PMID: 34474336 DOI: 10.1016/j.rmed.2021.106586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is increasing recognition of marked phenotypic heterogeneity within severe asthma patients. METHODS Severe asthma patients on GINA step 4 or 5 treatment, followed up at Al-Rashed Allergy center Kuwait, were evaluated for: demographics (gender, age, age of asthma onset), comorbidities (allergic rhinitis (AR), chronic rhinosinusitis (CRS), chronic rhinosinusitis with nasal polyposis (CRSwNP), obesity), blood biomarkers (total serum Immunoglobulin E (IgE), peripheral eosinophils), and sensitization to inhalants allergens. RESULTS A total of 169 patients were candidates for biological treatment. Patients were divided in two groups based on level of total IgE as a "low" group with IgE<160 IU/ml (n = 55) and "high" group with IgE≥ 160 IU/ml (n = 114). Both groups were further divided in subgroups, "low" and "high", based on absolute number of eosinophils (Eos) in peripheral blood with <300 cells/μl or ≥ 300 cells/μl. Only 10% of patients were in low IgE/low Eos while majority (46%) were in the high IgE/high Eos group. Mean age of patients was 44.1 year with domination of females (n = 123). Majority of patients were obese. AR, CRS and CRSwNP were more common in group with IgE ≥160 IU/ml, while CRS and CRSwNP in group with Eos ≥300 cells/μl. CONCLUSION The majority of severe asthma patients in Kuwait are obese females with adult-onset asthma (>18 years of age) who were allergic with comorbid conditions including AR, CRS and CRSwNP, which correlates well with the level of Eos.
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Affiliation(s)
- Mona Al-Ahmad
- Microbiology Department, Faculty of Medicine, Kuwait University, Kuwait; Al-Rashed Allergy Center, Ministry of Health, Kuwait.
| | | | | | - Edin Jusufovic
- Medical Faculty, University of Tuzla, Tuzla, Bosnia and Herzegovina.
| | - Ahmed Maher
- Al-Rashed Allergy Center, Ministry of Health, Kuwait.
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10
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Neder JA. Exercise ventilation and dyspnea in the obese patient with chronic obstructive pulmonary disease: "how much" versus "how well". Chron Respir Dis 2021; 18:14799731211059172. [PMID: 34823379 PMCID: PMC8649746 DOI: 10.1177/14799731211059172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jose Alberto Neder
- Laboratory of Clinical Exercise Physiology and Respiratory Investigation Unit, 4257Queen's University & Kingston General Hospital, Kingston, ON, Canada
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11
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Quirce S, Heffler E, Nenasheva N, Demoly P, Menzies-Gow A, Moreira-Jorge A, Nissen F, Hanania NA. Revisiting Late-Onset Asthma: Clinical Characteristics and Association with Allergy. J Asthma Allergy 2020; 13:743-752. [PMID: 33408487 PMCID: PMC7781019 DOI: 10.2147/jaa.s282205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/18/2020] [Indexed: 12/12/2022] Open
Abstract
The Global Initiative for Asthma (GINA) 2020 defines late-onset asthma (LOA) as one of the clinical phenotypes of asthma wherein patients, particularly women, present with asthma for the first time in adult life, tend to be non-allergic and often require higher doses of inhaled corticosteroids (ICS) or are relatively refractory to corticosteroid treatment. In this review, we examine the published literature improve the understanding of the following aspects of LOA: 1) the age cut-off for its diagnosis; 2) its distinct clinical phenotypes, characteristics and risk factors; and 3) its association with allergic comorbidities and conditions. Overall, our review reveals that clinicians and researchers have used multiple age cut-offs to define LOA, with cut-off ages ranging from >12 years to ≥65 years. LOA has also been classified into several distinct phenotypes, some of which drastically differ in their clinical characteristics, course and prognosis. Although LOA has traditionally been considered non-allergic in nature, our review indicates that it is commonly associated with allergic features and comorbidities. Our findings suggest that there is an urgent need for the development of more clear clinical practice guidelines that can provide more clarity on the definition and other aspects of LOA. In addition, the association of LOA and allergy needs to be re-examined to frame a more optimal treatment strategy for patients with LOA.
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Affiliation(s)
- Santiago Quirce
- Department of Allergy, La Paz University Hospital, IdiPAZ and Universidad Autónoma de Madrid, Madrid, Spain
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
| | - Natalia Nenasheva
- Department of Allergology and Immunology of Russian Medical Academy for Continuous Medical Education, Moscow, Russian Federation
| | - Pascal Demoly
- Department of Pulmonology, Division of Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
| | | | | | - Francis Nissen
- London School of Hygiene and Tropical Medicine, London, UK
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
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12
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Multiple breath washout: A noninvasive tool for identifying lung disease in symptomatic military deployers. Respir Med 2020; 176:106281. [PMID: 33340829 DOI: 10.1016/j.rmed.2020.106281] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 01/08/2023]
Abstract
RATIONALE Military deployments to austere environments since November 9, 2001 may put "deployers" at risk for respiratory disease. Sensitive, noninvasive tools for detecting large and small airways injury are needed to identify early disease and help inform management for this at-risk population. OBJECTIVES We examined multiple breath washout (MBW) as a tool for identifying deployment-related airways disease and assessed host and exposure risk factors compared to healthy controls. METHODS Between March 2015 and March 2020, 103 healthy controls and 71 symptomatic deployers with asthma and/or distal lung disease completed a questionnaire, spirometry and MBW testing. SAS v. 9.4 was used to compare MBW parameters between deployers and controls via univariate analyses and adjusted for demographic factors using multiple linear regression. MEASUREMENTS AND MAIN RESULTS Deployers were significantly more likely than controls to have an abnormal lung clearance index (LCI) score indicating global ventilation inhomogeneity. Adjusting for sex, smoking status, smoking pack-years and body mass index, LCI scores were significantly more abnormal among those with deployment-related asthma and distal lung disease compared to controls. The unadjusted variable Sacin (a marker of ventilation inhomogeneity in the acinar airways) was higher and thus more abnormal in those with both proximal and distal airways disease. Deployers who reported more frequent exposure to explosive blasts had significantly higher LCI scores. CONCLUSIONS This study demonstrates the utility of MBW in evaluating exposure-related airways disease in symptomatic military personnel following deployment to austere environments, and is the first to link exposure to explosive blasts to measurable small airways injury.
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13
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Al Khathlan N, Salem AM. The Effect of Adiposity Markers on Fractional Exhaled Nitric Oxide (FeNO) and Pulmonary Function Measurements. Int J Gen Med 2020; 13:955-962. [PMID: 33149659 PMCID: PMC7605624 DOI: 10.2147/ijgm.s280395] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/08/2020] [Indexed: 12/16/2022] Open
Abstract
Background The effect of increasing body weight on pulmonary function and the fractional exhaled nitric oxide (FeNO) remains controversial and the role of different body compositions in the relationship between obesity with pulmonary function and FeNO is still unrevealed. Thus, we aim to determine the effect of overweight/obesity on lung function and FeNO, focusing on the relationship with different body compositions. Methods Eighty-two non-smoker students (20 ± 1.9 years) were divided into two groups: 38 subjects with normal weight (BMI = 18.5–24.99) and 44 overweight/obese subjects (BMI ≥ 25). Spirometric parameters and FeNO were measured and compared between groups and were correlated with different adiposity markers. Results FeNO measurements were elevated in the overweight/obese group [median (IQR) 19.5 (13)] in comparison to the normal weight group [11 (10), p value = 0.017]. A positive correlation was found between FeNO measurements and body mass index (BMI), waist circumference, hip circumference, waist-hip ratio, and visceral fat percentage (all p values < 0.01). The absolute values of forced vital capacity (FVC) forced expiratory volume in the first second (FEV1), peak expiratory flow (PEF), forced expiratory flow during mid-expiration (FEF25–75%), and FEV1/FVC ratio showed no significant differences between groups. However, the percentage of the predicted values of FEV1 and FVC was significantly higher and the value of percentage predicted FEF25–75% was reduced significantly in the overweight/obese subjects. Conclusion Increase in BMI could significantly increase airway inflammation as measured by FeNO, as well as on distal airway function as determined by the percentage predicted values of FEF25–75%. A significant correlation was also identified between visceral fat and FeNO measurement.
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Affiliation(s)
- Noor Al Khathlan
- Respiratory Care Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ayad Mohammed Salem
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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14
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Abstract
This article will discuss in detail the pathophysiology of asthma from the point of view of lung mechanics. In particular, we will explain how asthma is more than just airflow limitation resulting from airway narrowing but in fact involves multiple consequences of airway narrowing, including ventilation heterogeneity, airway closure, and airway hyperresponsiveness. In addition, the relationship between the airway and surrounding lung parenchyma is thought to be critically important in asthma, especially as related to the response to deep inspiration. Furthermore, dynamic changes in lung mechanics over time may yield important information about asthma stability, as well as potentially provide a window into future disease control. All of these features of mechanical properties of the lung in asthma will be explained by providing evidence from multiple investigative methods, including not only traditional pulmonary function testing but also more sophisticated techniques such as forced oscillation, multiple breath nitrogen washout, and different imaging modalities. Throughout the article, we will link the lung mechanical features of asthma to clinical manifestations of asthma symptoms, severity, and control. © 2020 American Physiological Society. Compr Physiol 10:975-1007, 2020.
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Affiliation(s)
- David A Kaminsky
- University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - David G Chapman
- University of Technology Sydney, Sydney, New South Wales, Australia
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15
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Zimmermann SC, Thamrin C, Chan AS, Bertolin A, Chapman DG, King GG. Relationships Between Forced Oscillatory Impedance and 6-minute Walk Distance After Pulmonary Rehabilitation in COPD. Int J Chron Obstruct Pulmon Dis 2020; 15:157-166. [PMID: 32021155 PMCID: PMC6982450 DOI: 10.2147/copd.s225543] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/19/2019] [Indexed: 12/16/2022] Open
Abstract
Rationale Pulmonary rehabilitation for chronic obstructive pulmonary disease (COPD) reduces dyspnoea and improves exercise capacity and quality of life. The improvement in exercise capacity is variable and unpredictable, however. Respiratory system impedance obtained by forced oscillation technique (FOT) as a measure of ventilatory impairment in COPD may relate to improvement in exercise capacity with pulmonary rehabilitation. We aimed to determine if baseline FOT parameters relate to changes in exercise capacity following pulmonary rehabilitation. Methods At the start of rehabilitation, 15 COPD subjects (mean(SD) 75.2(6.1) years, FEV1 z-score −2.61(0.84)) had measurements by FOT, spirometry, plethysmographic lung volumes and 6-minute walk distance (6MWD). Respiratory system resistance (Rrs) and reactance (Xrs) parameters as the mean over all breaths (Rmean, Xmean), during inspiration only (Rinsp, Xinsp), and expiratory flow limitation (DeltaXrs = Xinsp−Xexp), were calculated. FOT and 6MWD measurements were repeated at completion of rehabilitation and 3 months after completion. Results At baseline, Xrs measures were unrelated to 6MWD. Xinsp improved significantly with rehabilitation (from mean(SD) −2.35(1.02) to −2.04(0.85) cmH2O.s.L−1, p=0.008), while other FOT parameters did not. No FOT parameters related to the change in 6MWD at program completion. Baseline Xmean, DeltaXrs, and FVC z-score correlated with the change in 6MWD between completion and 3 months after completion of rehabilitation (rs=0.62, p=0.03; rs=−0.65, p=0.02; and rs=0.62, p=0.03, respectively); with worse ventilatory impairment predicting loss of 6MWD. There were no relationships between Rrs parameters, FEV1 or FEV1/FVC z-scores and changes in 6MWD. Conclusion Baseline reactance parameters may be helpful in predicting those patients with COPD at most risk of loss of exercise capacity following completion of pulmonary rehabilitation.
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Affiliation(s)
- Sabine C Zimmermann
- The Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW 2037, Australia.,The Northern Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney, Camperdown, NSW 2006, Australia.,Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Cindy Thamrin
- The Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW 2037, Australia
| | - Andrew Sl Chan
- The Northern Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney, Camperdown, NSW 2006, Australia.,Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Amy Bertolin
- The Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW 2037, Australia
| | - David G Chapman
- The Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW 2037, Australia.,School of Life Sciences, Faculty of Science, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Gregory G King
- The Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW 2037, Australia.,The Northern Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney, Camperdown, NSW 2006, Australia.,Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
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16
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Rutting S, Mahadev S, Tonga KO, Bailey DL, Dame Carroll JR, Farrow CE, Thamrin C, Chapman DG, King GG. Obesity alters the topographical distribution of ventilation and the regional response to bronchoconstriction. J Appl Physiol (1985) 2020; 128:168-177. [DOI: 10.1152/japplphysiol.00482.2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Obesity is associated with reduced operating lung volumes that may contribute to increased airway closure during tidal breathing and abnormalities in ventilation distribution. We investigated the effect of obesity on the topographical distribution of ventilation before and after methacholine-induced bronchoconstriction using single-photon emission computed tomography (SPECT)-computed tomography (CT) in healthy subjects. Subjects with obesity ( n = 9) and subjects without obesity ( n = 10) underwent baseline and postbronchoprovocation SPECT-CT imaging, in which Technegas was inhaled upright and followed by supine scanning. Lung regions that were nonventilated (Ventnon), low ventilated (Ventlow), or well ventilated (Ventwell) were calculated using an adaptive threshold method and were expressed as a percentage of total lung volume. To determine regional ventilation, lungs were divided into upper, middle, and lower thirds of axial length, derived from CT. At baseline, Ventnon and Ventlow for the entire lung were similar in subjects with and without obesity. However, in the upper lung zone, Ventnon (17.5 ± 10.6% vs. 34.7 ± 7.8%, P < 0.001) and Ventlow (25.7 ± 6.3% vs. 33.6 ± 5.1%, P < 0.05) were decreased in subjects with obesity, with a consequent increase in Ventwell (56.8 ± 9.2% vs. 31.7 ± 10.1%, P < 0.001). The greater diversion of ventilation to the upper zone was correlated with body mass index ( rs = 0.74, P < 0.001), respiratory system resistance ( rs = 0.72, P < 0.001), and respiratory system reactance ( rs = −0.64, P = 0.003) but not with lung volumes or basal airway closure. Following bronchoprovocation, overall Ventnon increased similarly in both groups; however, in subjects without obesity, Ventnon only increased in the lower zone, whereas in subjects with obesity, Ventnon increased more evenly across all lung zones. In conclusion, obesity is associated with altered ventilation distribution during baseline and following bronchoprovocation, independent of reduced lung volumes. NEW & NOTEWORTHY Using ventilation SPECT-computed tomography imaging in healthy subjects, we demonstrate that ventilation in obesity is diverted to the upper lung zone and that this is strongly correlated with body mass index but is independent of operating lung volumes and of airway closure. Furthermore, methacholine-induced bronchoconstriction only occurred in the lower lung zone in individuals who were not obese, whereas in subjects who were obese, it occurred more evenly across all lung zones. These findings show that obesity-associated factors alter the topographical distribution of ventilation.
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Affiliation(s)
- S. Rutting
- Department of Respiratory Medicine, Royal North Shore Hospital, St. Leonards, NSW, Australia
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
| | - S. Mahadev
- Department of Respiratory Medicine, Royal North Shore Hospital, St. Leonards, NSW, Australia
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
| | - K. O. Tonga
- Department of Respiratory Medicine, Royal North Shore Hospital, St. Leonards, NSW, Australia
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
- Department of Thoracic and Transplant Medicine, St. Vincent's Hospital, Darlinghurst, NSW, Australia
- Faculty of Medicine & Health, University of Sydney, NSW, Australia
| | - D. L. Bailey
- Faculty of Medicine & Health, University of Sydney, NSW, Australia
- Department of Nuclear Medicine, Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - J. R. Dame Carroll
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
| | - C. E. Farrow
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
- Faculty of Medicine & Health, University of Sydney, NSW, Australia
- Department of Respiratory Medicine, Westmead Hospital, Westmead, NSW, Australia
| | - C. Thamrin
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
| | - D. G. Chapman
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Ultimo, NSW, Australia
| | - G. G. King
- Department of Respiratory Medicine, Royal North Shore Hospital, St. Leonards, NSW, Australia
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
- NHMRC Centre of Excellence in Severe Asthma, New Lambton Heights, NSW, Australia
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17
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Abstract
The role for direct assessment of small airway function in subjects with respiratory symptoms but normal airflow by spirometry is discussed. Small airway disease syndrome is described in numerous disease states using a multidisciplinary approach. Data demonstrate that small airway disease is related to presence of respiratory symptoms, exposure to inhaled toxins, presence of local and systemic inflammation, and presence of histologic abnormalities within the distal lung. Investigation of immunological derangements associated with distal airway dysfunction in the setting of normal spirometry may provide insight into pathophysiological mechanisms that are present at disease onset. For the purposes of this symposium, data were reviewed in selected clinical conditions (obesity, environmental inhalational injury, and cigarette smoking) that have been recently studied in the André Cournand Pulmonary Physiology Laboratory at Bellevue Hospital using the forced oscillation technique.
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18
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Sant'Anna MD, Carvalhal RF, Oliveira FDFBD, Zin WA, Lopes AJ, Lugon JR, Guimarães FS. Respiratory mechanics of patients with morbid obesity. ACTA ACUST UNITED AC 2019; 45:e20180311. [PMID: 31644708 PMCID: PMC8653979 DOI: 10.1590/1806-3713/e20180311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 04/16/2019] [Indexed: 02/19/2023]
Abstract
OBJECTIVE To evaluate the different components of the resistance of the respiratory system, respiratory muscle strength and to investigate the occurrence of expiratory flow limitation (EFL) in patients with morbid obesity (MO) when seated. METHODS The sample was composed of MO (BMI≥40 kg/m2) and non-obese individuals (NO) with a BMI between 18 and 30 kg/m2. The protocol consisted of the anthropometric assessment and the following measures of respiratory function: spirometry, maximal inspiratory and expiratory pressures (MIP and MEP, respectively) and impulse oscillometry. The group comparison was performed using T-test for unpaired samples. The correlations were evaluated by the Pearson test with a significance level of 5%. RESULTS Fifty MO (age 40±10.4 years, 1.64±0.09 m, 138.8±33.6 kg and 50.7±8.9 kg/m2), and 30 NO (age 37.6±11.5 years, 1.67±0.09 m, 65.2±10.3 kg and 23.2±22 kg/m2) were evaluated. The MO showed higher values of total, peripheral, airways, tissue and central resistance when compared to the NO. No patient showed EFL. The waist circumference was associated with spirometric variables, MIP, and MEP. The waist-to-hip ratio was correlated to respiratory mechanics and spirometric variables, MIP, and MEP. CONCLUSION Morbidly obese patients with no obstructive spirometric pattern show increased total, airway, peripheral, and tissue respiratory system resistance when compared to nonobese. These individuals, however, do not present with expiratory flow limitation and reduced respiratory muscles strength.
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Affiliation(s)
- Mauricio de Sant'Anna
- Curso de Fisioterapia, Instituto Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Renata Ferreira Carvalhal
- Programa de cirurgia bariátrica, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | | | - Walter Araújo Zin
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Agnaldo José Lopes
- Programa de Pós-Graduação em Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro (RJ) Brasil.,Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro (RJ) Brasil
| | - Jocemir Ronaldo Lugon
- Departamento de Medicina Clínica/Nefrologia, Faculdade de Medicina, Universidade Federal Fluminense, Niterói (RJ) Brasil
| | - Fernando Silva Guimarães
- Departamento de Fisioterapia, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
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19
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King GG, Thamrin C. Obesity and the lungs: Not just a crush. Respirology 2019; 24:502-503. [PMID: 30897266 DOI: 10.1111/resp.13532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 02/28/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Gregory G King
- Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, NSW, Australia.,Faculty of Medicine and Health, The Woolcock Institute of Medical Research and Northern Clinical School, The University of Sydney, Sydney, NSW, Australia.,NHMRC Centre of Excellence in Severe Asthma, Newcastle, NSW, Australia
| | - Cindy Thamrin
- Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, NSW, Australia.,Faculty of Medicine and Health, The Woolcock Institute of Medical Research and Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
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20
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Kaminsky DA, Chapman DG, Holbrook JT, Henderson RJ, Sugar EA, Mastronarde J, Teague WG, Busk M, Sumino K, Dixon AE, Wise RA, Irvin CG. Older age and obesity are associated with increased airway closure in response to methacholine in patients with asthma. Respirology 2019; 24:638-645. [PMID: 30838750 DOI: 10.1111/resp.13496] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 11/29/2018] [Accepted: 01/02/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND OBJECTIVE The reduction of forced expiratory volume in 1 s (FEV1 ) in response to methacholine challenge in asthma may reflect two components: airway narrowing, assessed by the change in FEV1 /forced vital capacity (FVC), and airway closure, assessed by the change in FVC. The purpose of this study was to determine the degree and determinants of airway closure in response to methacholine in a large group of asthmatic patients participating in studies conducted by the American Lung Association-Airways Clinical Research Centers (ALA-ACRC). METHODS We used the methacholine challenge data from participants in five studies of the ALA-ACRC to determine the closing index, defined as the contribution of airway closure to the decrease in FEV1 , and calculated as %ΔFVC/%ΔFEV1 . RESULTS There were a total of 936 participants with asthma, among whom the median closing index was 0.67 relative to that of a published healthy population of 0.54. A higher closing index was associated with increased age (10-year increments) (0.04, 95% CI = 0.02, 0.05, P < 0.005) and obesity (0.07, 95% CI = 0.03, 0.10, P < 0.001). There was no association between the closing index and asthma control. CONCLUSION Our findings confirm that airway closure in response to methacholine occurs in a large, diverse population of asthmatic participants, and that increased airway closure is associated with older age and obesity. These findings suggest that therapies targeting airway closure may be important in patients with a high closing index.
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Affiliation(s)
- David A Kaminsky
- Pulmonary and Critical Care, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - David G Chapman
- Pulmonary and Critical Care, University of Vermont Larner College of Medicine, Burlington, VT, USA.,Translational Airways Group, School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia.,Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, Sydney, NSW, Australia
| | - Janet T Holbrook
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Robert J Henderson
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Elizabeth A Sugar
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - John Mastronarde
- Division of Pulmonary Medicine, Providence Portland Medical Center, Portland, OR, USA
| | - William G Teague
- Division of Pediatric Respiratory Medicine and Allergy, University of Virginia, Charlottesville, VA, USA
| | - Michael Busk
- Division of Pulmonary Medicine, St. Vincent Hospital and Health Care Center, Inc., Indianapolis, IN, USA
| | - Kaharu Sumino
- Division of Pulmonary and Critical Care Medicine, Washington University, St. Louis, MO, USA
| | - Anne E Dixon
- Pulmonary and Critical Care, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Charles G Irvin
- Pulmonary and Critical Care, University of Vermont Larner College of Medicine, Burlington, VT, USA
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21
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Milne S, Jetmalani K, Chapman DG, Duncan JM, Farah CS, Thamrin C, King GG. Respiratory system reactance reflects communicating lung volume in chronic obstructive pulmonary disease. J Appl Physiol (1985) 2019; 126:1223-1231. [PMID: 30763164 DOI: 10.1152/japplphysiol.00503.2018] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Respiratory system reactance (Xrs) measured by the forced oscillation technique (FOT) is theoretically and experimentally related to lung volume. In chronic obstructive pulmonary disease (COPD), the absolute volume measured by body plethysmography includes a proportion that is inaccessible to pressure oscillations applied via the mouth, that is, a "noncommunicating" lung volume. We hypothesized that in COPD the presence of noncommunicating lung would disrupt the expected Xrs-volume relationship compared with plethysmographic functional residual capacity (FRCpleth). Instead, Xrs would relate to estimates of communicating volume, namely, expiratory reserve volume (ERV) and single-breath alveolar volume (VaSB). We examined FOT and lung function data from people with COPD (n = 51) and from healthy volunteers (n = 40). In healthy volunteers, we observed an expected inverse relationship between reactance at 5 Hz (X5) and FRCpleth. In contrast, there was no such relationship between X5 and FRCpleth in COPD subjects. However, there was an inverse relationship between X5 and both ERV and VaSB. Hence the theoretical Xrs-volume relationship is present in COPD but only when considering the communicating volume rather than the absolute lung volume. These findings confirm the role of reduced communicating lung volume as an important determinant of Xrs and therefore advance our understanding and interpretation of FOT measurements in COPD. NEW & NOTEWORTHY To investigate the determinants of respiratory system reactance (Xrs) measured by the forced oscillation technique (FOT) in chronic obstructive pulmonary disease (COPD), we examine the relationship between Xrs and lung volume. We show that Xrs does not relate to absolute lung volume (functional residual capacity) in COPD but instead relates only to the volume of lung in communication with the airway opening. This communicating volume may therefore be fundamental to our interpretation of FOT measurements in COPD and other pulmonary diseases.
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Affiliation(s)
- Stephen Milne
- The Woolcock Emphysema Centre and Airway Physiology and Imaging Group, Woolcock Institute of Medical Research and Sydney Medical School, University of Sydney, Glebe, New South Wales , Australia.,Department of Respiratory Medicine, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales , Australia.,Department of Respiratory Medicine, Concord Repatriation General Hospital, Sydney Local Health District, Concord, New South Wales , Australia
| | - Kanika Jetmalani
- The Woolcock Emphysema Centre and Airway Physiology and Imaging Group, Woolcock Institute of Medical Research and Sydney Medical School, University of Sydney, Glebe, New South Wales , Australia
| | - David G Chapman
- The Woolcock Emphysema Centre and Airway Physiology and Imaging Group, Woolcock Institute of Medical Research and Sydney Medical School, University of Sydney, Glebe, New South Wales , Australia.,Translational Airways Group, School of Life Sciences, University of Technology Sydney , Ultimo, New South Wales , Australia
| | - Joseph M Duncan
- Department of Respiratory Medicine, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales , Australia
| | - Claude S Farah
- The Woolcock Emphysema Centre and Airway Physiology and Imaging Group, Woolcock Institute of Medical Research and Sydney Medical School, University of Sydney, Glebe, New South Wales , Australia.,Department of Respiratory Medicine, Concord Repatriation General Hospital, Sydney Local Health District, Concord, New South Wales , Australia.,Faculty of Medicine and Health Sciences, Macquarie University , North Ryde, New South Wales , Australia
| | - Cindy Thamrin
- The Woolcock Emphysema Centre and Airway Physiology and Imaging Group, Woolcock Institute of Medical Research and Sydney Medical School, University of Sydney, Glebe, New South Wales , Australia
| | - Gregory G King
- The Woolcock Emphysema Centre and Airway Physiology and Imaging Group, Woolcock Institute of Medical Research and Sydney Medical School, University of Sydney, Glebe, New South Wales , Australia.,Department of Respiratory Medicine, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales , Australia.,Centre of Research Excellence in Severe Asthma, New Lambton, New South Wales , Australia
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22
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Duan XZ, Xu ZY, Lu FL, Han L, Tang YF, Tang H, Liu Y. Inflammation is related to preoperative hypoxemia in patients with acute Stanford type A aortic dissection. J Thorac Dis 2018; 10:1628-1634. [PMID: 29707315 DOI: 10.21037/jtd.2018.03.48] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Preoperative hypoxemia is a frequent complication of acute Stanford type A aortic dissection (ATAAD). The aim of the present study was to determine which factors were associated with hypoxemia. Methods A series of data were collected in a statistical analysis to evaluate preoperative hypoxemia in patients with ATAAD. After retrospectively analyzing data for 172 patients, we identified the risk factors for preoperative hypoxemia. Hypoxemia was defined by an arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) ratio of 200 or lower. Subsequent to identifying the patient population, a prospective study was conducted using ulinastatin as a preoperative intervention. The ulinastatin group received ulinastatin at a total dose of 300,000 units prior to surgery. All the pertinent factors were investigated through univariate and multiple logistic regression analysis. Results The factors associated with preoperative hypoxemia in ATAAD comprised the following: body mass index (BMI) ≥25; white blood cell count (WBC) and neutrophil counts; levels of C-reactive protein (CRP), D-dimer, and interleukin-6 (IL-6); ATAAD involving the celiac trunk, renal artery, or mesenteric artery. Logistic regression analysis showed that CRP and IL-6 levels were independent predictive factors. We found that ulinastatin effectively could improve oxygenation, since compared to the control group the oxygenation in the ulinastatin group was significantly improved. Conclusions Systemic inflammatory reactions played a vital role in preoperative hypoxemia after the onset of ATAAD. The oxygenation of the patient could be improved significantly by inhibiting the inflammatory response prior to surgery.
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Affiliation(s)
- Xu-Zhou Duan
- Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Zhi-Yun Xu
- Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Fang-Lin Lu
- Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Lin Han
- Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Yang-Feng Tang
- Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Hao Tang
- Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Yang Liu
- Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
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Abstract
Because the pathophysiology of asthma has diverse characteristics, to manage the disease effectively, it is important for clinicians to distinguish among the clinical phenotypes. Among them, adult-onset asthma, that is, late-onset asthma (LOA), is increasing because of the aging of the population. The phenotype of LOA is largely divided into two types according to the presence or absence of eosinophilic inflammation, T-helper (Th)2- and non-Th2-associated LOA. Especially in Th2 LOA related to rhinosinusitis, as pulmonary function at onset is poor and asthma exacerbations occur frequently, it is important to detect this phenotype in the early phase by using a biomarker of Th2-type inflammation such as fractional exhaled nitric oxide (FENO). As non-Th2-LOA is often resistant to corticosteroids, this phenotype often requires another treatment strategy such as macrolide, diet, or smoking cessation. We often struggle with the management of LOA patients due to a lack of evidence; therefore, the elucidation of the mechanism of LOA contributes to increased efficiency of diagnosis and treatment of LOA. Age-related immune system and structural changes are thought to be associated with the pathophysiology of LOA. In the former case, changes in inflammatory cell function such as variations in the innate immune response and acquisition of autoimmunity or upregulation of oxidative stress are thought to be involved in the mechanism. Meanwhile, the latter can also become triggers or exacerbating factors of LOA via enhancement of airway hyperresponsiveness, decline in lung function, increased air trapping, and reduction in chest wall compliance. Therefore, appropriate individualized management in LOA may be possible through precisely assessing the pathophysiology based on age-related functional changes, including the immune and structural system.
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Affiliation(s)
- Tsunahiko Hirano
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Kazuto Matsunaga
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
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24
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Abstract
OBJECTIVE This literature review aims to compare obese-asthmatic adults and children, and to characterize differences and similarities between the two subgroups from epidemiological, demographical, phenotypical, and physiological perspectives. METHODS Literature search was conducted using Pubmed database with "obesity," "asthma," "epidemiology," "cluster analysis," "demography," "mechanics," and ''FeNO'' as search terms. METHODS Articles investigating epidemiological, demographic, phenotypical variation, and mechanical aspects of breathing specifically in obese asthmatics were identified. The studies were then divided according to age: children (<18 years of age) and adults (>18 years of age). RESULTS Increase in asthma incidence and prevalence is observed in both obese-asthmatic children and adults. Asthma prevalence is greater in adult females regardless of ethnic background, and in men of African American and Hispanic ethnicities. Degree of weight gain and early onset of menarche appears to directly affect asthma severity in adolescent girls and females. Airway hyperresponsiveness and fractional exhaled nitric oxide do not have any positive correlation with high BMI in obese-asthmatic children and adults. Obesity also alters lung mechanics in asthmatics, but the impact is different for children and adults likely due to differential effect of obesity on central and peripheral airway. CONCLUSION Existing literature suggests both similarities and differences in obese-asthmatic children and adults. The most pertinent differences are related to gender, ethnicity, and lung functions.
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Affiliation(s)
- Faiza Khalid
- a Department of Internal Medicine , University Hospitals Cleveland Medical Center/ Case Western Reserve University , Cleveland , OH , USA
| | - Fernando Holguin
- b Division of Pulmonary and Critical Care , University of Colorado , Denver , CO , USA
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25
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Robinson PD, King GG, Sears MR, Hong CY, Hancox RJ. Determinants of peripheral airway function in adults with and without asthma. Respirology 2017; 22:1110-1117. [PMID: 28397998 DOI: 10.1111/resp.13045] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/10/2017] [Accepted: 01/26/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Peripheral airway involvement in asthma remains poorly understood. We investigated impulse oscillometry (IOS) measures of peripheral airway function in a population-based birth cohort. METHODS Pre- and post-bronchodilator spirometry and IOS measures of respiratory resistance and reactance were measured in 915 participants at age 38 years. RESULTS Current asthma was associated with impairments in both spirometry and IOS parameters. These impairments were greater in men and in those with childhood persistent asthma. Spirometry and IOS values for those whose asthma was in remission were not different to non-asthmatic participants. There were significant changes in IOS in both asthmatic and non-asthmatic participants after bronchodilator, but between-group differences persisted. Higher BMIs were associated with impairments in IOS but not spirometry. Cumulative tobacco use was associated with spirometric airflow obstruction in both sexes, whereas cannabis use was associated with impairments in IOS in women. Despite higher lifetime exposure, there were few associations between cannabis and IOS in men. CONCLUSION Asthma is associated with abnormalities in IOS measures of peripheral airway dysfunction. This association is stronger in men and in those with asthma persisting since childhood. Tobacco and cannabis use are associated with different patterns of spirometry and IOS abnormalities and may affect the bronchial tree at different airway generations with differences in susceptibility between sexes.
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Affiliation(s)
- Paul D Robinson
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, New South Wales, Australia.,Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Gregory G King
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, New South Wales, Australia.,NHMRC Centre of Excellence in Severe Asthma, The University of Sydney, Sydney, New South Wales, Australia.,Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Malcolm R Sears
- Firestone Institute for Respiratory Health, Michael de Groote School of Medicine, McMaster University and St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Chuen Y Hong
- Department of Mathematics and Statistics, University of Otago, Dunedin, New Zealand
| | - Robert J Hancox
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
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26
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Lorx A, Czövek D, Gingl Z, Makan G, Radics B, Bartusek D, Szigeti S, Gál J, Losonczy G, Sly PD, Hantos Z. Airway dynamics in COPD patients by within-breath impedance tracking: effects of continuous positive airway pressure. Eur Respir J 2017; 49:49/2/1601270. [DOI: 10.1183/13993003.01270-2016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 11/08/2016] [Indexed: 11/05/2022]
Abstract
Tracking of the within-breath changes of respiratory mechanics using the forced oscillation technique may provide outcomes that characterise the dynamic behaviour of the airways during normal breathing.We measured respiratory resistance (Rrs) and reactance (Xrs) at 8 Hz in 55 chronic obstructive pulmonary disease (COPD) patients and 20 healthy controls, and evaluated Rrs and Xrs as functions of gas flow (V′) and volume (V) during normal breathing cycles. In 12 COPD patients, additional measurements were made at continuous positive airway pressure (CPAP) levels of 4, 8, 14 and 20 hPa.The Rrs and Xrsversus V′ and V relationships displayed a variety of loop patterns, allowing characterisation of physiological and pathological processes. The main outcomes emerging from the within-breath analysis were the Xrsversus V loop area (AXV) quantifying expiratory flow limitation, and the tidal change in Xrs during inspiration (ΔXI) reflecting alteration in lung inhomogeneity in COPD. With increasing CPAP, AXV and ΔXI approached the normal ranges, although with a large variability between individuals, whereas mean Rrs remained unchanged.Within-breath tracking of Rrs and Xrs allows an improved assessment of expiratory flow limitation and functional inhomogeneity in COPD; thereby it may help identify the physiological phenotypes of COPD and determine the optimal level of respiratory support.
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Mafort TT, Rufino R, Costa CH, Lopes AJ. Obesity: systemic and pulmonary complications, biochemical abnormalities, and impairment of lung function. Multidiscip Respir Med 2016; 11:28. [PMID: 27408717 PMCID: PMC4940831 DOI: 10.1186/s40248-016-0066-z] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 05/10/2016] [Indexed: 12/11/2022] Open
Abstract
Obesity is currently one of the major epidemics of this millennium and affects individuals throughout the world. It causes multiple systemic complications, some of which result in severe impairment of organs and tissues. These complications involve mechanical changes caused by the accumulation of adipose tissue and the numerous cytokines produced by adipocytes. Obesity also significantly interferes with respiratory function by decreasing lung volume, particularly the expiratory reserve volume and functional residual capacity. Because of the ineffectiveness of the respiratory muscles, strength and resistance may be reduced. All these factors lead to inspiratory overload, which increases respiratory effort, oxygen consumption, and respiratory energy expenditure. It is noteworthy that patterns of body fat distribution significantly influence the function of the respiratory system, likely via the direct mechanical effect of fat accumulation in the chest and abdominal regions. Weight loss caused by various types of treatment, including low-calorie diet, intragastric balloon, and bariatric surgery, significantly improves lung function and metabolic syndrome and reduces body mass index. Despite advances in the knowledge of pulmonary and systemic complications associated with obesity, longitudinal randomized studies are needed to assess the impact of weight loss on metabolic syndrome and lung function.
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Affiliation(s)
- Thiago Thomaz Mafort
- Laboratory of Respiration Physiology, Pulmonary Medicine Department, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Boulevard 28 de Setembro, 77, Vila Isabel, 20551-030 Rio de Janeiro Brazil
| | - Rogério Rufino
- Laboratory of Respiration Physiology, Pulmonary Medicine Department, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Boulevard 28 de Setembro, 77, Vila Isabel, 20551-030 Rio de Janeiro Brazil ; Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, Av. Prof. Manoel de Abreu, 444, Vila Isabel, 20550-170 Rio de Janeiro Brazil
| | - Cláudia Henrique Costa
- Laboratory of Respiration Physiology, Pulmonary Medicine Department, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Boulevard 28 de Setembro, 77, Vila Isabel, 20551-030 Rio de Janeiro Brazil ; Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, Av. Prof. Manoel de Abreu, 444, Vila Isabel, 20550-170 Rio de Janeiro Brazil
| | - Agnaldo José Lopes
- Laboratory of Respiration Physiology, Pulmonary Medicine Department, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Boulevard 28 de Setembro, 77, Vila Isabel, 20551-030 Rio de Janeiro Brazil ; Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, Av. Prof. Manoel de Abreu, 444, Vila Isabel, 20550-170 Rio de Janeiro Brazil
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van de Kant KDG, Paredi P, Meah S, Kalsi HS, Barnes PJ, Usmani OS. The effect of body weight on distal airway function and airway inflammation. Obes Res Clin Pract 2015; 10:564-573. [PMID: 26620577 DOI: 10.1016/j.orcp.2015.10.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/14/2015] [Accepted: 10/05/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Obesity is a global health problem that adversely influences the respiratory system. We assessed the effects of body mass index (BMI) on distal airway function and airway inflammation. SUBJECTS/METHODS Impulse oscillometry (IOS) as a measure of distal airway function, together with spirometry, were assessed in adults with a range of different BMIs. Airway inflammation was assessed with the fraction of exhaled nitric oxide (FeNO) and participants exhaled at various exhalation flows to determine alveolar and bronchial NO. RESULTS In total 34 subjects were enrolled in the study; 19 subjects had a normal BMI (18.50-24.99), whilst 15 subjects were overweight (BMI 25.00-29.99), or obese (BMI ≥30). All subjects had normal spirometry. However, IOS measures of airway resistance (R) at 5Hz, 20Hz and frequency dependence (R5-20) were elevated in overweight/obese individuals, compared to subjects with a normal BMI (median (interquartile range)); 5Hz: 0.41 (0.37, 0.45) vs. 0.32 (0.30, 0.37)kPa/l/s; 20Hz: 0.34 (0.30, 0.37) vs. 0.30 (0.26, 0.33)kPa/l/s; R5-20: 0.06 (0.04, 0.11) vs. 0.03 (0.01, 0.05)kPa/l/s; p<0.05), whereas airway reactance at 20Hz was decreased in overweight/obese individuals (20Hz: 0.07 (0.03, 0.09) vs. 0.10 (0.07, 0.13)kPa/l/s, p=0.009; 5Hz: -0.12 (-0.15, -0.10) vs. -0.10 (-0.13, -0.09)kPa/l/s, p=0.07). In contrast, within-breath IOS measures (a sign of expiratory flow limitation) and FeNO inflammatory measures, did not differ between groups (p>0.05). CONCLUSIONS Being overweight has significant effects on distal and central airway function as determined by IOS, which is not detected by spirometry. Obesity does not influence airway inflammation as measured by FeNO. IOS is a reliable technique to identify airway abnormalities in the presence of normal spirometry in overweight people.
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Affiliation(s)
- Kim D G van de Kant
- National Heart and Lung Institute, Imperial College, Dovehouse Street, London SW3 6LY, United Kingdom.
| | - Paolo Paredi
- National Heart and Lung Institute, Imperial College, Dovehouse Street, London SW3 6LY, United Kingdom.
| | - Sally Meah
- National Heart and Lung Institute, Imperial College, Dovehouse Street, London SW3 6LY, United Kingdom.
| | - Harpal S Kalsi
- National Heart and Lung Institute, Imperial College, Dovehouse Street, London SW3 6LY, United Kingdom.
| | - Peter J Barnes
- National Heart and Lung Institute, Imperial College, Dovehouse Street, London SW3 6LY, United Kingdom.
| | - Omar S Usmani
- National Heart and Lung Institute, Imperial College, Dovehouse Street, London SW3 6LY, United Kingdom.
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Liu Y, Pleasants RA, Croft JB, Lugogo N, Ohar J, Heidari K, Strange C, Wheaton AG, Mannino DM, Kraft M. Body mass index, respiratory conditions, asthma, and chronic obstructive pulmonary disease. Respir Med 2015; 109:851-9. [PMID: 26006753 DOI: 10.1016/j.rmed.2015.05.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 05/05/2015] [Accepted: 05/06/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study aims to assess the relationship of body mass index (BMI) status with respiratory conditions, asthma, and chronic obstructive pulmonary disease (COPD) in a state population. METHODS Self-reported data from 11,868 adults aged ≥18 years in the 2012 South Carolina Behavioral Risk Factor Surveillance System telephone survey were analyzed using multivariable logistic regression that accounted for the complex sampling design and adjusted for sex, age, race/ethnicity, education, smoking status, physical inactivity, and cancer history. RESULTS The distribution of BMI (kg/m(2)) was 1.5% for underweight (<18.5), 32.3% for normal weight (18.5-24.9), 34.6% for overweight (25.0-29.9), 26.5% for obese (30.0-39.9), and 5.1% for morbidly obese (≥40.0). Among respondents, 10.0% had frequent productive cough, 4.3% had frequent shortness of breath (SOB), 7.3% strongly agreed that SOB affected physical activity, 8.4% had current asthma, and 7.4% had COPD. Adults at extremes of body weight were more likely to report having asthma or COPD, and to report respiratory conditions. Age-adjusted U-shaped relationships of BMI categories with current asthma and strongly agreeing that SOB affected physical activity, but not U-shaped relationship with COPD, persisted after controlling for the covariates (p < 0.001). Morbidly obese but not underweight or obese respondents were significantly more likely to have frequent productive cough and frequent SOB than normal weight adults after adjustment. CONCLUSION Our data confirm that both underweight and obesity are associated with current asthma and obesity with COPD. Increased emphasis on exercise and nutrition may improve respiratory conditions.
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Affiliation(s)
- Yong Liu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA.
| | - Roy A Pleasants
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Janet B Croft
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
| | - Njira Lugogo
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Jill Ohar
- Section on Pulmonary, Critical Care, Allergy & Immunologic Disease, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Khosrow Heidari
- Chronic Disease Epidemiology Office, South Carolina Department of Health and Environmental Control, Columbia, SC, USA; Department of Epidemiology & Statistics, University of South Carolina, Columbia, SC, USA
| | - Charlie Strange
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, USA
| | - Anne G Wheaton
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
| | - David M Mannino
- Division of Pulmonary, Critical Care, and Sleep Medicine, Pulmonary Epidemiology Research Laboratory, University of Kentucky, Lexington, KY, USA
| | - Monica Kraft
- Department of Medicine, University of Arizona, Phoenix, AZ, USA
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30
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Bates JHT, Dixon AE. Potential role of the airway wall in the asthma of obesity. J Appl Physiol (1985) 2014; 118:36-41. [PMID: 25342709 DOI: 10.1152/japplphysiol.00684.2014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The pathogenesis of late-onset TH2-low asthma in obesity is thought to be related to weight-related decreases in lung volume, but why only a subset of individuals with obesity develop this condition is unknown. We tested the hypothesis that natural variations in both airway wall stiffness and airway wall thickness could lead to a subpopulation of hyperresponsive individuals exhibiting the symptoms of asthma in the setting of obesity. Increases in airway resistance (Raw) after airway smooth muscle stimulation were simulated using a computational model of an elastic airway embedded in elastic parenchyma. Using a range of randomly chosen values for both airway wall stiffness and thickness, we determined the resulting probability distributions of Raw responsiveness for a variety of different levels of transpulmonary pressure (Ptp). As Ptp decreased from 5 to 1 cmH2O, the resulting distributions of Raw moved toward progressively higher levels of responsiveness. With appropriate choices for the mean and standard deviation of the parameter that controls either airway wall stiffness or thickness, the model predicts a relationship between airway hyperresponsiveness and body mass index that is similar to that which has been reported in populations with obesity. We conclude that natural variations in airway wall mechanics and geometry between different individuals can potentially explain why an increasing percentage of the population exhibits the symptoms of asthma as the obesity of the population increases.
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Affiliation(s)
- Jason H T Bates
- Vermont Lung Center, Department of Medicine, University of Vermont College of Medicine, Burlington, Vermont
| | - Anne E Dixon
- Vermont Lung Center, Department of Medicine, University of Vermont College of Medicine, Burlington, Vermont
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31
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Sideleva O, Dixon AE. The many faces of asthma in obesity. J Cell Biochem 2014; 115:421-6. [PMID: 24115053 DOI: 10.1002/jcb.24678] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 09/12/2013] [Indexed: 01/18/2023]
Abstract
Obesity is a major risk factor for the development of asthma, and causes severe, uncontrolled disease that responds poorly to therapy. The obese state alters early onset allergic asthma, and leads to the development of a novel form of late onset asthma secondary to obesity. The presentation of early onset allergic asthma is altered through effects on immune function. Factors such as mechanical loading, effects of adipokines on airways, altered diet, insulin resistance and altered metabolism of nitric oxide likely all contribute to increased airway reactivity in obesity, causing late onset asthma in obesity. Obesity also alters responses to environmental factors such as ozone and particulate matter. Focused studies to understand the importance of these factors in the pathogenesis of airway disease in obesity will be essential to develop therapies to intervene in this new epidemic of airway disease.
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Affiliation(s)
- O Sideleva
- Department of Medicine, Fletcher Allen Health Care, University of Vermont, Given D209, 89 Beaumont Avenue, Burlington, Vermont, 05405
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Davidson WJ, Mackenzie-Rife KA, Witmans MB, Montgomery MD, Ball GDC, Egbogah S, Eves ND. Obesity negatively impacts lung function in children and adolescents. Pediatr Pulmonol 2014; 49:1003-10. [PMID: 24167154 DOI: 10.1002/ppul.22915] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 09/06/2013] [Accepted: 09/07/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To investigate the relationship between weight status (body mass index [BMI] percentile and BMI z-score) and lung volumes in healthy children and adolescents. HYPOTHESES We hypothesized that: (a) there would be a significant inverse relationship between age- and sex-specific BMI distribution and functional residual capacity (FRC), and expiratory reserve volume (ERV), respectively; and (b) obese children would have significantly reduced FRC and ERV compared to their non-obese peers. METHODS The medical records of all individuals who successfully performed pulmonary function testing between 2000 and 2007 at two university children's hospitals were reviewed. Participants were excluded if they had cardiopulmonary, neuromuscular, or chest wall disease. RESULTS Of 1,469 record reviewed, 327 subjects met study criteria. Percent predicted ERV was lowest in the obese group (P < 0.001) while residual volume (RV) was lowest in the overweight and obese groups (P < 0.001). Underweight participants had a lower percent predicted forced vital capacity (FVC) (P = 0.027) and vital capacity (VC; P = 0.039). Obese participants had the lowest FEV1 /FVC (P < 0.001). A positive linear relationship existed between BMI z-score and percent predicted FVC, VC, and diffusing capacity of carbon monoxide (DLCO ). A negative linear relationship was found between BMI z-score and percent predicted FRC, ERV, RV, and absolute FEV1 /FVC. CONCLUSIONS Our results show that increasing weight status in children and adolescents is associated with a general reduction in lung volume measurements, which may reflect impaired lung function, increased respiratory symptoms, and decreased functional status.
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Robinson PD. Obesity and its impact on the respiratory system. Paediatr Respir Rev 2014; 15:219-26. [PMID: 25092493 DOI: 10.1016/j.prrv.2014.06.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 06/26/2014] [Indexed: 11/27/2022]
Abstract
Obesity has complex and incompletely understood effects upon the respiratory system in childhood, which differs in some aspects to those seen in adults. There is increasing evidence that excess adiposity will impact negatively upon static and dynamic respiratory function as measured through lung volumes, lung compartment mechanics, measures of airway function and exercise capability to varying degrees. Further information is needed to better understand the effects in children, and the importance of onset and duration of obesity on subsequent outcomes. Consensus about how best to express adiposity is also an essential part of this process and fat distribution is another important factor. From a clinical standpoint this creates challenges in distinguishing a deconditioned obese young person from a non-atopic asthmatic because of symptom overlap and lung function testing results, including responses seen during airway challenges. There is evidence to support the role of weight loss in achieving normalisation of lung function parameters, but as always with obesity there are enormous challenges in realising this goal for many subjects.
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Affiliation(s)
- Paul D Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Australia.
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Al-Alwan A, Bates JHT, Chapman DG, Kaminsky DA, DeSarno MJ, Irvin CG, Dixon AE. The nonallergic asthma of obesity. A matter of distal lung compliance. Am J Respir Crit Care Med 2014; 189:1494-502. [PMID: 24821412 DOI: 10.1164/rccm.201401-0178oc] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE The pathogenesis of asthma in obesity is poorly understood, but may be related to breathing at low lung volumes. OBJECTIVES To determine if lung function in obese patients with asthma and control subjects would respond differently to weight loss. METHODS Lung function was evaluated by conventional clinical tests and by impulse oscillometry in female late-onset, nonallergic patients with asthma and control subjects before, and 12 months after, bariatric surgery. MEASUREMENTS AND MAIN RESULTS Patients with asthma (n = 10) had significantly lower FEV1 (79.8 ± 10.6 vs. 95.5 ± 7.0%) and FVC (82.4 ± 13.2 vs. 93.7 ± 8.9%) compared with control subjects (n = 13). There were no significant differences in FRC or TLC at baseline. Twelve months after surgery, control subjects had significant increases in FEV1 (95.5 ± 7.0 to 100.7 ± 5.9), FVC (93.6 ± 8.9 to 98.6 ± 8.3%), FRC (45.4 ± 18.5 to 62.1 ± 15.3%), and TLC (84.8 ± 15.0 to 103.1 ± 15.3%), whereas patients with asthma had improvement only in FEV1 (79.8 ± 10.6 to 87.2 ± 11.5). Control subjects and patients with asthma had a significantly different change in respiratory system resistance with weight loss: control subjects exhibited a uniform decrease in respiratory system resistance at all frequencies, whereas patients with asthma exhibited a decrease in frequency dependence of resistance. Fits of a mathematical model of lung mechanics to these impedance spectra suggest that the lung periphery was more collapsed by obesity in patients with asthma compared with control subjects. CONCLUSIONS Weight loss decompresses the lung in both obese control subjects and patients with asthma, but the more pronounced effects of weight loss on lung elastance suggest that the distal lung is inherently more collapsible in people with asthma.
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Brown RH. Obesity and asthma: "What we've got here is failure to communicate". Am J Respir Crit Care Med 2014; 189:i-ii. [PMID: 24930541 DOI: 10.1164/rccm.201405-0989ed] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Robert H Brown
- 1 Departments of Anesthesiology, Medicine, Environmental Health Sciences, and Radiology The Johns Hopkins University Baltimore, Maryland
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Correlations Between Small Airway Function, Ventilation Distribution, and Functional Exercise Capacity in COPD Patients. Lung 2014; 192:653-9. [DOI: 10.1007/s00408-014-9626-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 07/08/2014] [Indexed: 10/25/2022]
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Pellegrino R, Gobbi A, Antonelli A, Torchio R, Gulotta C, Pellegrino GM, Dellacà R, Hyatt RE, Brusasco V. Ventilation heterogeneity in obesity. J Appl Physiol (1985) 2014; 116:1175-81. [PMID: 24651986 DOI: 10.1152/japplphysiol.01339.2013] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Obesity is associated with important decrements in lung volumes. Despite this, ventilation remains normally or near normally distributed at least for moderate decrements in functional residual capacity (FRC). We tested the hypothesis that this is because maximum flow increases presumably as a result of an increased lung elastic recoil. Forced expiratory flows corrected for thoracic gas compression volume, lung volumes, and forced oscillation technique at 5-11-19 Hz were measured in 133 healthy subjects with a body mass index (BMI) ranging from 18 to 50 kg/m(2). Short-term temporal variability of ventilation heterogeneity was estimated from the interquartile range of the frequency distribution of the difference in inspiratory resistance between 5 and 19 Hz (R5-19_IQR). FRC % predicted negatively correlated with BMI (r = -0.72, P < 0.001) and with an increase in slope of either maximal (r = -0.34, P < 0.01) or partial flow-volume curves (r = -0.30, P < 0.01). Together with a slight decrease in residual volume, this suggests an increased lung elastic recoil. Regression analysis of R5-19_IQR against FRC % predicted and expiratory reserve volume (ERV) yielded significantly higher correlation coefficients by nonlinear than linear fitting models (r(2) = 0.40 vs. 0.30 for FRC % predicted and r(2) = 0.28 vs. 0.19 for ERV). In conclusion, temporal variability of ventilation heterogeneities increases in obesity only when FRC falls approximately below 65% of predicted or ERV below 0.6 liters. Above these thresholds distribution is quite well preserved presumably as a result of an increase in lung recoil.
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Affiliation(s)
- Riccardo Pellegrino
- Allergologia e Fisiopatologia Respiratoria, ASO S. Croce e Carle, Cuneo, Italy
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