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Kaminsky DA, Anekonda VT, Verbanck S, Graham BL. Using the phase III slope of exhaled methane during a single breath D LCO test to assess ventilation heterogeneity. Respir Med 2024; 231:107725. [PMID: 38950682 DOI: 10.1016/j.rmed.2024.107725] [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: 01/20/2024] [Revised: 06/18/2024] [Accepted: 06/28/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND The Phase III slope from a single breath nitrogen washout test provides information about ventilation heterogeneity (VH) in the lungs. PURPOSE To determine if the Phase III slope from the exhaled tracer gas concentration during a standard, single breath DLCO test using rapid gas analysis provides similar information about VH. BASIC PROCEDURES Retrospective analysis of clinical pulmonary function laboratory data including spirometry, lung volumes, and DLCO. The normalized Phase III slope from the exhaled CH4 concentration (SnCH4) was compared among different patterns of physiologic abnormality and with VA/TLC as an indicator of VH. MAIN FINDINGS SnCH4 was the steepest in the group with "Obstruction and Low DLCO", with significant differences between this group and the "Normal", "Obstruction with Normal DLCO", "Mixed Obstruction and Restriction" and "Isolated Low DLCO" groups. SnCH4 was steeper in current and former smokers compared to non-smokers. Among the entire study sample, SnCH4 correlated with VA/TLC (Spearman rho = -0.56, p < 0.01) and remained a significant determinant of VA/TLC by regression modeling. PRINCIPAL CONCLUSIONS The SnCH4 derived from a standard, single breath DLCO test using rapid gas analysis varied among distinct patterns of physiologic abnormalities and was associated with VA/TLC as a measure of VH.
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Affiliation(s)
- David A Kaminsky
- Pulmonary and Critical Care, University of Vermont Larner College of Medicine, Given D213, 89 Beaumont Avenue, Burlington, VT, 05405, USA.
| | - Vishwanath T Anekonda
- Department of General Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA.
| | - Sylvia Verbanck
- Respiratory Division, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Brian L Graham
- Emeritus Division of Respirology, Critical Care and Sleep Medicine University of Saskatchewan Saskatoon, SK, Canada.
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Bessa EJC, Ribeiro FDMC, Rodrigues RS, Henrique da Costa C, Rufino R, Pinheiro GDRC, Lopes AJ. Association between clinical, serological, functional and radiological findings and ventilatory distribution heterogeneity in patients with rheumatoid arthritis. PLoS One 2023; 18:e0291659. [PMID: 37862308 PMCID: PMC10588833 DOI: 10.1371/journal.pone.0291659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/02/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND In rheumatoid arthritis (RA), the involvement of the pulmonary interstitium can lead to structural changes in the small airways and alveoli, leading to reduced airflow and maldistribution of ventilation. The single-breath nitrogen washout (SBN2W) test is a measure of the ventilatory distribution heterogeneity and evaluates the small airways. This study aimed to find out which clinical, serological, functional and radiological findings are useful to identify RA patients with pathological values of the phase III slope (SIII) measured by the SBN2W test. METHODS This was a cross-sectional study in which RA patients were assessed using the Health Assessment Questionnaire-Disability Index (HAQ-DI) and the Clinical Disease Activity Index (CDAI) and underwent serological analysis of autoantibodies and inflammatory markers. In addition, they underwent pulmonary function tests (including the SBN2W test) and chest computed tomography (CT). RESULTS Of the 60 RA patients evaluated, 39 (65%) had an SIII >120% of the predicted value. There were significant correlations between SIII and age (r = 0.56, p<0.0001), HAQ-DI (r = 0.34, p = 0.008), forced vital capacity (FVC, r = -0.67, p<0.0001), total lung capacity (r = -0.46, p = 0.0002), residual volume/total lung capacity (TLC) (r = 0.44, p = 0.0004), and diffusing capacity of the lungs for carbon monoxide (r = -0.45, p = 0.0003). On CT scans, the subgroup with moderate/severe disease had a significantly higher SIII than the normal/minimal/mild subgroup (662 (267-970) vs. 152 (88-283)% predicted, p = 0.0004). In the final multiple regression model, FVC, extent of moderate/severe involvement and age were associated with SIII, explaining 59% of its variability. CONCLUSIONS In patients with RA, FVC, extent of lung involvement and age, all of which are easily obtained variables in clinical practice, identify poorly distributed ventilation. In addition, the presence of respiratory symptoms and deteriorated physical function are closely related to the distribution of ventilation in these patients.
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Affiliation(s)
- Elizabeth Jauhar Cardoso Bessa
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Rosana Souza Rodrigues
- D’Or Institute for Research and Education, Rio de Janeiro, Brazil
- Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cláudia Henrique da Costa
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rogério Rufino
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Agnaldo José Lopes
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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Tamura K, Shirai T, Hirai K, Nakayasu H, Takahashi S, Kishimoto Y, Akamatsu T, Asada K, Kato S. Mucus Plugs and Small Airway Dysfunction in Asthma, COPD, and Asthma-COPD Overlap. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2022; 14:196-209. [PMID: 35255537 PMCID: PMC8914605 DOI: 10.4168/aair.2022.14.2.196] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 11/20/2022]
Abstract
Purpose There are reports concerning mucus plugs detected on high-resolution computed tomography images and airflow obstruction in asthma and chronic obstructive pulmonary disease (COPD). However, little is known about the associations between mucus plugs and small airway dysfunction (SAD). We evaluated the relationship between mucus plugs and pulmonary function in patients with asthma, COPD, and asthma-COPD overlap (ACO), and investigated the relevance to SAD and type 2 inflammation in a retrospective study. Methods Subjects included 49 asthmatic, 40 ACO, and 41 COPD patients. ACO was diagnosed based on the Japanese Respiratory Society ACO guidelines. Clinical and laboratory parameters, including blood eosinophil count, serum total IgE levels, fractional exhaled nitric oxide (FeNO), spirometry, and forced oscillation technique (FOT), were compared between patients with and without mucus plugs. Results Mucus plugs were found in 29 (59%) asthmatic, 25 (65%) ACO, 17 (41%) COPD patients. Patients with mucus plugs had reduced spirometry and larger FOT parameters, especially in COPD patients. Mucus scores correlated positively with IgE in ACO and FeNO in asthmatic patients, but not in COPD patients. Multivariate logistic regression analysis revealed that SAD parameters, including forced vital capacity and resonant frequency, a respiratory reactance parameter, were significantly associated with the presence of mucus plugs in the whole studied population. Conclusions SAD, rather than large airway dysfunction, was associated with mucus plugs in asthma, ACO, and COPD patients.
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Affiliation(s)
- Kanami Tamura
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Toshihiro Shirai
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Keita Hirai
- Department of Clinical Pharmacology and Genetics, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
- Laboratory of Clinical Pharmacogenomics, Shizuoka General Hospital, Shizuoka, Japan
| | - Hiromasa Nakayasu
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Shingo Takahashi
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Yutaro Kishimoto
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Taisuke Akamatsu
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Kazuhiro Asada
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Satoshi Kato
- Department of Radiology, Shizuoka General Hospital, Shizuoka, Japan
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Giri PC, Chowdhury AM, Bedoya A, Chen H, Lee HS, Lee P, Henriquez C, MacIntyre NR, Huang YCT. Application of Machine Learning in Pulmonary Function Assessment Where Are We Now and Where Are We Going? Front Physiol 2021; 12:678540. [PMID: 34248665 PMCID: PMC8264499 DOI: 10.3389/fphys.2021.678540] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/02/2021] [Indexed: 12/24/2022] Open
Abstract
Analysis of pulmonary function tests (PFTs) is an area where machine learning (ML) may benefit clinicians, researchers, and the patients. PFT measures spirometry, lung volumes, and carbon monoxide diffusion capacity of the lung (DLCO). The results are usually interpreted by the clinicians using discrete numeric data according to published guidelines. PFT interpretations by clinicians, however, are known to have inter-rater variability and the inaccuracy can impact patient care. This variability may be caused by unfamiliarity of the guidelines, lack of training, inadequate understanding of lung physiology, or simply mental lapses. A rules-based automated interpretation system can recapitulate expert’s pattern recognition capability and decrease errors. ML can also be used to analyze continuous data or the graphics, including the flow-volume loop, the DLCO and the nitrogen washout curves. These analyses can discover novel physiological biomarkers. In the era of wearables and telehealth, particularly with the COVID-19 pandemic restricting PFTs to be done in the clinical laboratories, ML can also be used to combine mobile spirometry results with an individual’s clinical profile to deliver precision medicine. There are, however, hurdles in the development and commercialization of the ML-assisted PFT interpretation programs, including the need for high quality representative data, the existence of different formats for data acquisition and sharing in PFT software by different vendors, and the need for collaboration amongst clinicians, biomedical engineers, and information technologists. Hurdles notwithstanding, the new developments would represent significant advances that could be the future of PFT, the oldest test still in use in clinical medicine.
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Affiliation(s)
- Paresh C Giri
- Division of Pulmonary and Critical Care Medicine, Loma Linda University Medical Center, Loma Linda, CA, United States
| | - Anand M Chowdhury
- Division of Pulmonary, Allergy and Critical Care Medicine, Duke University Medical Center, Durham, NC, United States
| | - Armando Bedoya
- Division of Pulmonary, Allergy and Critical Care Medicine, Duke University Medical Center, Durham, NC, United States
| | - Hengji Chen
- Department of Mechanical Engineering and Materials Science, Pratt School of Engineering, Duke University Medical Center, Durham, NC, United States
| | - Hyun Suk Lee
- Hartford HealthCare, Hartford, CT, United States
| | - Patty Lee
- Division of Pulmonary, Allergy and Critical Care Medicine, Duke University Medical Center, Durham, NC, United States
| | - Craig Henriquez
- Department of Mechanical Engineering and Materials Science, Pratt School of Engineering, Duke University Medical Center, Durham, NC, United States
| | - Neil R MacIntyre
- Division of Pulmonary, Allergy and Critical Care Medicine, Duke University Medical Center, Durham, NC, United States
| | - Yuh-Chin T Huang
- Division of Pulmonary, Allergy and Critical Care Medicine, Duke University Medical Center, Durham, NC, United States
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Ferrari da Cruz T, Rufino R, Lopes A, Henrique Costa C. Small airway evaluation in three subjects with alpha-1 antitrypsin deficiency without diagnosed lung disease. BMJ Case Rep 2021; 14:14/3/e239146. [PMID: 33785603 PMCID: PMC8011716 DOI: 10.1136/bcr-2020-239146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We describe three cases of female subjects (aged 16, 44 and 41 years) with no respiratory symptoms, who have alpha-1 antitripsyn mutation (PiSZ, PiZZ and PiZZ) and who performed traditional pulmonary function tests and the single breath nitrogen washout test. They still did not have chronic obstructive pulmonary disease (COPD) or any identifiable change in traditional pulmonary function tests but already have change in nitrogen washout tests. Alpha-1 antitrypsin deficiency is a genetic disorder associated with early-onset COPD. There is evidence that although patients who have well-preserved FEV1 may already have signs of emphysema associated with symptoms. Therefore, the nitrogen washout test is considered to have more sensitive outcomes than other pulmonary function tests for early investigation of small airways disease and could allow the monitoring pulmonary function and evaluating of therapeutic decision.
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Affiliation(s)
| | - Rogério Rufino
- Pneumology, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
| | - Agnaldo Lopes
- Pneumology, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
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Ferrari da Cruz T, Rufino R, Lopes AJ, Noronha A, Medeiros Anselmo F, Henrique da Costa C. <p>Evaluation of the Small Airways in Patients with Chronic Obstructive Pulmonary Disease and Alpha-1 Antitrypsin Deficiency</p>. Int J Chron Obstruct Pulmon Dis 2020; 15:2267-2274. [PMID: 33061344 PMCID: PMC7522299 DOI: 10.2147/copd.s262418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 07/27/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Small airways are not evaluated with traditional pulmonary function tests. The aim of this study was to evaluate the small airways in patients with chronic obstructive pulmonary disease (COPD) with a nitrogen washout test and to verify whether there is a difference between patients with COPD due to smoking and those with COPD due to alpha-1 antitrypsin mutation. Methods Sixteen patients with mutation in the SERPINA1 gene and 45 patients with no mutation were included in this cross-sectional study. All pulmonary function tests, including the single breath nitrogen washout test, were performed for all patients and alpha-1 antitrypsin dosage was assessed with immunonephelometry. Results A comparison of patients with COPD due to smoking and those with COPD due to smoking and mutation revealed a significant difference in closure volume (%), which was the poorest in the mutation group. In the group with COPD and mutation, there was an inverse correlation between smoking and closure volume (%). We also verified that similar to forced expiratory volume in the first second (FEV1), the phase III slope (%) and ΔN2 750–1250 mL (%) could be used to differentiate the severity of airflow limitation. Conclusion Our results suggest that both variables, phase III slope and the ΔN2 750–1250 mL (%), could be related to COPD severity. Therefore, alterations at the distribution of the location of the emphysema could alter the results of closer volume and that the nitrogen washout test is more sensitive when compared to traditional pulmonary function test in evaluating COPD patients.
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Affiliation(s)
- Thaís Ferrari da Cruz
- Pneumology Department, Pedro Ernesto Hospital of State University of Rio de Janeiro, Rio de Janeiro, PR, Brazil
- Correspondence: Thaís Ferrari da Cruz Av João Gualberto, 253 Ap 241, Cep: 80030-000, Curitiba, PR, BrazilTel +55 41 99911-4487 Email
| | - Rogerio Rufino
- Pneumology Department, Pedro Ernesto Hospital of State University of Rio de Janeiro, Rio de Janeiro, PR, Brazil
| | - Agnaldo José Lopes
- Pneumology Department, Pedro Ernesto Hospital of State University of Rio de Janeiro, Rio de Janeiro, PR, Brazil
| | - Arnaldo Noronha
- Pneumology Department, Pedro Ernesto Hospital of State University of Rio de Janeiro, Rio de Janeiro, PR, Brazil
| | - Fernando Medeiros Anselmo
- Pneumology Department, Pedro Ernesto Hospital of State University of Rio de Janeiro, Rio de Janeiro, PR, Brazil
| | - Cláudia Henrique da Costa
- Pneumology Department, Pedro Ernesto Hospital of State University of Rio de Janeiro, Rio de Janeiro, PR, Brazil
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Mori Y, Nishikiori H, Chiba H, Yamada G, Kuronuma K, Takahashi H. Respiratory reactance in forced oscillation technique reflects disease stage and predicts lung physiology deterioration in idiopathic pulmonary fibrosis. Respir Physiol Neurobiol 2020; 275:103386. [PMID: 31931177 DOI: 10.1016/j.resp.2020.103386] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 01/08/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is a chronic progressive disease. Although pulmonary function test (PFT) is useful for evaluating the progression of IPF, obtaining adequate results in advanced cases can be challenging. Conversely, the forced oscillation technique (FOT) can be noninvasively performed, even in patients with severely deteriorated lung function. In this study, the usefulness of FOT for the evaluation of IPF disease status was investigated. METHODS We analyzed the PFT and FOT data of 97 patients with IPF. RESULTS The respiratory reactance (Xrs) components of FOT, especially in the inspiratory phase, correlated with the PFT values. Patients with advanced disease had significantly lower reactance at 5 Hz (X5), higher resonant frequency (Fres) and low-frequency reactance area (ALX). The longitudinal deterioration of Xrs was also observed. Moreover, X5 in the inspiratory phase predicted subsequent lung capacity deterioration. CONCLUSION The Xrs components of FOT, especially in the inspiratory phase, reflected restrictive ventilatory impairment and disease severity in patients with IPF.
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Affiliation(s)
- Yuki Mori
- Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, South-1 West-16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan.
| | - Hirotaka Nishikiori
- Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, South-1 West-16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan.
| | - Hirofumi Chiba
- Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, South-1 West-16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan.
| | - Gen Yamada
- Department of Respiratory Medicine, Teine Keijinkai Hospital, 1-12 Maeda, Teineku, Sapporo, Hokkaido 006-8555, Japan.
| | - Koji Kuronuma
- Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, South-1 West-16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan.
| | - Hiroki Takahashi
- Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, South-1 West-16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan.
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Capron T, Bourdin A, Perez T, Chanez P. COPD beyond proximal bronchial obstruction: phenotyping and related tools at the bedside. Eur Respir Rev 2019; 28:28/152/190010. [PMID: 31285287 DOI: 10.1183/16000617.0010-2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 05/04/2019] [Indexed: 11/05/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is characterised by nonreversible proximal bronchial obstruction leading to major respiratory disability. However, patient phenotypes better capture the heterogeneously reported complaints and symptoms of COPD. Recent studies provided evidence that classical bronchial obstruction does not properly reflect respiratory disability, and symptoms now form the new paradigm for assessment of disease severity and guidance of therapeutic strategies. The aim of this review was to explore pathways addressing COPD pathogenesis beyond proximal bronchial obstruction and to highlight innovative and promising tools for phenotyping and bedside assessment. Distal small airways imaging allows quantitative characterisation of emphysema and functional air trapping. Micro-computed tomography and parametric response mapping suggest small airways disease precedes emphysema destruction. Small airways can be assessed functionally using nitrogen washout, probing ventilation at conductive or acinar levels, and forced oscillation technique. These tests may better correlate with respiratory symptoms and may well capture bronchodilation effects beyond proximal obstruction.Knowledge of inflammation-based processes has not provided well-identified targets so far, and eosinophils probably play a minor role. Adaptative immunity or specific small airways secretory protein may provide new therapeutic targets. Pulmonary vasculature is involved in emphysema through capillary loss, microvascular lesions or hypoxia-induced remodelling, thereby impacting respiratory disability.
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Affiliation(s)
- Thibaut Capron
- Clinique des Bronches, Allergies et Sommeil, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Arnaud Bourdin
- Université de Montpellier, PhyMedExp, INSERM, CNRS, CHU de Montpellier, Dept of Respiratory Diseases, Montpellier, France
| | - Thierry Perez
- Dept of Respiratory Diseases, CHU Lille, Center for Infection and Immunity of Lille, INSERM U1019 - CNRS UMR 8204, Université Lille Nord de France, Lille, France
| | - Pascal Chanez
- Clinique des Bronches, Allergies et Sommeil, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Aix Marseille Université, Marseille, France .,Aix Marseille Université, INSERM, INRA, CV2N, Marseille, France
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9
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Gove K, Wilkinson T, Jack S, Ostridge K, Thompson B, Conway J. Systematic review of evidence for relationships between physiological and CT indices of small airways and clinical outcomes in COPD. Respir Med 2018; 139:117-125. [DOI: 10.1016/j.rmed.2018.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/21/2018] [Accepted: 05/06/2018] [Indexed: 10/17/2022]
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Kjellberg S, Viklund E, Robinson PD, Zetterström O, Olin AC, Gustafsson P. Utility of single versus multiple breath washout in adult asthma. Clin Physiol Funct Imaging 2018; 38:936-943. [PMID: 29368419 DOI: 10.1111/cpf.12503] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 12/19/2017] [Indexed: 11/30/2022]
Abstract
Nitrogen multiple breath washout (N2 MBW) is a sensitive method to identify peripheral airway involvement in asthma, but is a time-consuming test. The N2 vital capacity single breath (VC SBW) test offers greater time efficiency, but concordance with N2 MBW is poorly understood. The prevalence of peripheral airway abnormality was determined by N2 MBW and N2 SBW tests in 194 asthmatic subjects aged 18-1 years. N2 MBW data were related to findings in 400 healthy controls, aged 17-71 years, while N2 SBW data were compared to findings in 224 healthy controls, aged 15-65 years, to derive equipment-specific reference values. Amongst asthmatic subjects, relationships between N2 SBW and N2 MBW outcomes were studied. N2 SBW relationship with clinical history, spirometry, blood eosinophils and fraction exhaled nitric oxide (FENO) data was also explored. The prevalence of peripheral airway involvement (i.e. abnormal ventilation distribution) determined by N2 SBW-derived phase III slope (N2 SIII ) was 24·7%, compared to 44% determined by N2 MBW-derived lung clearance index (LCI) (P<0·001). Predictors of abnormal N2 SIII were older age, smoking history and lower FEV1. N2 SBW offers lower sensitivity than N2 MBW to detect small airway dysfunction in adult asthma, but may be a marker of more severe disease.
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Affiliation(s)
- S Kjellberg
- Department of Pediatrics, Skaraborg Hospital Skövde, Skövde, Sweden
- The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - E Viklund
- The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department for Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
| | - P D Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - O Zetterström
- Allergy Centre, Skaraborg Hospital Skövde, Skövde, Sweden
| | - A-C Olin
- The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department for Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
| | - P Gustafsson
- Department of Pediatrics, Skaraborg Hospital Skövde, Skövde, Sweden
- The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Allergy Centre, Skaraborg Hospital Skövde, Skövde, Sweden
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11
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Guerrero Zúñiga S, Sánchez Hernández J, Mateos Toledo H, Mejía Ávila M, Gochicoa-Rangel L, Miguel Reyes JL, Selman M, Torre-Bouscoulet L. Small airway dysfunction in chronic hypersensitivity pneumonitis. Respirology 2017; 22:1637-1642. [PMID: 28748646 DOI: 10.1111/resp.13124] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 04/22/2017] [Accepted: 05/02/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Lung biopsies from patients with hypersensitivity pneumonitis (HP) have demonstrated small airway (SA) involvement, but there is no information concerning SA function in HP, and it is unknown whether pharmacological treatment could modify its function. SA function in patients with chronic HP using ultrasonic pneumography (UPG) and impulse oscillometry (IOS) was explored. We also compared initial results with those obtained after 4 weeks of standardized treatment with azathioprine and prednisone. METHODS The study group consisted of adults with recent diagnoses of HP. All patients completed UPG, IOS, spirometry, body plethysmography, single-breath carbon monoxide diffusing capacity (DLCO ) and the 6-min walk test (6MWT). The fraction of exhaled nitric oxide (FENO ) was obtained to assess eosinophilic airway inflammation. Measurements were taken at diagnosis and after 4 weeks of treatment. RESULTS A total of 20 consecutive patients (16 women) with chronic HP participated in the study. Median age was 50 years (interquartile range (IQR): 42-54). At diagnosis, the UPG phase 3 slope was abnormally high, consistent with maldistribution of ventilation. For IOS, all patients had low reactance at 5 Hz (X5) and elevated reactance area (AX) reflecting low compliance, and only eight (40%) patients had elevated R5 (resistance at 5 Hz (total)) and R5-20 (resistance at 5 Hz-resistance at 20 Hz (peripheral)) attributed to SA resistance. In contrast, FENO parameters were within normal limits. After treatment, forced vital capacity (FVC), the 6-min walk distance and the distribution of ventilation showed significant improvement, although DLCO did not. CONCLUSION Patients with chronic HP have SA abnormalities that are partially revealed by the UPG and IOS tests. Lung volumes, but not gas exchange, improved after treatment with azathioprine and prednisone.
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Affiliation(s)
- Selene Guerrero Zúñiga
- Department of Respiratory Physiology, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Julia Sánchez Hernández
- Department of Respiratory Physiology, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Heidegger Mateos Toledo
- Interstitial Lung Diseases Clinic, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Mayra Mejía Ávila
- Interstitial Lung Diseases Clinic, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Laura Gochicoa-Rangel
- Department of Respiratory Physiology, National Institute of Respiratory Diseases, Mexico City, Mexico
| | | | - Moisés Selman
- Research Unit, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Luis Torre-Bouscoulet
- Department of Respiratory Physiology, National Institute of Respiratory Diseases, Mexico City, Mexico.,Research Unit, National Institute of Respiratory Diseases, Mexico City, Mexico
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Zaigham S, Wollmer P, Engström G. The Association of Lung Clearance Index with COPD and FEV1 Reduction in ‘Men Born in 1914’. COPD 2017; 14:324-329. [DOI: 10.1080/15412555.2017.1314455] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Suneela Zaigham
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Per Wollmer
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
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Silva BRA, Rufino R, Costa CH, Vilela VS, Levy RA, Lopes AJ. Ventilation distribution and small airway function in patients with systemic sclerosis. REVISTA PORTUGUESA DE PNEUMOLOGIA 2017; 23:132-138. [PMID: 28258938 DOI: 10.1016/j.rppnen.2017.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 12/09/2016] [Accepted: 01/09/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Despite the importance of traditional pulmonary function tests (PFTs) in managing systemic sclerosis (SSc), many patients with pulmonary disease diagnosed by computed tomography (CT) present with normal PFTs. OBJECTIVE To evaluate the efficacy of the nitrogen single-breath washout (N2SBW) test in diagnosing SSc and to correlate N2SBW parameters with the PFT indexes used in the follow-up of these patients, clinical data, and CT findings. METHODS Cross-sectional study in which 52 consecutive SSc patients were subjected to spirometry, body plethysmography, analysis of the diffusing capacity for carbon monoxide (DLCO), analysis of respiratory muscle strength, N2SBW testing, and CT analysis. RESULTS Twenty-eight patients had a forced vital capacity (FVC) that was <70% of the predicted value. In the N2SBW test, 44 patients had a phase III slope (Phase III slopeN2SBW) that was >120% of the predicted value, while 15 patients had a closing volume/vital capacity (CV/VC) that was >120% of the predicted value. A significant difference in Phase III slopeN2SBW was observed when the patients with predominant traction bronchiectasis and honeycombing were compared to the patients with other CT patterns (p<0.0001). The Phase III slopeN2SBW was correlated with FVC (rs=-0.845, p<0.0001) and DLCO (rs=-0.600, p<0.0001), and the CV/VC was correlated with FVC (rs=-0.460, p=0.0006) and residual volume/total lung capacity (rs=0.328, p=0.017). CONCLUSION Ventilation heterogeneity is a frequent finding in SSc patients that is associated with restrictive damage, changes in pulmonary diffusion, and CT patterns. In addition, approximately one-third of the patients presented with findings that were compatible with small airway disease.
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Affiliation(s)
- B R A Silva
- Laboratory of Respiratory Physiology, State University of Rio de Janeiro, and Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - R Rufino
- Department of Pulmonology, State University of Rio de Janeiro, and Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - C H Costa
- Department of Pulmonology, State University of Rio de Janeiro, and Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - V S Vilela
- Department of Rheumatology, State University of Rio de Janeiro, and Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - R A Levy
- Department of Rheumatology, State University of Rio de Janeiro, and Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - A J Lopes
- Laboratory of Respiratory Physiology, State University of Rio de Janeiro, and Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
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Forno E, Weiner DJ, Mullen J, Sawicki G, Kurland G, Han YY, Cloutier MM, Canino G, Weiss ST, Litonjua AA, Celedón JC. Obesity and Airway Dysanapsis in Children with and without Asthma. Am J Respir Crit Care Med 2017; 195:314-323. [PMID: 27552676 PMCID: PMC5328183 DOI: 10.1164/rccm.201605-1039oc] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/23/2016] [Indexed: 02/02/2023] Open
Abstract
RATIONALE For unclear reasons, obese children with asthma have higher morbidity and reduced response to inhaled corticosteroids. OBJECTIVES To assess whether childhood obesity is associated with airway dysanapsis (an incongruence between the growth of the lungs and the airways) and whether dysanapsis is associated with asthma morbidity. METHODS We examined the relationship between obesity and dysanapsis in six cohorts of children with and without asthma, as well as the relationship between dysanapsis and clinical outcomes in children with asthma. Adjusted odds ratios (ORs) were calculated for each cohort and in a combined analysis of all cohorts; longitudinal analyses were also performed for cohorts with available data. Hazard ratios (HRs) for clinical outcomes were calculated for children with asthma in the Childhood Asthma Management Program. MEASUREMENTS AND MAIN RESULTS Being overweight or obese was associated with dysanapsis in both the cross-sectional (OR, 1.95; 95% confidence interval [CI], 1.62-2.35 [for overweight/obese compared with normal weight children]) and the longitudinal (OR, 4.31; 95% CI, 2.99-6.22 [for children who were overweight/obese at all visits compared with normal weight children]) analyses. Dysanapsis was associated with greater lung volumes (FVC, vital capacity, and total lung capacity) and lesser flows (FEV1 and forced expiratory flow, midexpiratory phase), and with indicators of ventilation inhomogeneity and anisotropic lung and airway growth. Among overweight/obese children with asthma, dysanapsis was associated with severe disease exacerbations (HR, 1.95; 95% CI, 1.38-2.75) and use of systemic steroids (HR, 3.22; 95% CI, 2.02-5.14). CONCLUSIONS Obesity is associated with airway dysanapsis in children. Dysanapsis is associated with increased morbidity among obese children with asthma and may partly explain their reduced response to inhaled corticosteroids.
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Affiliation(s)
- Erick Forno
- Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Daniel J. Weiner
- Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - James Mullen
- Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Gregory Sawicki
- Division of Pulmonary Diseases, Boston Children’s Hospital, Boston, Massachusetts
| | - Geoffrey Kurland
- Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yueh Ying Han
- Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michelle M. Cloutier
- Department of Pediatrics, University of Connecticut Health Center, Connecticut Children’s Medical Center, Farmington, Connecticut
| | - Glorisa Canino
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Scott T. Weiss
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts; and
| | - Augusto A. Litonjua
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts; and
- Brigham and Women’s Hospital, Boston, Massachusetts
| | - Juan C. Celedón
- Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
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15
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Boeck L, Gensmer A, Nyilas S, Stieltjes B, Re TJ, Tamm M, Latzin P, Stolz D. Single-Breath Washout Tests to Assess Small Airway Disease in COPD. Chest 2016; 150:1091-1100. [DOI: 10.1016/j.chest.2016.05.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 04/18/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022] Open
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16
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Clinical Significance of Forced Oscillation Technique for Evaluation of Small Airway Disease in Interstitial Lung Diseases. Lung 2016; 194:975-983. [DOI: 10.1007/s00408-016-9949-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 10/01/2016] [Indexed: 02/02/2023]
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17
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Kitaguchi Y, Yasuo M, Hanaoka M. Comparison of pulmonary function in patients with COPD, asthma-COPD overlap syndrome, and asthma with airflow limitation. Int J Chron Obstruct Pulmon Dis 2016; 11:991-7. [PMID: 27274220 PMCID: PMC4869610 DOI: 10.2147/copd.s105988] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study was conducted in order to investigate the differences in the respiratory physiology of patients with chronic obstructive pulmonary disease (COPD), asthma-COPD overlap syndrome (ACOS), and asthma with airflow limitation (asthma FL(+)). METHODS The medical records for a series of all stable patients with persistent airflow limitation due to COPD, ACOS, or asthma were retrospectively reviewed and divided into the COPD group (n=118), the ACOS group (n=32), and the asthma FL(+) group (n=27). All the patients underwent chest high-resolution computed tomography (HRCT) and pulmonary function tests, including respiratory impedance. RESULTS The low attenuation area score on chest HRCT was significantly higher in the COPD group than in the ACOS group (9.52±0.76 vs 5.09±1.16, P<0.01). The prevalence of bronchial wall thickening on chest HRCT was significantly higher in the asthma FL(+) group than in the COPD group (55.6% vs 25.0%, P<0.01). In pulmonary function, forced expiratory volume in 1 second (FEV1) and peak expiratory flow rate were significantly higher in the asthma FL(+) group than in the ACOS group (76.28%±2.54% predicted vs 63.43%±3.22% predicted, P<0.05 and 74.40%±3.16% predicted vs 61.08%±3.54% predicted, P<0.05, respectively). Although residual volume was significantly lower in the asthma FL(+) group than in the COPD group (112.05%±4.34% predicted vs 137.38%±3.43% predicted, P<0.01) and the ACOS group (112.05%±4.34% predicted vs148.46%±6.25% predicted, P<0.01), there were no significant differences in functional residual capacity or total lung capacity. The increase in FEV1 in response to short-acting β2-agonists was significantly greater in the ACOS group than in the COPD group (229±29 mL vs 72±10 mL, P<0.01) and the asthma FL(+) group (229±29 mL vs 153±21 mL, P<0.05). Regarding respiratory impedance, resistance at 5 Hz and resistance at 20 Hz, which are oscillatory parameters of respiratory resistance, were significantly higher in the asthma FL(+) group than in the COPD group at the whole-breath (4.29±0.30 cmH2O/L/s vs 3.41±0.14 cmH2O/L/s, P<0.01 and 3.50±0.24 cmH2O/L/s vs 2.68±0.10 cmH2O/L/s, P<0.01, respectively), expiratory, and inspiratory phases. CONCLUSION Although persistent airflow limitation occurs in patients with COPD, ACOS, and asthma FL(+), they may have distinct characteristics of the respiratory physiology and different responsiveness to bronchodilators.
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Affiliation(s)
- Yoshiaki Kitaguchi
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masanori Yasuo
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masayuki Hanaoka
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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18
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Leitão Filho FS, Hang Chen H, Ngan DA, Tam A, Kirby M, Sin DD. Current methods to diagnose small airway disease in patients with COPD. Expert Rev Respir Med 2016; 10:417-429. [PMID: 26890226 DOI: 10.1586/17476348.2016.1155455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The small airways are characterized by an internal diameter < 2 mm and absence of cartilage. Approximately 10-25% of total airway resistance in healthy lungs is due to the small airways, with their contribution to total airway resistance increasing substantially in chronic obstructive pulmonary disease (COPD). As the small airways are located in the lung periphery, they are not easily evaluable, which can potentially interfere with the diagnosis (especially at early stages), monitoring, detection of responses to clinical interventions, and prognostic evaluation in COPD. Here, we will discuss the currently available methods in clinical practice to evaluate small airway disease in COPD, focusing on the concept, advantages, and disadvantages of each method.
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Affiliation(s)
- Fernando Sergio Leitão Filho
- a Centre for Heart Lung Innovation, St. Paul´s Hospital, & Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| | - Hao Hang Chen
- a Centre for Heart Lung Innovation, St. Paul´s Hospital, & Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| | - David A Ngan
- a Centre for Heart Lung Innovation, St. Paul´s Hospital, & Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| | - Anthony Tam
- a Centre for Heart Lung Innovation, St. Paul´s Hospital, & Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| | - Miranda Kirby
- a Centre for Heart Lung Innovation, St. Paul´s Hospital, & Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| | - Don D Sin
- a Centre for Heart Lung Innovation, St. Paul´s Hospital, & Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
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19
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Abstract
The forced oscillation technique (FOT) is a noninvasive method with which to measure respiratory system resistance and reactance during tidal breathing. Recently, its clinical application has spread worldwide with the expansion of commercially available broadband frequency FOT devices, including MostGraph and Impulse Oscillometry. An increasing number of reports have supported the usefulness of the FOT in the management of asthma and chronic obstructive pulmonary disease (COPD). However, the FOT is not a surrogate test for spirometry, but should be used complementarily. Furthermore, reference values are not necessarily available and the interpretation of some measured data is controversial. There is a need to update the international statement for not only technical aspects but also the clinical use of the FOT. In this review, we summarize the previously published studies and discuss how to use the FOT in a clinical setting.
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Affiliation(s)
- Toshihiro Shirai
- Department of Respiratory Medicine, Shizuoka General Hospital, Japan
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20
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Jarenbäck L, Ankerst J, Bjermer L, Tufvesson E. Acinar ventilation heterogeneity in COPD relates to diffusion capacity, resistance and reactance. Respir Med 2015; 110:28-33. [PMID: 26607879 DOI: 10.1016/j.rmed.2015.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/02/2015] [Accepted: 11/05/2015] [Indexed: 12/23/2022]
Abstract
The aim of this study was to investigate heterogenic ventilation in the acinar (Sacin) and conductive (Scond) airways of patients with varying chronic obstructive pulmonary disease (COPD) severity and how these relates to advanced lung function parameters, primarily measured by impulse oscillometry (IOS). A secondary aim was to investigate the effects of a short acting beta2-agonist and a muscarinic antagonist on the heterogenic ventilation. Eleven never smoking controls, 12 smoking controls, and 57 COPD patients (7 GOLD 1, 25 GOLD 2, 14 GOLD 3 and 11 GOLD 4) performed flow-volume spirometry, IOS, body plethysmography, single breath carbon monoxide diffusion, and N2-multiple breath washout. Six smoking controls and 13 of the COPD patients also performed double reversibility test by using salbutamol and its combination with ipratropium. Sacin was significantly higher in GOLD 2-4 compared to never smoking controls and smoking controls, but showed similar levels in GOLD 3 and 4. A factor analysis identified 4 components consisting of; 1) IOS parameters, 2) volume parameters, 3) diffusion parameters, Sacin and some IOS parameters and 4) Scond with central obstruction/air trapping. Salbutamol and its combination with ipratropium had no effect on Sacin and Scond. Increased Sacin in COPD was strongly related to diffusion capacity and lung volumes, but also weakly to resistance and reactance, showing a link between ventilation heterogeneity in the acinar airways and parameters measured by IOS.
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Affiliation(s)
- Linnea Jarenbäck
- Dept. of Clinical Sciences, Lund, Lund University, 221 84 Lund, Sweden.
| | - Jaro Ankerst
- Dept. of Clinical Sciences, Lund, Lund University, 221 84 Lund, Sweden
| | - Leif Bjermer
- Dept. of Clinical Sciences, Lund, Lund University, 221 84 Lund, Sweden
| | - Ellen Tufvesson
- Dept. of Clinical Sciences, Lund, Lund University, 221 84 Lund, Sweden
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21
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Santus P, Radovanovic D, Di Marco F, Raccanelli R, Valenti V, Centanni S. Faster reduction in hyperinflation and improvement in lung ventilation inhomogeneity promoted by aclidinium compared to glycopyrronium in severe stable COPD patients. A randomized crossover study. Pulm Pharmacol Ther 2015; 35:42-9. [PMID: 26549785 DOI: 10.1016/j.pupt.2015.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 10/31/2015] [Accepted: 11/02/2015] [Indexed: 10/22/2022]
Abstract
Standard spyrometric assessment in chronic obstructive pulmonary disease (COPD) only evaluates bronchial obstruction. However, airflow limitation and hyperinflation are the main pathophysiological factors responsible for dyspnoea and reduced exercise tolerance in patients with COPD. This study evaluated the effects of aclidinium bromide 400 μg and glycopyrronium bromide 50 μg on these parameters. Patients with stable severe/very severe COPD were randomized in this double-blind, double-dummy, crossover, Phase IV study. Patients received single doses of each drug on separate days. Primary endpoints were changes in residual volume (RV) and intra-thoracic gas volume (ITGV), assessed by full-body plethysmography. Other endpoints included changes variations in lung ventilation inhomogeneity (Phase III slope of single-breath nitrogen washout test, SBN2), dyspnoea visual analogue scale, and pulmonary specific total airway resistances. Assessments were performed at baseline and 5, 15, 30, 60, and 180 min post-administration. Thirty-seven patients were randomized (31 male; mean age 71 years). Aclidinium and glycopyrronium significantly improved ITGV versus baseline at all-time points (p < 0.05). Significant improvements in RV were observed after 5 min with aclidinium and after 60 min with glycopyrronium. RV improvements were significantly greater with aclidinium than glycopyrronium from 5 to 60 min post-administration (p < 0.05). Both treatments improved dyspnoea versus baseline at all-time points (p < 0.05). Aclidinium significantly improved ventilation inhomogeneity versus baseline at all-time points; no significant changes were observed for glycopyrronium. For the first time two long-acting muscarinic antagonists have been compared in acute conditions with body plethysmography and SBN2 test. We demonstrated that both aclidinium and glycopyrronium significantly reduce hyperinflation and dyspnoea in severe and very severe COPD patients. Aclidinium however promoted a faster reduction in RV and was the only able to reduce lung ventilation inhomogeneity. Trial Registration numbers available on Clinicaltrials.gov: NCT02181023.
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Affiliation(s)
- Pierachille Santus
- Health Science Department, University of Milan - Pulmonary Rehabilitation Unit, Fondazione, Salvatore Maugeri, IRCCS - Scientific Institute of Milan, Milan, Italy.
| | - Dejan Radovanovic
- Health Science Department, University of Milan - Pulmonary Rehabilitation Unit, Fondazione, Salvatore Maugeri, IRCCS - Scientific Institute of Milan, Milan, Italy.
| | - Fabiano Di Marco
- Health Science Department, University of Milan - Respiratory Unit, San Paolo Hospital, Milan, Italy.
| | - Rita Raccanelli
- Health Science Department, University of Milan - Pulmonary Rehabilitation Unit, Fondazione, Salvatore Maugeri, IRCCS - Scientific Institute of Milan, Milan, Italy.
| | - Vincenzo Valenti
- Department of Health Bioscience, University of Milan - Respiratory Unit, Policlinico di San Donato, IRCCS - San Donato Milanese, Milan, Italy.
| | - Stefano Centanni
- Health Science Department, University of Milan - Respiratory Unit, San Paolo Hospital, Milan, Italy.
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Inui N, Matsushima S, Kato S, Yasui H, Kono M, Fujisawa T, Enomoto N, Nakamura Y, Toyoshima M, Suda T. Effects of indacaterol versus tiotropium on respiratory mechanics assessed by the forced oscillation technique in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2015; 10:1139-46. [PMID: 26124653 PMCID: PMC4476438 DOI: 10.2147/copd.s87058] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The forced oscillation technique (FOT) can measure respiratory mechanics and has attracted attention in chronic obstructive pulmonary disease (COPD). We aimed to evaluate the effects of only indacaterol and tiotropium monotherapies on airflow limitation and respiratory impedance. Pulmonary function tests, COPD assessment test (CAT), and multifrequency FOT with MostGraph-01 were performed at the beginning and after 8 weeks of treatment with indacaterol or tiotropium. The resistance index, resistance at 5 Hz (R5), resistance at 20 Hz (R20), reactance index, reactance at 5 Hz (X5), resonant frequency (Fres), and low-frequency reactance area (ALX) were determined at whole-breath, inspiratory, and expiratory phases. Eighty-two patients (mean age: 73 years; mean forced expiratory volume in 1 second (FEV1): 61.6%±19.0% predicted) were randomized to indacaterol or tiotropium treatment. Both bronchodilators improved airflow limitation, with mean trough improvements in FEV1 of 165 mL and 80 mL in the indacaterol and tiotropium groups, respectively. The CAT score decreased in the indacaterol group (P<0.001; 11.2±6.6 to 7.5±5.6). Compared with tiotropium, indacaterol significantly improved FEV1, percent predicted FEV1, and CAT score (P=0.042, P=0.008, and P=0.027, respectively). For respiratory impedance, indacaterol and tiotropium changed R5, X5, Fres, and ALX at whole-breath, inspiratory, and expiratory phases. In the indacaterol group, the changes in R5, R5-R20, X5, Fres, and ALX were significantly correlated with the changes in FEV1. The use of the FOT may enable the evaluation of the effects of bronchodilators in addition to FEV1-indicated therapeutic effects in COPD.
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Affiliation(s)
- Naoki Inui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Handayama, Hamamatsu, Japan
- Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, Handayama, Hamamatsu, Japan
| | - Sayomi Matsushima
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Handayama, Hamamatsu, Japan
| | - Shinpei Kato
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Handayama, Hamamatsu, Japan
| | - Hideki Yasui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Handayama, Hamamatsu, Japan
| | - Masato Kono
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Handayama, Hamamatsu, Japan
| | - Tomoyuki Fujisawa
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Handayama, Hamamatsu, Japan
| | - Noriyuki Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Handayama, Hamamatsu, Japan
| | - Yutaro Nakamura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Handayama, Hamamatsu, Japan
| | - Mikio Toyoshima
- Department of Respiratory Medicine, Hamamatsu Rosai Hospital, Shougen-cho, Hamamatsu, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Handayama, Hamamatsu, Japan
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23
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Fujii M, Shirai T, Mori K, Mikamo M, Shishido Y, Akita T, Morita S, Asada K, Suda T. Inspiratory resonant frequency of forced oscillation technique as a predictor of the composite physiologic index in interstitial lung disease. Respir Physiol Neurobiol 2014; 207:22-7. [PMID: 25514184 DOI: 10.1016/j.resp.2014.12.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 12/10/2014] [Accepted: 12/11/2014] [Indexed: 12/31/2022]
Abstract
The composite physiologic index (CPI), which is derived from FEV1, FVC, and diffusing capacity, has been developed to predict the extent of fibrosis on high-resolution computed tomography (HRCT). However, the relevance to the forced oscillation technique (FOT) is not fully understood. We hypothesized that FOT would independently predict the CPI in interstitial lung disease (ILD). In this cross-sectional study we assessed the relationship between pulmonary function tests, forced oscillatory parameters, and the degree of fibrosis in ILD. Spirometry, evaluation of diffusing capacity for carbon monoxide, and the broadband frequency FOT were performed in 93 patients with a clinical/HRCT diagnosis of ILD. The CPI was calculated and fibrosis extent was measured by HRCT and scored. Univariate analyses revealed that, of the forced oscillatory parameters, inspiratory resonant frequency best correlated with FVC, FEV1, diffusing capacity, CPI, and fibrosis score. In multiple regression analyses, CPI was independently predicted by inspiratory resonant frequency and fibrosis score (model R(2)=0.405, p<0.0001).
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Affiliation(s)
- Masato Fujii
- Department of Respiratory Medicine, Shizuoka General Hospital, 4-27-1 Kita-Ando, Aoi, Shizuoka, 420-8527, Japan.
| | - Toshihiro Shirai
- Department of Respiratory Medicine, Shizuoka General Hospital, 4-27-1 Kita-Ando, Aoi, Shizuoka, 420-8527, Japan.
| | - Kazutaka Mori
- Second Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.
| | - Masashi Mikamo
- Second Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.
| | - Yuichiro Shishido
- Department of Respiratory Medicine, Shizuoka General Hospital, 4-27-1 Kita-Ando, Aoi, Shizuoka, 420-8527, Japan.
| | - Takefumi Akita
- Department of Respiratory Medicine, Shizuoka General Hospital, 4-27-1 Kita-Ando, Aoi, Shizuoka, 420-8527, Japan.
| | - Satoru Morita
- Department of Respiratory Medicine, Shizuoka General Hospital, 4-27-1 Kita-Ando, Aoi, Shizuoka, 420-8527, Japan.
| | - Kazuhiro Asada
- Department of Respiratory Medicine, Shizuoka General Hospital, 4-27-1 Kita-Ando, Aoi, Shizuoka, 420-8527, Japan.
| | - Takafumi Suda
- Second Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.
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24
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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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