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Klimenko O, Luu P, Dominelli P, Noggle N, Petrics G, Haverkamp HC. Effect of exercise-induced bronchoconstriction on the configuration of the maximal expiratory flow-volume curve in adults with asthma. Physiol Rep 2023; 11:e15614. [PMID: 36823958 PMCID: PMC9950550 DOI: 10.14814/phy2.15614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/28/2023] [Indexed: 02/25/2023] Open
Abstract
We determined the effect of exercise-induced bronchoconstriction (EIB) on the shape of the maximal expiratory flow-volume (MEFV) curve in asthmatic adults. The slope-ratio index (SR) was used to quantitate the shape of the MEFV curve. We hypothesized that EIB would be accompanied by increases in SR and thus increased curvilinearity of the MEFV curve. Adult asthmatic ( n = 10) and non-asthmatic control subjects ( n = 9) cycled for 6-8 min at 85% of peak power. Following exercise, subjects remained on the ergometer and performed a maximal forced exhalation every 2 min for a total 20 min. In each MEFV curve, the slope-ratio index (SR) was calculated in 1% volume increments beginning at peak expiratory flow (PEF) and ending at 20% of forced vital capacity (FVC). Baseline spirometry was lower in asthmatics compared to control subjects (FEV1 % predicted, 89.1 ± 14.3 vs. 96.5 ± 12.2% [SD] in asthma vs. control; p < 0.05). In asthmatic subjects, post-exercise FEV1 decreased by 29.9 ± 13.2% from baseline (3.48 ± 0.74 and 2.24 ± 0.59 [SD] L for baseline and post-exercise nadir; p < 0.001). At baseline and at all timepoints after exercise, average SR between 80 and 20% of FVC was larger in asthmatic than control subjects (1.48 ± 0.02 vs. 1.23 ± 0.02 [SD] for asthma vs. control; p < 0.005). This averaged SR did not change after exercise in either subject group. In contrast, post-exercise SR between PEF and 75% of FVC was increased from baseline in subjects with asthma, suggesting that airway caliber heterogeneity increases with EIB. These findings suggest that the SR-index might provide useful information on the physiology of acute airway narrowing that complements traditional spirometric measures.
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Affiliation(s)
- Oksana Klimenko
- Department of Nutrition and Exercise Physiology, Washington State University-Spokane Health Sciences, Elson S. Floyd College of Medicine, Spokane, Washington, USA
| | - Peter Luu
- Department of Nutrition and Exercise Physiology, Washington State University-Spokane Health Sciences, Elson S. Floyd College of Medicine, Spokane, Washington, USA
| | - Paolo Dominelli
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Nathan Noggle
- Department of Nutrition and Exercise Physiology, Washington State University-Spokane Health Sciences, Elson S. Floyd College of Medicine, Spokane, Washington, USA
| | - Gregory Petrics
- Department of Mathematics, Northern Vermont University-Johnson, Johnson, Vermont, USA
| | - Hans Christian Haverkamp
- Department of Nutrition and Exercise Physiology, Washington State University-Spokane Health Sciences, Elson S. Floyd College of Medicine, Spokane, Washington, USA
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MOLGAT-SEON YANNICK, DOMINELLI PAOLOB, PETERS CARLIM, KIPP SHALAYA, WELCH JOSEPHF, PARMAR HANNAR, RABBANI TIAN, MANN LEAHM, GRIFT GRACIEO, GUENETTE JORDANA, SHEEL AWILLIAM. Predictors of Expiratory Flow Limitation during Exercise in Healthy Males and Females. Med Sci Sports Exerc 2022; 54:1428-1436. [DOI: 10.1249/mss.0000000000002938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Dominelli PB, Molgat-Seon Y. Sex, gender and the pulmonary physiology of exercise. Eur Respir Rev 2022; 31:31/163/210074. [PMID: 35022254 PMCID: PMC9488949 DOI: 10.1183/16000617.0074-2021] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/09/2021] [Indexed: 01/11/2023] Open
Abstract
In this review, we detail how the pulmonary system's response to exercise is impacted by both sex and gender in healthy humans across the lifespan. First, the rationale for why sex and gender differences should be considered is explored, and then anatomical differences are highlighted, namely that females typically have smaller lungs and airways than males. Thereafter, we describe how these anatomical differences can impact functional aspects such as respiratory muscle energetics and activation, mechanical ventilatory constraints, diaphragm fatigue, and pulmonary gas exchange in healthy adults and children. Finally, we detail how gender can impact the pulmonary response to exercise. Biological sex can influence the pulmonary response to exercise in healthy individuals across the lifespanhttps://bit.ly/3ejMDrv
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Affiliation(s)
| | - Yannick Molgat-Seon
- Dept of Kinesiology and Applied Health, University of Winnipeg, Winnipeg, MB, Canada.,Centre for Heart and Lung Innovation, Providence Health Care Research Institute, St Paul's Hospital, Vancouver, BC, Canada
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Welch R, Francis A, Babbage T, Lardenoye M, Kolbe J, Ellyett K. Quantifying tidal expiratory flow limitation using a vector-based analysis technique. Physiol Meas 2021; 42. [PMID: 34874285 DOI: 10.1088/1361-6579/ac3f96] [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: 10/12/2020] [Accepted: 12/01/2021] [Indexed: 11/12/2022]
Abstract
Objective. Tidal expiratory flow limitation (EFLT) is commonly identified by tidal breaths exceeding the forced vital capacity (FVC) loop. This technique, known as the Hyatt method, is limited by the difficulties in defining the FVC and tidal flow-volume (TV) loops. The vector-based analysis (VBA) technique described and piloted in this manuscript identifies and quantifies EFLTas tidal breaths that conform to the contour of the FVC loop.Approach. The FVC and TV loops are interpolated to generate uniformly spaced plots. VBA is performed to determine the smallest vector difference between each point on the FVC and TV curves, termed the flow reserve vector (FRV). From the FVC point yielding the lowest FRV, the tangential angles of the FVC and TV segments are recorded. If the TV and FVC loops become parallel, the difference between the tangential angles tends towards zero. We infer EFLTas parallel TV and FVC segments where the FRV is < 0.1 and the tangential angle is within ±18 degrees for ≥5% of TV. EFLTis quantified by the percent of TV loop fulfilling these criteria. We compared the presence and degree of EFLTat rest and during peak exercise using the Hyatt method and our VBA technique in 25 healthy subjects and 20 subjects with moderate-severe airflow obstruction.Main results. Compared to the Hyatt method, our VBA technique reported a significantly lower degree of EFLTin healthy subjects during peak exercise, and in obstructed subjects at rest and during peak exercise. In contrast to the Hyatt method, our VBA technique re-classified five subjects (one in the healthy group and four in the obstructed group) as demonstrating EFLT.Significance.Our VBA technique provides an alternative approach to determine and quantify EFLTwhich may reduce the overestimation of the degree EFLTand more accurately identify subjects experiencing EFLT.
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Affiliation(s)
- Ryan Welch
- Respiratory Services, Auckland District Health Board, Auckland, New Zealand.,The University of Auckland, Auckland, New Zealand
| | | | | | - Mandy Lardenoye
- Respiratory Services, Auckland District Health Board, Auckland, New Zealand
| | - John Kolbe
- Respiratory Services, Auckland District Health Board, Auckland, New Zealand.,The University of Auckland, Auckland, New Zealand
| | - Kevin Ellyett
- Respiratory Services, Auckland District Health Board, Auckland, New Zealand.,The University of Auckland, Auckland, New Zealand
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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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Zhang Y, Shi H, Su A, Dai F, Wang X, Zhang Y, Zheng Y, Cai C, Wang X. Angle β combined with FeNO and FEV1/FVC% for the detection of asthma in school-aged children. J Asthma 2021; 59:746-754. [PMID: 33435766 DOI: 10.1080/02770903.2021.1874979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The diagnostic value of angle β in school-aged children with asthma is unknown. We speculate that angle β may reflect diversification of the forced expiratory flow (FEF) to some extent. The objective of this study was to assess the diagnostic accuracy of angle β, FeNO, pulmonary function parameters and their combinations for asthma in school-aged children. METHODS In total, 248 children participated in this study (140 children with asthma and 108 healthy children). The diagnostic performance of angle β, FeNO and pulmonary function parameters was determined using receiver operating characteristic (ROC) curves. In the ROC analysis, we used the hold out cross-validation method to avoid overfitting. This study was performed in China and followed the Guidelines for the diagnosis and optimal management of asthma in children (China). RESULTS 1) In the asthma group, the mean angle β value was significantly smaller than that in the control group (P < 0.001), but the mean FeNO value was significantly higher than that in the control group (P < 0.001). 2) More acute exacerbation or greater severity corresponded to a smaller angle β. 3) Among the single indices, the area under the ROC curve of angle β was the largest (except for FEV1/FVC%). For combined indicators, after cross-verification, the combination of angle β, FEV1/FVC% and FeNO showed the highest diagnostic accuracy. CONCLUSION Angle β combined with FeNO and FEV1/FVC% can improve the diagnostic accuracy for asthma in school-aged children.
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Affiliation(s)
- Yanli Zhang
- Department of Pediatrics, The Third Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Hongke Shi
- Department of Pediatrics, The Third Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Aifang Su
- Department of Pediatrics, Henan Province Luohe City Children's Hospital, Luohe, China
| | - Fuli Dai
- Department of Pediatrics, Henan Province Luoyang City Women and Children Medical Care Center, Luoyang, China
| | - Xiufang Wang
- Department of Pediatrics, The Third Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Yan Zhang
- Department of Pediatrics, The Third Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Yuehong Zheng
- Department of Pediatrics, The Third Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Chunling Cai
- Department of Pediatrics, The Third Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Xiao Wang
- Department of Pediatrics, The Third Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
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Berrier A, Tiotiu A, Bonabel C, Richard D, Nguyen-Thi PL, Demoulin-Alexikova S, Schweitzer C, Ioan I. Assessment of bronchial obstruction and its reversibility by shape indexes of the flow-volume loop in asthmatic children. Pediatr Pulmonol 2021; 56:226-233. [PMID: 33169929 DOI: 10.1002/ppul.25162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/23/2020] [Accepted: 10/31/2020] [Indexed: 11/10/2022]
Abstract
Asthma assessment by spirometry is challenging in children as forced expiratory volume in 1 s (FEV1) is frequently normal at baseline. Bronchodilator (BD) reversibility testing may reinforce asthma diagnosis but FEV1 sensitivity in children is controversial. Ventilation inhomogeneity, an early sign of airway obstruction, is described by the upward concavity of the descending limb of the forced expiratory flow-volume loop (FVL), not detected by FEV1. The aim was to test the sensitivity and specificity of FVL shape indexes as β-angle and forced expiratory flow at 50% of the forced vital capacity (FEF50)/peak expiratory flow (PEF) ratio, to identify asthmatics from healthy children in comparison to "usual" spirometric parameters. Seventy-two school-aged asthmatic children and 29 controls were prospectively included. Children performed forced spirometry at baseline and after BD inhalation. Parameters were expressed at baseline as z-scores and BD reversibility as percentage of change reported to baseline value (Δ%). Receiver operating characteristic curves were generated and sensitivity and specificity at respective thresholds reported. Asthmatics presented significantly smaller zβ-angle, zFEF50/PEF and zFEV1 (p ≤ .04) and higher BD reversibility, significant for Δ%FEF50/PEF (p = .02) with no difference for Δ%FEV1. zβ-angle and zFEF50/PEF exhibited better sensitivity (0.58, respectively 0.60) than zFEV1 (0.50), and similar specificity (0.72). Δ%β-angle showed higher sensitivity compared to Δ%FEV1 (0.72 vs. 0.42), but low specificity (0.52 vs. 0.86). Quantitative and qualitative assessment of FVL by adding shape indexes to spirometry interpretation may improve the ability to detect an airway obstruction, FEV1 reflecting more proximal while shape indexes peripheral bronchial obstruction.
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Affiliation(s)
- Amaury Berrier
- Department of Pulmonology, University Children's Hospital of Nancy, Nancy, France
| | - Angelica Tiotiu
- Department of Pulmonology, University Children's Hospital of Nancy, Nancy, France.,DevAH, Université de Lorraine, Nancy, France
| | - Claude Bonabel
- DevAH, Université de Lorraine, Nancy, France.,Department of Pediatric Respiratory Function Testing, University Children's Hospital of Nancy, Nancy, France
| | - David Richard
- Department of Pediatric Respiratory Function Testing, University Children's Hospital of Nancy, Nancy, France
| | - Phi Linh Nguyen-Thi
- Department of Methodology, Promotion, Investigation-MPI, University Children's Hospital of Nancy, Nancy, France
| | - Silvia Demoulin-Alexikova
- DevAH, Université de Lorraine, Nancy, France.,Department of Pediatric Respiratory Function Testing, University Children's Hospital of Nancy, Nancy, France
| | - Cyril Schweitzer
- DevAH, Université de Lorraine, Nancy, France.,Department of Pediatric Respiratory Function Testing, University Children's Hospital of Nancy, Nancy, France
| | - Iulia Ioan
- DevAH, Université de Lorraine, Nancy, France.,Department of Pediatric Respiratory Function Testing, University Children's Hospital of Nancy, Nancy, France
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Molgat-Seon Y, Dominelli PB, Peters CM, Guenette JA, Sheel AW, Gladstone IM, Lovering AT, Duke JW. Analysis of maximal expiratory flow-volume curves in adult survivors of preterm birth. Am J Physiol Regul Integr Comp Physiol 2019; 317:R588-R596. [PMID: 31433666 DOI: 10.1152/ajpregu.00114.2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Adult survivors of very preterm (≤32 wk gestational age) birth without (PRE) and with bronchopulmonary dysplasia (BPD) have variable degrees of airflow obstruction at rest. Assessment of the shape of the maximal expiratory flow-volume (MEFV) curve in PRE and BPD may provide information concerning their unique pattern of airflow obstruction. The purposes of the present study were to 1) quantitatively assess the shape of the MEFV curve in PRE, BPD, and healthy adults born at full-term (CON), 2) identify where along the MEFV curve differences in shape existed between groups, and 3) determine the association between an index of MEFV curve shape and characteristics of preterm birth (i.e., gestational age, mass at birth, duration of oxygen therapy) in PRE and BPD. To do so, we calculated the average slope ratio (SR) throughout the effort-independent portion of the MEFV curve and at increments of 5% of forced vital capacity (FVC) between 20 and 80% of FVC in PRE (n = 19), BPD (n = 25), and CON (n = 20). We found that average SR was significantly higher in PRE (1.34 ± 0.35) and BPD (1.33 ± 0.45) compared with CON (1.03 ± 0.22; both P < 0.05) but similar between PRE and BPD (P = 0.99). Differences in SR between groups occurred early in expiration (i.e., 20-30% of FVC). There was no association between SR and characteristics of preterm birth in PRE and BPD groups (all P > 0.05). The mechanism(s) of increased SR during early expiration in PRE/BPD relative to CON is unknown but may be due to differences in the structural and mechanical properties of the airways.
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Affiliation(s)
- Yannick Molgat-Seon
- Department of Kinesiology and Applied Health, University of Winnipeg, Winnipeg, Manitoba, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Heart and Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Paolo B Dominelli
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Carli M Peters
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jordan A Guenette
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Heart and Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada.,School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - A William Sheel
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Igor M Gladstone
- Oregon Health and Sciences University, Department of Paediatrics, Portland, Oregon
| | - Andrew T Lovering
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | - Joseph W Duke
- Department of Biological Sciences, Northern Arizona University, Flagstaff, Arizona
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Reply to Topalovic and Janssens: Re: Quantifying the shape of the maximal expiratory flow-volume curve to address flow limitation. Respir Physiol Neurobiol 2016; 227:68. [PMID: 26899171 DOI: 10.1016/j.resp.2016.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 11/22/2022]
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