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Jacquerie P, André B, De Seny D, Henket M, Giltay L, Ernst M, Louis R, Malaise M, Ribbens C, Guiot J. Reproducibility of pulmonary function tests in patients with systemic sclerosis. Sci Rep 2023; 13:18960. [PMID: 37923803 PMCID: PMC10624913 DOI: 10.1038/s41598-023-45881-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 10/25/2023] [Indexed: 11/06/2023] Open
Abstract
Systemic sclerosis (SSc) is a rare autoimmune disease in which interstitial lung disease (ILD) is the leading cause of morbidity and mortality. Clinical management of the lung disease is mainly based on pulmonary function testing (PFT) and their changes over time. Little is known about the reproducibility of PFT testing in SSc patients. The aim of this study was to assess the test-retest reliability and reproducibility of PFTs in SSc patients with or without ILD over 30 days in order determine the potential physiologic variation over the time. We performed prospective observational study of SSc patients. The FVC, FEV1/FVC ratio, DLCO and KCO parameters were assessed in this population at four different timepoints; T0 (time 0) and H3 (T0 + 3 h) defined test-retest reliability, D15 (T0 + 15 days) and D30 (T0 + 30 days) for reproducibility. A mixed linear model was used to test the effect of time (and therefore reproducibility) on patients and we looked for an interaction. We included 25 SSc patients divided in two groups, 14 with ILD and 11 non-ILD. Interactions between time and group were not significant and were not reported. Time and group did not significantly influence the different measures of the PFT: FVC [p values time and group effect respectively (0.33; 0.34)], FEV1/FVC ratio (0.093; 0.056) and DLCO (0.99; 0.13) in the ILD and non ILD group (Table S2). The analyse with interactions between time and group were not significant and are not reported. We also used a Bland Altman test to assess reproducibility for FVC (L) and DLCO (mMKpa/min/L), Figs. 1 and 2 respectively. The measurements were therefore reproducible over time and in each group. PFT parameters are reproducible over time in a clinically stable population of SSc (no significant effect of the time T0, H3, D15 and D30) and there is no significant distinction between patients with ILD and no ILD. These respiratory functional data can further underline their use in clinical practice.
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Affiliation(s)
- P Jacquerie
- Rheumatology Department, CHU LiègeULiège, Domaine Universitaire Sart Tilman, B35, 4020, Liège, Belgium.
| | - B André
- Rheumatology Department, CHU LiègeULiège, Domaine Universitaire Sart Tilman, B35, 4020, Liège, Belgium
| | - D De Seny
- Pneumology Department, CHU Liège, GIGA Research, ULiège, Domaine Universitaire Sart Tilman, Liège, Belgium
| | - M Henket
- Pneumology Department, CHU Liège, GIGA Research, ULiège, Domaine Universitaire Sart Tilman, Liège, Belgium
| | - L Giltay
- Pneumology Department, CHU Liège, GIGA Research, ULiège, Domaine Universitaire Sart Tilman, Liège, Belgium
| | - M Ernst
- Biostatistics and Research Method Center (B-STAT), ULiège, Domaine Universitaire Sart Tilman, Liège, Belgium
| | - R Louis
- Pneumology Department, CHU Liège, GIGA Research, ULiège, Domaine Universitaire Sart Tilman, Liège, Belgium
| | - M Malaise
- Rheumatology Department, CHU LiègeULiège, Domaine Universitaire Sart Tilman, B35, 4020, Liège, Belgium
| | - C Ribbens
- Rheumatology Department, CHU LiègeULiège, Domaine Universitaire Sart Tilman, B35, 4020, Liège, Belgium
| | - J Guiot
- Pneumology Department, CHU Liège, GIGA Research, ULiège, Domaine Universitaire Sart Tilman, Liège, Belgium
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Zavorsky GS, Cao J. Reference equations for pulmonary diffusing capacity using segmented regression show similar predictive accuracy as GAMLSS models. BMJ Open Respir Res 2022; 9:9/1/e001087. [PMID: 35172984 PMCID: PMC8852756 DOI: 10.1136/bmjresp-2021-001087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/24/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose To determine whether generalised additive models of location, scale and shape (GAMLSS) developed for pulmonary diffusing capacity are superior to segmented (piecewise) regression models, and to update reference equations for pulmonary diffusing capacity for carbon monoxide (DLCO) and nitric oxide (DLNO), which may be affected by the equipment used for its measurement. Methods Data were pooled from five studies that developed reference equations for DLCO and DLNO (n=530 F/546 M; 5–95 years old, body mass index 12.4–39.0 kg/m2). Reference equations were created for DLCO and DLNO using both GAMLSS and segmented linear regression. Cross-validation was applied to compare the prediction accuracy of the two models as follows: 80% of the pooled data were used to create the equations, and the remaining 20% was used to examine the fit. This was repeated 100 times. Then, the root-mean-square error was compared between both models. Results In males, GAMLSS models were 7% worse to 3% better compared to segmented regression for DLCO and DLNO. In females, GAMLSS models were 2% worse to 5% better compared to segmented linear regression for DLCO and DLNO. The Hyp'Air Compact measured DLNO and alveolar volume (VA) that was approximately 16–20 mL/min/mm Hg and 0.2–0.4 L higher, respectively, compared to the Jaeger MasterScreen Pro. The measured DLCO was similar between devices after controlling for altitude. Conclusions For the development of pulmonary function reference equations, we propose that segmented linear regression can be used instead of GAMLSS due to its simplicity, especially when the predictive accuracy is similar between the two models, overall.
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Affiliation(s)
| | - Jiguo Cao
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, British Columbia, Canada
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Radtke T, de Groot Q, Haile SR, Maggi M, Hsia CCW, Dressel H. Lung diffusing capacity for nitric oxide measured by two commercial devices: a randomised crossover comparison in healthy adults. ERJ Open Res 2021; 7:00193-2021. [PMID: 34435029 PMCID: PMC8381155 DOI: 10.1183/23120541.00193-2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/15/2021] [Indexed: 12/02/2022] Open
Abstract
In Europe, two commercial devices are available to measure combined single-breath diffusing capacity of the lung for nitric oxide (DLNO) and carbon monoxide (DLCO) in one manoeuvre. Reference values were derived by pooling datasets from both devices, but agreement between devices has not been established. We conducted a randomised crossover trial in 35 healthy adults (age 40.0±15.5 years, 51% female) to compare DLNO (primary end-point) between MasterScreen™ (Vyaire Medical, Mettawa, IL, USA) and HypAir (Medisoft, Dinant, Belgium) devices during a single visit under controlled conditions. Linear mixed models were used adjusting for device and period as fixed effects and random intercept for each participant. Difference in DLNO between HypAir and MasterScreen was 24.0 mL·min−1·mmHg−1 (95% CI 21.7–26.3). There was no difference in DLCO (−0.03 mL·min−1·mmHg−1, 95% CI −0.57–0.12) between devices while alveolar volume (VA) was higher on HypAir compared to MasterScreen™ (0.48 L, 95% CI 0.45–0.52). Disparity in the estimation of VA and the rate of NO uptake (KNO=DLNO/VA) could explain the discrepancy in DLNO between devices. Disparity in the estimation of VA and the rate of CO uptake (KCO=DLCO/VA) per unit of VA offset each other resulting in negligible discrepancy in DLCO between devices. Differences in methods of expiratory gas sampling and sensor specifications between devices likely explain these observations. These findings have important implications for derivation of DLNO reference values and comparison of results across studies. Until this issue is resolved, reference values, established on the respective devices, should be used for test interpretation. Large discrepancies between commercial devices to measure single-breath diffusing capacity of the lung for nitric oxide in healthy subjects caution against pooling or direct comparison of measurements obtained using different protocols and deviceshttps://bit.ly/3vKyF7U
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Affiliation(s)
- Thomas Radtke
- Division of Occupational and Environmental Medicine, Epidemiology, Biostatistics and Prevention Institute, University of Zurich & University Hospital Zurich, Zurich, Switzerland.,These authors contributed equally
| | - Quintin de Groot
- Division of Occupational and Environmental Medicine, Epidemiology, Biostatistics and Prevention Institute, University of Zurich & University Hospital Zurich, Zurich, Switzerland.,Zurich University of Applied Sciences, School of Health Professions, Institute of Physiotherapy, Winterthur, Switzerland.,These authors contributed equally
| | - Sarah R Haile
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Marion Maggi
- Division of Occupational and Environmental Medicine, Epidemiology, Biostatistics and Prevention Institute, University of Zurich & University Hospital Zurich, Zurich, Switzerland
| | - Connie C W Hsia
- Dept of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Holger Dressel
- Division of Occupational and Environmental Medicine, Epidemiology, Biostatistics and Prevention Institute, University of Zurich & University Hospital Zurich, Zurich, Switzerland
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Variability in pulmonary diffusing capacity in heart failure. Respir Physiol Neurobiol 2020; 280:103473. [DOI: 10.1016/j.resp.2020.103473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 11/22/2022]
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Desjardin A, Creveuil C, Bergot E, Normand H. Assessment of concordance between diffusion of carbon monoxide through the lung using the 10 s breath-hold method, and the simultaneous NO/CO technique, in healthy participants. Respir Physiol Neurobiol 2019; 273:103319. [PMID: 31654813 DOI: 10.1016/j.resp.2019.103319] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 09/23/2019] [Accepted: 10/08/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION There is limited, large sample size, healthy control data comparing measurement of diffusing capacity of the lungs for carbon monoxide (DLCO) via the 10 s single-breath carbon monoxide uptake method (DLCO10) and using a DLCO-DLNO double diffusion test performed with a 5 s time of apnoea (DLCO5). OBJECTIVES The primary objective was to compare DLCO5 and DLCO10 in healthy participants. The secondary objective was to evaluate the reproducibility of DLCO5. MATERIAL AND METHODS We included medical students at Caen University Hospital, from 2008 to 2011. We performed a standard single-breath carbon monoxide uptake and combined DLCO and DLNO measurement for each participant. The combined test was repeated one week later. RESULTS Among the 153 study participants, there was no statistically significant difference between the mean values of DLCO10 (10.2 ± 2.2 mmol.min-1 kPa-1) and DLCO5 (10.3 ± 2.2 mmol.min-1 kPa-1; paired t-test p = 0.19). Corrected for the same FiO2, DLCO5 was calculated at 10.5 ± 2.3 mmol.min-1 kPa-1 and was significantly different from DLCO10 (paired t-test p < 0.001). DLCO5 deviates from 1,6 mmol.min-1 kPa-1 (4,6 mL.min-1. mmHg-1) or 15 % of DLCO10 (17 % above and 13% below, for 95 % of the subjects). Forty-seven participants were included in the DLCO5 reproducibility test. The 2 test sessions were carried out at 6 ± 2 day intervals. Reproducibilities for DLCO, DLNO, DmCO and Vc was respectively 1.2 (11 %), 6.8 (13%), 16.5 (32 %), 12.5 (17 %) mmol.min-1 kPa-1. CONCLUSION In healthy participants, discrepancies between DLCO measured during the double diffusion and DLCO measured on an apnoea of 10 s are quite large. It may be an indication that the Roughton and Forster interpretation to describe this type of measurements is inadequate.
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Affiliation(s)
- Amaury Desjardin
- Service de Pneumologie, Centre Hospitalier Universitaire, 14000 Caen, France
| | - Christian Creveuil
- Unité de Biostatistique et Recherche Clinique (UBRC), Centre Hospitalier Universitaire, 14000 Caen, France
| | - Emmanuel Bergot
- Service de Pneumologie, Centre Hospitalier Universitaire, 14000 Caen, France
| | - Hervé Normand
- Service des Explorations fonctionnelles, Centre Hospitalier Universitaire, 14000 Caen, France; Normandie University, Unicaen, Inserm Comete, GIP Cyceron, France.
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Winkler A, Kahnert K, Behr J, Neurohr C, Kneidinger N, Hatz R, Dressel H, Radtke T, Jörres RA. Combined diffusing capacity for nitric oxide and carbon monoxide as predictor of bronchiolitis obliterans syndrome following lung transplantation. Respir Res 2018; 19:171. [PMID: 30200966 PMCID: PMC6131787 DOI: 10.1186/s12931-018-0881-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a need for non-invasive parameters that are sensitive to the development of the bronchiolitis obliterans syndrome (BOS) in lung transplantation (LTx) patients. We studied whether the pulmonary diffusing capacity for inhaled nitric oxide is capable of detecting BOS stages. METHODS Sixty-one LTx patients were included into this cross-sectional study (19/29/7/3/3 in BOS stages 0/0-p/1/2/3). For analysis stages 0/0-p versus 1/2/3 ("BOS binary-early"), and stages 0/0-p/1 versus 2/3 ("BOS binary-late") were summarized. Measurements of the combined diffusing capacity for nitric oxide (DLNO) and carbon monoxide (DLCO) were compared with spirometry and bodyplethysmography, and their relative importance was evaluated by discriminant analysis. RESULTS Regarding the recognition of "BOS binary-early", among spirometric parameters forced expiratory volume in 1 s (FEV1) was best, among bodyplethysmographic parameters airway resistance, and among diffusing parameters DLNO. Regarding "BOS binary-late", DLNO was inferior to bodyplethysmographic parameters. CONCLUSION Although the study comprised only measurements at a single time point and no follow-up, DLNO outperformed FEV1, the time course of which is used in detecting BOS. Together with its pathophysiological plausibility, this result suggests that the measurement of DLNO, possibly over time, could be an easily applicable tool for the monitoring of LTx patients and should be evaluated in larger studies.
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Affiliation(s)
- Anna Winkler
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians-Universität München, Munich, Germany
| | - Kathrin Kahnert
- Department of Internal Medicine V, University of Munich (LMU), Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), Ziemssenstr. 1, 80336, Munich, Germany.
| | - Jürgen Behr
- Department of Internal Medicine V, University of Munich (LMU), Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), Ziemssenstr. 1, 80336, Munich, Germany
| | - Claus Neurohr
- Robert-Bosch-Hospital, Klinik Schillerhöhe, Gerlingen, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, University of Munich (LMU), Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), Ziemssenstr. 1, 80336, Munich, Germany
| | - Rudolf Hatz
- Department of Thoracic Surgery, University of Munich (LMU), Munich, Germany
| | - Holger Dressel
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Division of Occupational and Environmental Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Thomas Radtke
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Division of Occupational and Environmental Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians-Universität München, Munich, Germany
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Acute effects of combined exercise and oscillatory positive expiratory pressure therapy on sputum properties and lung diffusing capacity in cystic fibrosis: a randomized, controlled, crossover trial. BMC Pulm Med 2018; 18:99. [PMID: 29898704 PMCID: PMC6000950 DOI: 10.1186/s12890-018-0661-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/24/2018] [Indexed: 11/10/2022] Open
Abstract
Background Regular airway clearance by chest physiotherapy and/or exercise is critical to lung health in cystic fibrosis (CF). Combination of cycling exercise and chest physiotherapy using the Flutter® device on sputum properties has not yet been investigated. Methods This prospective, randomized crossover study compared a single bout of continuous cycling exercise at moderate intensity (experiment A, control condition) vs a combination of interval cycling exercise plus Flutter® (experiment B). Sputum properties (viscoelasticity, yield stress, solids content, spinnability, and ease of sputum expectoration), pulmonary diffusing capacity for nitric oxide (DLNO) and carbon monoxide (DLCO) were assessed at rest, directly and 45 min post-exercise (recovery) at 2 consecutive visits. Primary outcome was change in sputum viscoelasticity (G’, storage modulus; G”, loss modulus) over a broad frequency range (0.1–100 rad.s− 1). Results 15 adults with CF (FEV1range 24–94% predicted) completed all experiments. No consistent differences between experiments were observed for G’ and G” and other sputum properties, except for ease of sputum expectoration during recovery favoring experiment A. DLNO, DLCO, alveolar volume (VA) and pulmonary capillary blood volume (Vcap) increased during experiment A, while DLCO and Vcap increased during experiment B (all P < 0.05). We found no differences in absolute changes in pulmonary diffusing capacity and its components between experiments, except a higher VA immediately post-exercise favoring experiment A (P = 0.032). Conclusions The additional use of the Flutter® to moderate intensity interval cycling exercise has no measurable effect on the viscoelastic properties of sputum compared to moderate intensity continuous cycling alone. Elevations in diffusing capacity represent an acute exercise-induced effect not sustained post-exercise. Trial registration ClinicalTrials.gov; No.: NCT02750722; URL: clinical.trials.gov; Registration date: April 25th, 2016. Electronic supplementary material The online version of this article (10.1186/s12890-018-0661-1) contains supplementary material, which is available to authorized users.
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