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Choi JS, Kwak SH, Kim MC, Seol CH, Heo SJ, Kim SR, Lee EH. Usefulness of Impulse Oscillometry in Predicting the Severity of Bronchiectasis. Tuberc Respir Dis (Seoul) 2024; 87:368-377. [PMID: 38783483 PMCID: PMC11222088 DOI: 10.4046/trd.2023.0160] [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: 10/18/2023] [Revised: 02/17/2024] [Accepted: 04/19/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Bronchiectasis is a chronic respiratory disease that leads to airway inflammation, destruction, and airflow limitation, which reflects its severity. Impulse oscillometry (IOS) is a non-invasive method that uses sound waves to estimate lung function and airway resistance. The aim of this study was to assess the usefulness of IOS in predicting the severity of bronchiectasis. METHODS We retrospectively reviewed the IOS parameters and clinical characteristics in 145 patients diagnosed with bronchiectasis between March 2020 and May 2021. Disease severity was evaluated using the FACED score, and patients were divided into mild and moderate/severe groups. RESULTS Forty-four patients (30.3%) were in the moderate/severe group, and 101 (69.7%) were in the mild group. Patients with moderate/severe bronchiectasis had a higher airway resistance at 5 Hz (R5), a higher difference between the resistance at 5 and 20 Hz (R5-R20), a higher resonant frequency (Fres), and a higher area of reactance (AX) than patients with mild bronchiectasis. R5 ≥0.43, resistance at 20 Hz (R20) ≥0.234, R5-R20 ≥28.3, AX ≥1.02, reactance at 5 Hz (X5) ≤-0.238, and Fres ≥20.88 revealed significant univariable relationships with bronchiectasis severity (p<0.05). Among these, only X5 ≤-0.238 exhibited a significant multivariable relationship with bronchiectasis severity (p=0.039). The receiver operating characteristic curve for predicting moderate- to-severe bronchiectasis of FACED score based on IOS parameters exhibited an area under the curve of 0.809. CONCLUSION The IOS assessed by the disease severity of FACED score can effectively reflect airway resistance and elasticity in bronchiectasis patients and serve as valuable tools for predicting bronchiectasis severity.
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Affiliation(s)
- Ji Soo Choi
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Se Hyun Kwak
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Min Chul Kim
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Chang Hwan Seol
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Seok-Jae Heo
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Ryeol Kim
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Eun Hye Lee
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
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Nasr A, Papapostolou G, Jarenbäck L, Romberg K, Tunsäter A, Ankerst J, Bjermer L, Tufvesson E. Expiratory and inspiratory resistance and reactance from respiratory oscillometry defining expiratory flow limitation in obstructive lung diseases. Clin Physiol Funct Imaging 2024. [PMID: 38873744 DOI: 10.1111/cpf.12895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 05/19/2024] [Accepted: 06/05/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Expiratory flow limitation (EFL) during tidal breathing and lung hyperinflation have been identified as major decisive factors for disease status, prognosis and response to therapy in obstructive lung diseases. AIM To investigate the delta values between expiratory and inspiratory resistance and reactance, measured using respiratory oscillometry and its correlation with air trapping and symptoms in subjects with obstructive lung diseases. METHODS Four hundred and seventy-one subjects (96 with chronic obstructive pulmonary disease [COPD], 311 with asthma, 30 healthy smokers and 34 healthy subjects) were included. Spirometry, body plethysmography and respiratory oscillometry measurements were performed and the differences between the expiratory and inspiratory respiratory oscillometry values (as delta values) were calculated. Questionnaires regarding symptoms and quality of life were administered. RESULTS Patients with COPD and healthy smokers had an increased delta resistance at 5 Hz (R5) compared with patients with asthma (p < 0.0001 and p = 0.037, respectively) and healthy subjects (p = 0.0004 and p = 0.012, respectively). Patients with COPD also had higher values of ΔR5-R19 than healthy subjects (p = 0.0001) and patients with asthma (p < 0.0001). Delta reactance at 5 Hz (X5) was significantly more impaired in COPD patients than in asthma and healthy subjects (p < 0.0001 for all). There was a correlation between the ratio of residual volume and total lung capacity and ΔR5 (p = 0.0047; r = 0.32), ΔR5-R19 (p = 0.0002; r = 0.41) and ΔX5 (p < 0.0001; r = -0.44), for all subjects. ΔX5 correlated with symptoms in COPD, healthy smokers and patients with asthma. In addition, ΔR5 correlated with asthma symptoms. CONCLUSION EFL was most prominent in parameters measuring peripheral resistance and reactance and correlated with air trapping and airway symptoms.
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Affiliation(s)
- Abir Nasr
- Department of Clinical Sciences, Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
| | - Georgia Papapostolou
- Department of Clinical Sciences, Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
| | - Linnea Jarenbäck
- Department of Clinical Sciences, Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
| | | | - Alf Tunsäter
- Department of Clinical Sciences, Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
| | - Jaro Ankerst
- Department of Clinical Sciences, Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
| | - Leif Bjermer
- Department of Clinical Sciences, Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
| | - Ellen Tufvesson
- Department of Clinical Sciences, Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
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Xu J, Sun X, Cao Y, Zhu H, Yang W, Liu J, Guo J. Fractional exhaled nitric oxide in idiopathic pulmonary arterial hypertension and mixed connective tissue disease complicating pulmonary hypertension. BMC Pulm Med 2024; 24:199. [PMID: 38654208 PMCID: PMC11036718 DOI: 10.1186/s12890-024-03004-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 04/09/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Fractional exhaled nitric oxide (FeNO) has been extensively studied in various causes of pulmonary hypertension (PH), but its utility as a noninvasive marker remains highly debated. The objective of our study was to assess FeNO levels in patients with idiopathic pulmonary arterial hypertension (IPAH) and mixed connective tissue disease complicating pulmonary hypertension (MCTD-PH), and to correlate them with respiratory functional data, disease severity, and cardiopulmonary function. METHODS We collected data from 54 patients diagnosed with IPAH and 78 patients diagnosed with MCTD-PH at the Shanghai Pulmonary Hospital Affiliated to Tongji University. Our data collection included measurements of brain natriuretic peptide (pro-BNP), cardiopulmonary exercise test (CPET), pulmonary function test (PFT), impulse oscillometry (IOS), and FeNO levels. Additionally, we assessed World Health Organization functional class (WHO-FC) of each patient. RESULTS (1) The fractional exhaled concentration of nitric oxide was notably higher in patients with IPAH compared to those with MCTD-PH. Furthermore, within the IPAH group, FeNO levels were found to be lower in cases of severe IPAH compared to mild IPAH (P = 0.024); (2) In severe pulmonary hypertension as per the WHO-FC classification, FeNO levels in IPAH exhibited negative correlations with FEV1/FVC (Forced Expiratory Velocity at one second /Forced Vital Capacity), MEF50% (Maximum Expiratory Flow at 50%), MEF25%, and MMEF75/25% (Maximum Mid-expiratory Flow between 75% and 25%), while in severe MCTD-PH, FeNO levels were negatively correlated with R20% (Resistance at 20 Hz); (3) ROC (Receiving operator characteristic curve) analysis indicated that the optimal cutoff value of FeNO for diagnosing severe IPAH was 23ppb; (4) While FeNO levels tend to be negatively correlated with peakPETO2(peak end-tidal partial pressure for oxygen) in severe IPAH, in mild IPAH they had a positive correlation to peakO2/Heart rate (HR). An interesting find was observed in cases of severe MCTD-PH, where FeNO levels were negatively correlated with HR and respiratory exchange ratio (RER), while positively correlated with O2/HR throughout the cardiopulmonary exercise test. CONCLUSION FeNO levels serve as a non-invasive measure of IPAH severity. Although FeNO levels may not assess the severity of MCTD-PH, their significant makes them a valuable tool when assessing severe MCTD-PH.
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Affiliation(s)
- Jianhua Xu
- Department of Pulmonary Function Test, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, 200092, Shanghai, China
| | - Xingxing Sun
- Department of Pulmonary Function Test, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, 200092, Shanghai, China
| | - Yuan Cao
- Department of Pulmonary Function Test, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, 200092, Shanghai, China
| | - Hanqing Zhu
- Department of Pulmonary Function Test, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, 200092, Shanghai, China
| | - Wenlan Yang
- Department of Pulmonary Function Test, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, 200092, Shanghai, China
| | - Jinming Liu
- Department of Pulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, 200092, Shanghai, China
| | - Jian Guo
- Department of Pulmonary Function Test, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, 200092, Shanghai, China.
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Friedlander Y, Munidasa S, Thakar A, Ragunayakam N, Venegas C, Kjarsgaard M, Zanette B, Capaldi DPI, Santyr G, Nair P, Svenningsen S. Phase-Resolved Functional Lung (PREFUL) MRI to Quantify Ventilation: Feasibility and Physiological Relevance in Severe Asthma. Acad Radiol 2024:S1076-6332(24)00061-8. [PMID: 38378325 DOI: 10.1016/j.acra.2024.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/28/2024] [Accepted: 01/28/2024] [Indexed: 02/22/2024]
Abstract
RATIONALE AND OBJECTIVES Emergent evidence in several respiratory diseases supports translational potential for Phase-Resolved Functional Lung (PREFUL) MRI to spatially quantify ventilation but its feasibility and physiological relevance have not been demonstrated in patients with asthma. This study compares PREFUL-derived ventilation defect percent (VDP) in severe asthma patients to healthy controls and measures its responsiveness to bronchodilator therapy and relation to established measures of airways disease. MATERIALS AND METHODS Forty-one adults with severe asthma and seven healthy controls performed same-day free-breathing 1H MRI, 129Xe MRI, spirometry, and oscillometry. A subset of participants (n = 23) performed chest CT and another subset of participants with asthma (n = 19) repeated 1H MRI following the administration of a bronchodilator. VDP was calculated for both PREFUL and 129Xe MRI. Additionally, the percent of functional small airways disease was determined from CT parametric response maps (PRMfSAD). RESULTS PREFUL VDP measured pre-bronchodilator (19.1% [7.4-43.3], p = 0.0002) and post-bronchodilator (16.9% [6.1-38.4], p = 0.0007) were significantly greater than that of healthy controls (7.5% [3.7-15.5]) and was significantly decreased post-bronchodilator (from 21.9% [10.1-36.9] to 16.9% [6.1-38.4], p = 0.0053). PREFUL VDP was correlated with spirometry (FEV1%pred: r = -0.46, p = 0.0023; FVC%pred: r = -0.35, p = 0.024, FEV1/FVC: r = -0.46, p = 0.0028), 129Xe MRI VDP (r = 0.39, p = 0.013), and metrics of small airway disease (CT PRMfSAD: r = 0.55, p = 0.021; Xrs5 Hz: r = -0.44, p = 0.0046, and AX: r = 0.32, p = 0.044). CONCLUSION PREFUL-derived VDP is responsive to bronchodilator therapy in asthma and is associated with measures of airflow obstruction and small airway dysfunction. These findings validate PREFUL VDP as a physiologically relevant and accessible ventilation imaging outcome measure in asthma.
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Affiliation(s)
- Yonni Friedlander
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Samal Munidasa
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Ashutosh Thakar
- Department of Medicine, McMaster University, Hamilton, Canada
| | | | - Carmen Venegas
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, Canada
| | - Melanie Kjarsgaard
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, Canada
| | - Brandon Zanette
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Canada
| | - Dante P I Capaldi
- Department of Radiation Oncology, Division of Physics, University of California, San Francisco, CA
| | - Giles Santyr
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Parameswaran Nair
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, Canada
| | - Sarah Svenningsen
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, Canada.
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Savushkina OI, Astanin PA, Nekludova GV, Avdeev SN, Zaytsev AA. [The possibilities of impulse oscillometry in the diagnosis of the lung function disorders after COVID-19]. TERAPEVT ARKH 2023; 95:924-929. [PMID: 38158947 DOI: 10.26442/00403660.2023.11.202474] [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: 11/23/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Impulse oscillometry (IOS) is an effort independent method of studying lung mechanics. AIM To study the diagnostic significance of IOS in assessing lung mechanics after COVID-19. MATERIALS AND METHODS Spirometry, body plethysmography, diffusion test (DLco), IOS parameters were analyzed in 315 patients (the median age 48 years), the median period from the beginning of COVID-19 to the study was 50 days. Statistical analysis included descriptive statistics, correlation analysis and one-dimensional logistic regression analysis with an assessment of odds ratios. RESULTS In general group, spirometry and body plethysmography parameters were in normal values, while DLCO was reduced in 61% of patients. Parameters of IOS were analyzed in the general group and between the groups, depending on the value of DLco and total lung capacity (TLC): normal or reduced. In general group, reactance area (AX), hererogeneity of resistance Rrs5-Rrs20, resistance at 5 Hz (Rrs5), reactance at 5 Hz (ΔXrs5) were increased in 29.8%, 17.8%, 6%, 4.8% of patients, respectively, and were statistically significantly higher in the group with reduced TLC, whereas in the group with reduced DLco AX, Rrs5-Rrs20 were statistically significantly higher. Logistic regression analysis showed that patients with Rrs5-Rrs20>0.07 kPa×sec/l or AX>0.32 kPa/l had a 1.99-fold and 2.24-fold increased risk for decrease DLco, respectively, while the risk of decrease in TLC was 2.25-fold (p=0.012) and 3.16-fold (p<0.001) higher, respectively. CONCLUSION IOS allow to detect both dysfunction of small airways (if AX or Rrs5-Rrs20 are increased) and the risk of restrictive pattern and lung diffusion impairment after COVID-19.
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Affiliation(s)
- O I Savushkina
- Burdenko Main Military Clinical Hospital
- Federal Pulmonology Research Institute
| | - P A Astanin
- Pirogov Russian National Research Medical University
- Izmerov Research Institute of Occupational Health
| | - G V Nekludova
- Federal Pulmonology Research Institute
- Sechenov First Moscow State Medical University (Sechenov University)
| | - S N Avdeev
- Federal Pulmonology Research Institute
- Sechenov First Moscow State Medical University (Sechenov University)
| | - A A Zaytsev
- Burdenko Main Military Clinical Hospital
- BIOTECH University
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Cottini M, Bondi B, Bagnasco D, Braido F, Passalacqua G, Licini A, Lombardi C, Berti A, Comberiati P, Landi M, Heffler E, Paoletti G. Impulse oscillometry defined small airway dysfunction in asthmatic patients with normal spirometry: Prevalence, clinical associations, and impact on asthma control. Respir Med 2023; 218:107391. [PMID: 37595673 DOI: 10.1016/j.rmed.2023.107391] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND The small-airway dysfunction (SAD), detected with impulse oscillometry (IOS) methods, has been recently better characterized in patients with asthma. However, little is known about SAD in asthmatic patients with normal spirometry (NS). OBJECTIVE In this study, we aimed to investigate, in an unselected sample of 321 patients with physician-diagnosed asthma and NS, prevalence, clinical characterization, and impact on asthma control of IOS-defined SAD. As a secondary objective of the study, we focused on comparing the difference between IOS- and spirometry-defined SAD. METHODS Consecutive patients with a previous diagnosis of asthma but normal spirometry at the moment of the enrollment were stratified by the presence of IOS-defined SAD (difference in resistance at 5 Hz and at 20 Hz [R5-R20] greater than 0.07 kPa x s x L-1). We have also assessed the presence of SAD defined by spirometry, according to FEF 25-75 < 65% of the predicted. Clinical and laboratory features were collected, and univariable and multivariable analyses were used to analyze cross-sectional associations between clinical variables and outcomes (SAD). RESULTS IOS-defined SAD was present in 54.1% of the cohort. In contrast, spirometry-defined SAD was present in only 10% of patients. Subjects with IOS-defined SAD showed less well-controlled asthma and a higher mean inhaled corticosteroid dosage use compared with subjects without SAD (both P < .001). Overweight (odds ratio [OR], 1.14; 95% CI, 1.05-1.23), exacerbation history (OR, 3.06; 95% CI, 1.34-6.97), asthma-related night awakenings (OR, 6.88; 95% CI, 2.13-22.23), exercise-induced asthma symptoms (OR, 33.5; 95% CI, 9.51-117.8), and controlled asthma (OR, 0.22; 95% CI, 0.06-0.84) were independently associated with SAD. CONCLUSIONS Asthmatic patients with IOS-defined SAD showed less well-controlled asthma, more severe exacerbations and higher mean inhaled corticosteroid dosage. We confirmed exercise-induced asthma, asthma-related night awakenings, exacerbation history, and overweight as independently associated with SAD, while showing well-controlled asthma as inversely associated. SAD may be overlooked by standard spirometry.
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Affiliation(s)
| | - Benedetta Bondi
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genova, Italy.
| | - Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genova, Italy
| | - Fulvio Braido
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genova, Italy
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genova, Italy
| | - Anita Licini
- Allergy and Pneumology Outpatient Clinic, Bergamo, Italy
| | - Carlo Lombardi
- Departmental Unit of Allergology, Immunology & Pulmonary Diseases, Fondazione Poliambulanza, Brescia, Italy
| | - Alvise Berti
- Center for Medical Sciences (CISMed) and Department of Cellular, Computational and Integrative Biology (CIBIO), University of Trento, Italy, and Santa Chiara Regional Hospital, APSS, Trento, Italy
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | - Massimo Landi
- Dipartimento di Scienze Mediche, SSDDU Allergologia e Immunologia Clinica, Università degli Studi di Torino, AO Ordine Mauriziano Umberto I, Torino, Italy
| | - Enrico Heffler
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Personalized Medicine, Asthma and Allergy - IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giovanni Paoletti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Personalized Medicine, Asthma and Allergy - IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Sarkar S, Jadhav U, Ghewade B, Sarkar S, Wagh P. Oscillometry in Lung Function Assessment: A Comprehensive Review of Current Insights and Challenges. Cureus 2023; 15:e47935. [PMID: 38034137 PMCID: PMC10685051 DOI: 10.7759/cureus.47935] [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: 09/18/2023] [Accepted: 10/29/2023] [Indexed: 12/02/2023] Open
Abstract
Oscillometry, a non-invasive technique for assessing lung function, has gained significant recognition and importance in modern pulmonary medicine. This comprehensive review thoroughly explores its principles, applications, advantages, limitations, recent innovations, and future directions. Oscillometry's primary strength lies in its ability to offer a holistic assessment of lung mechanics. Unlike traditional spirometry, oscillometry captures the natural airflow during quiet breathing, making it suitable for patients of all ages and those with severe respiratory conditions. It provides a comprehensive evaluation of airway resistance, reactance, and compliance, offering insights into lung function that were previously challenging to obtain. In clinical practice, oscillometry finds extensive application in diagnosing and managing respiratory diseases. It plays a pivotal role in asthma, chronic obstructive pulmonary disease (COPD), and interstitial lung diseases. By detecting subtle changes in lung function before symptoms manifest, oscillometry facilitates early interventions, improving disease management and patient outcomes. Oscillometry's non-invasive and patient-friendly nature is precious in pediatric care, where traditional spirometry may be challenging for young patients. It aids in diagnosing and monitoring pediatric respiratory disorders, ensuring that children receive the care they need from an early age. Despite its many advantages, oscillometry faces challenges, such as the need for standardized protocols and the complexity of data interpretation. However, ongoing efforts to establish global standards and provide education and training for healthcare professionals aim to address these issues. Looking ahead, oscillometry holds great promise in the field of personalized medicine. With its ability to tailor treatment plans based on individualized lung function data, healthcare providers can optimize therapy selection and dosing, ultimately improving patient care and quality of life. In conclusion, oscillometry is poised to play an increasingly pivotal role in modern pulmonary medicine. As standardization efforts continue and technology evolves, it is an indispensable tool in the clinician's arsenal for diagnosing, managing, and personalizing respiratory care, ultimately leading to improved patient outcomes and better respiratory health.
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Affiliation(s)
- Souvik Sarkar
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Ulhas Jadhav
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Babaji Ghewade
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Syamal Sarkar
- Respiratory Medicine, Advanced Chest Care Centre, Ranchi, IND
| | - Pankaj Wagh
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Rogliani P, Radovanovic D, Ora J, Starc N, Verri S, Pistocchini E, Calzetta L. Assessing the relationship between cardiovascular and small airway disease and acute events in COPD: The ARCADIA study protocol. Pulm Pharmacol Ther 2023; 82:102231. [PMID: 37414133 DOI: 10.1016/j.pupt.2023.102231] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/26/2023] [Accepted: 07/03/2023] [Indexed: 07/08/2023]
Abstract
The initial alterations of chronic obstructive pulmonary disease (COPD) involve the small airways. Small airway disease (SAD) is related to lung hyperinflation and air trapping. Several lung function tests may detect the presence of SAD, namely forced mid-expiratory flows, residual volume (RV), RV/total lung capacity (TLC) ratio, functional residual capacity, airway resistances obtained with body-plethysmography and oscillometry, and the single-breath nitrogen washout test. Additionally, high-resolution computed tomography can detect SAD. In addition to SAD, COPD is related to cardiovascular disease (CVD) such as heart failure, peripheral vascular disease, and ischemic heart disease. No studies have assessed the relationship between CVD, COPD, and SAD. Therefore, the main objective of the Assessing the Relationship between Cardiovascular and small Airway Disease and Acute events in COPD (ARCADIA) study is to assess the risk of CVD in COPD patients according to SAD in a real-life setting. The correlation between CVD, mortality, and acute exacerbation of COPD (AECOPD) is also evaluated. ARCADIA is a 52-week prospective, multicentre, pilot, observational, cohort study conducted in ≥22 pulmonary centres in Italy and that enrols ≥500 COPD patients, regardless of disease severity (protocol registration: ISRCTN49392136). SAD is evaluated at baseline, after that CVD, mortality, and AECOPD are recorded at 6 and 12 months. Bayesian inference is used to quantify the risk and correlation of the investigated outcomes in COPD patients according to SAD. The ARCADIA study provides relevant findings in the daily clinical management of COPD patients.
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Affiliation(s)
- Paola Rogliani
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | - Dejan Radovanovic
- Division of Respiratory Diseases, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milano, Italy
| | - Josuel Ora
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Nadia Starc
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Stefano Verri
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Elena Pistocchini
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Luigino Calzetta
- Department of Medicine and Surgery, University of Parma, Parma, Italy
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Kostorz-Nosal S, Jastrzębski D, Błach A, Skoczyński S. Window of opportunity for respiratory oscillometry: A review of recent research. Respir Physiol Neurobiol 2023; 316:104135. [PMID: 37536553 DOI: 10.1016/j.resp.2023.104135] [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: 05/31/2023] [Revised: 07/19/2023] [Accepted: 07/30/2023] [Indexed: 08/05/2023]
Abstract
Oscillometry has been around for almost 70 years, but there are still many unknowns. The test is performed during tidal breathing and is therefore free from patient-dependent factors that could influence the results. The Forced Oscillation Technique (FOT), which requires minimal patient cooperation, is gaining ground, particularly with elderly patients and children. In pulmonology, it is a valuable tool for assessing obstructive conditions (with a distinction between central and peripheral obstruction) and restrictive disorders (intrapulmonary and extrapulmonary). Its sensitivity allows the assessment of bronchodilator and bronchoconstrictor responses. Different lung diseases show different patterns of changes in FOT, especially studied in asthma and chronic obstructive pulmonary disease. Because of these differences, many studies have analysed the usefulness of this technique in different areas of medicine. In this paper, the authors would like to present the basics of oscillometry with the areas of its most recent clinical applications.
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Affiliation(s)
- Sabina Kostorz-Nosal
- Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-803 Zabrze, Poland.
| | - Dariusz Jastrzębski
- Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-803 Zabrze, Poland
| | - Anna Błach
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Szymon Skoczyński
- Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-803 Zabrze, Poland
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De Jesús-Rojas W, Reyes-Peña L, Muñiz-Hernández J, Quiles Ruiz de Porras P, Meléndez-Montañez J, Ramos-Benitez MJ, Mosquera RA. Bronchiectasis Assessment in Primary Ciliary Dyskinesia: A Non-Invasive Approach Using Forced Oscillation Technique. Diagnostics (Basel) 2023; 13:2287. [PMID: 37443681 PMCID: PMC10340430 DOI: 10.3390/diagnostics13132287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/30/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
Primary ciliary dyskinesia (PCD) is an autosomal recessive disorder that results from the dysfunction of motile cilia, which can cause chronic upper and lower respiratory infections leading to bronchiectasis. However, there is a need for additional tools to monitor the progression of bronchiectasis in PCD. The forced oscillation technique (FOT) is an effort-independent lung function test that can be used to evaluate respiratory mechanics. In this retrospective study, we aimed to describe the radiographic findings associated with respiratory impedance (resistance (Rrs) and reactance (Xrs)) measured by FOT in six adult PCD patients and one pediatric with the (RSPH4A (c.921+3_921+6delAAGT (intronic)) founder mutation. We compared the radiographic findings on a high-resolution chest computed tomography (CT) scan with the FOT results. Our findings suggest that respiratory impedance measured by FOT may be a valuable tool for detecting and monitoring the progression of bronchiectasis in PCD patients with the (RSPH4A (c.921+3_921+6delAAGT (intronic)) founder mutation. However, further research is necessary to validate these results and determine the sensitivity and specificity of bronchiectasis monitoring in PCD patients with other genetic mutations.
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Affiliation(s)
- Wilfredo De Jesús-Rojas
- Department of Pediatrics and Basic Science, Ponce Health Sciences University, Ponce, PR 00716, USA; (J.M.-H.); (P.Q.R.d.P.); (M.J.R.-B.)
| | - Luis Reyes-Peña
- San Juan Bautista School of Medicine, Caguas, PR 00725, USA;
| | - José Muñiz-Hernández
- Department of Pediatrics and Basic Science, Ponce Health Sciences University, Ponce, PR 00716, USA; (J.M.-H.); (P.Q.R.d.P.); (M.J.R.-B.)
| | | | - Jesús Meléndez-Montañez
- Department of Pediatrics and Basic Science, Ponce Health Sciences University, Ponce, PR 00716, USA; (J.M.-H.); (P.Q.R.d.P.); (M.J.R.-B.)
| | - Marcos J. Ramos-Benitez
- Department of Pediatrics and Basic Science, Ponce Health Sciences University, Ponce, PR 00716, USA; (J.M.-H.); (P.Q.R.d.P.); (M.J.R.-B.)
| | - Ricardo A. Mosquera
- Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA;
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Menzella F, Antonicelli L, Cottini M, Imeri G, Corsi L, Di Marco F. Oscillometry in severe asthma: the state of the art and future perspectives. Expert Rev Respir Med 2023; 17:563-575. [PMID: 37452692 DOI: 10.1080/17476348.2023.2237872] [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: 04/18/2023] [Revised: 07/07/2023] [Accepted: 07/14/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Approximately 3-10% of people with asthma have severe asthma (SA). Patients with SA have greater impairment in daily life and much higher costs. Even if asthma affects the entire bronchial tree, small airways have been recognized as the major site of airflow limitation. There are several tools for studying small airway dysfunction (SAD), but certainly the most interesting is oscillometry. Despite several studies, the clinical usefulness of oscillometry in asthma is still in question. This paper aims to provide evidence supporting the use of oscillometry to improve the management of SA in clinical practice. AREAS COVERED In the ATLANTIS study, SAD was strongly evident across all severity. Various tools are available for evaluation of SAD, and certainly an integrated use of these can provide complete and detailed information. However, the most suitable method is oscillometry, implemented for clinical routine by using either small pressure impulses or small pressure sinusoidal waves. EXPERT OPINION Oscillometry, despite its different technological implementations is the best tool for determining the impact of SAD on asthma and its control. Oscillometry will also be increasingly useful for choosing the appropriate drug, and there is ample room for a more widespread diffusion in clinical practice.
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Affiliation(s)
| | | | | | - Gianluca Imeri
- Respiratory Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Lorenzo Corsi
- Pulmonology Unit, S. Valentino Hospital, Treviso, Italy
| | - Fabiano Di Marco
- Respiratory Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
- Department of Health Sciences, University of Milan, Bergamo, Italy
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12
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Hao Y, Liu S, Liu T, Huang X, Xie M, Wang D. Pulmonary Function Test and Obstructive Sleep Apnea Hypopnea Syndrome in Obese Adults: A Retrospective Study. Int J Chron Obstruct Pulmon Dis 2023; 18:1019-1030. [PMID: 37304766 PMCID: PMC10253010 DOI: 10.2147/copd.s409383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/28/2023] [Indexed: 06/13/2023] Open
Abstract
Objective We explore risk factors related to severe obstructive sleep apnea (OSA) in obese patients, including pulmonary ventilation function, diffusion function, and impulse oscillometry (IOS) data. Methods The medical records of 207 obese patients who were prepared to undergo bariatric surgery in a hospital from May 2020 to September 2021 were retrospectively reviewed. Polysomnography (PSG), pulmonary ventilation function, diffusion function, and IOS parameters were collected according to the ethical standards of the institutional research committee (registration number: KYLL-202008-144). Logistic regression analysis was used to analyze the related independent risk factors. Results There were significantly statistical difference in a number of pulmonary ventilation and diffusion function parameters among the non-OSAHS group, the mild-to-moderate OSA group, and the severe OSA group. However, only airway resistance parameters R5%, R10%, R15%, R20%, R25%, and R35% increased with increasing OSA severity and were positively correlated with apnea hypopnea index (AHI). Age (P = 0.012, 1.104 (1.022, 1.192)), body mass index (P< 0.0001, 1.12 (1.057, 1.187)), gender (P = 0.003, 4.129 (1.625, 10.49)), and R25% (P = 0.007, 1.018 (1.005, 1.031)) were independent risk factors for severe OSA. In patients aged 35 to 60, RV/TLC (P = 0.029, 1.272 (1.025, 1.577)) is an independent risk factor for severe OSA. Conclusion R25% was an independent risk factor for severe OSA in obese individuals, while RV/TLC was also an independent risk factor in those aged 35 to 60. Pulmonary function tests (PFTs), particularly IOS levels, are recommended to assess severe OSA in obese patients.
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Affiliation(s)
- Yijia Hao
- Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Shaozhuang Liu
- Division of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People’s Republic of China
| | - Teng Liu
- Division of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People’s Republic of China
| | - Xin Huang
- Division of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People’s Republic of China
| | - Mengshuang Xie
- Department of Geriatrics & Key Laboratory of Cardiovascular Proteomics of Shandong Province, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People’s Republic of China
| | - Dexiang Wang
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People’s Republic of China
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Krefft SD, Zell-Baran LM. Deployment-Related Respiratory Disease: Where Are We? Semin Respir Crit Care Med 2023; 44:370-377. [PMID: 37068518 DOI: 10.1055/s-0043-1764407] [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] [Indexed: 04/19/2023]
Abstract
Military personnel and veterans who have deployed to Afghanistan, Iraq, and parts of Southwest Asia (SWA) since 1990 are at risk of developing a host of respiratory symptoms and deployment-related respiratory diseases (DRRDs). This review aims to summarize our current understanding of DRRD and inform pulmonary practitioners of recent updates to DRRD screening, diagnosis, evaluation, and management. The most common respiratory diseases in these patients include asthma, chronic sinonasal disease, laryngeal disease/dysfunction, and distal lung disease. Pulmonary function testing and chest imaging are the most commonly used diagnostic tools, but techniques such as lung clearance index testing via multiple breath washout, forced oscillation testing/impulse oscillometry, and quantitative chest computed tomography (CT) assessment appear promising as noninvasive modalities to aid in lung disease detection in this population. We also summarize guidance on conducting an occupational and deployment exposure history as well as recommendations for testing. Finally, we discuss the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act) that includes a list of health conditions that are "presumptively" considered to be related to SWA military deployment toxic exposures, and provide resources for clinicians who evaluate and treat patients with DRRD.
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Affiliation(s)
- Silpa D Krefft
- Division of Environmental and Occupational Health Sciences, Department of Medicine, National Jewish Health, Denver, Colorado
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Department of Environmental and Occupational Health, Colorado School of Public Health, Aurora, Colorado
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Veterans Administration Eastern Colorado Health Care System, Aurora, Colorado
| | - Lauren M Zell-Baran
- Division of Environmental and Occupational Health Sciences, Department of Medicine, National Jewish Health, Denver, Colorado
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
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Cottini M, Lombardi C, Comberiati P, Landi M, Berti A, Ventura L. Small airway dysfunction in asthmatic patients treated with as-needed SABA monotherapy: A perfect storm. Respir Med 2023; 209:107154. [PMID: 36796546 DOI: 10.1016/j.rmed.2023.107154] [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: 01/07/2023] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Short-acting beta agonist (SABA)-only treatment is associated with poor asthma control and adverse clinical outcomes. The importance of small airway dysfunction (SAD) is increasingly recognized in asthma, but less is known in patients using SABA-only therapy. We aimed to investigate the impact of SAD on asthma control in an unselected cohort of 60 adults with physician-diagnosed intermittent asthma treated with as-needed SABA monotherapy. METHODS All patients underwent standard spirometry and impulse oscillometry (IOS) at the first visit and were stratified by the presence of SAD defined by IOS (fall in resistance 5-20 Hz [R5-R20]>0.07 kPa × s*L-1). Univariable and multivariable analyses were used to analyze cross-sectional relationships between clinical variables and SAD. RESULTS SAD was present in 73% of the cohort. Compared with patients without SAD, adults with SAD had a higher number of severe exacerbations (65.9% versus 25.0%, p < 0.05), higher use of annual SABA canisters (median (IQR), 3 (1.75-3) versus 1 (1-2), p < 0.001), and significantly less well-controlled asthma (11.7% versus 75.0%, p < 0.001). Spirometry parameters were similar between patients with IOS-defined SAD and those without SAD. The multivariable logistic regression analysis showed that exercise-induced bronchoconstriction symptoms (EIB, odds ratio [OR] 31.18; 95%CI:4.85-365.00) and night awakenings due to asthma (OR 30.30; 95%CI:2.61-1141.00) were independent predictors of SAD, with a high predictive power of the model incorporating these baseline predictors (AUC 0.92). CONCLUSIONS EIB and nocturnal symptoms are strong predictors of SAD in asthmatic patients using as-needed SABA-monotherapy, helping to distinguish subjects with SAD among patients with asthma when IOS cannot be performed.
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Affiliation(s)
| | - Carlo Lombardi
- Departmental Unit of Allergology, Immunology & Pulmonary Diseases, Fondazione Poliambulanza, Brescia, Italy
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | - Massimo Landi
- Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy; Pediatric National Healthcare System, Turin, Italy
| | - Alvise Berti
- Centre for Medical Sciences (CISMED), Department of Cellular, Computational and Integrative Biology (CIBIO), University of Trento, and Santa Chiara Hospital, APSS Trento, Italy.
| | - Laura Ventura
- Department of Statistics, University of Padova, Italy
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Impulse Oscillometry as a Diagnostic Test for Pulmonary Emphysema in a Clinical Setting. J Clin Med 2023; 12:jcm12041547. [PMID: 36836082 PMCID: PMC9967696 DOI: 10.3390/jcm12041547] [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: 01/04/2023] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Body plethysmography (BP) is the standard pulmonary function test (PFT) in pulmonary emphysema diagnosis, but not all patients can cooperate to this procedure. An alternative PFT, impulse oscillometry (IOS), has not been investigated in emphysema diagnosis. We investigated the diagnostic accuracy of IOS in the diagnosis of emphysema. Eighty-eight patients from the pulmonary outpatient clinic at Lillebaelt Hospital, Vejle, Denmark, were included in this cross-sectional study. A BP and an IOS were performed in all patients. Computed tomography scan verified presence of emphysema in 20 patients. The diagnostic accuracy of BP and IOS for emphysema was evaluated with two multivariable logistic regression models: Model 1 (BP variables) and Model 2 (IOS variables). Model 1 had a cross-validated area under the ROC curve (CV-AUC) = 0.892 (95% CI: 0.654-0.943), a positive predictive value (PPV) = 59.3%, and a negative predictive value (NPV) = 95.0%. Model 2 had a CV-AUC = 0.839 (95% CI: 0.688-0.931), a PPV = 55.2%, and an NPV = 93.7%. We found no statistically significant difference between the AUC of the two models. IOS is quick and easy to perform, and it can be used as a reliable rule-out method for emphysema.
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Marczak H, Peradzyńska J, Lange J, Bogusławski S, Krenke K. Pulmonary function in children with persistent tachypnea of infancy. Pediatr Pulmonol 2023; 58:81-87. [PMID: 36177553 DOI: 10.1002/ppul.26162] [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: 03/30/2022] [Revised: 09/01/2022] [Accepted: 09/19/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Data on the prevalence and type of lung function impairment in preschool and school-aged children previously diagnosed with persistent tachypnea of infancy (PTI) are scarce. Therefore, this study aims to assess pulmonary function in this age group. METHODS Children diagnosed with PTI over 3 years old were admitted for follow-up visits and healthy controls were enrolled. The study group included children who were able to complete pulmonary function tests (PFTs). Medical history, physical examination, and pulmonary function (spirometry, body plethysmography, impulse oscillometry, nitrogen multiple breath washout test, diffusing capacity for carbon monoxide [DLCO ]) were assessed. RESULTS Thirty-seven children (26 boys, 11 girls; median age: 5.6 years) diagnosed with PTI and 37 healthy controls were recruited. Forced expiratory volume in 1 s and forced vital capacity were significantly lower (-1.12 vs. 0.48, p = 0.002 and -0.83 vs. 0.31, p = 0.009, respectively); respiratory resistance at 5 Hz (0.06 vs. -0.62, p = 0.003), resonant frequency (1.86 vs. 1.36, p = 0.04), residual volume (RV) (2.34 vs. -1.2, p < 0.0001), RV%TLC (total lung capacity) (2.63 vs. -0.72, p < 0.0001), and specific airway resistance (5.4 vs. 2.59, p = 0.04) were significantly higher in PTI patients as compared with controls (data were presented as median z-score). Air trapping was found in 60.0%, and abnormally high lung clearance index and DLCO were found in 73.3% and 90.9% of PTI patients, respectively. CONCLUSIONS This study demonstrated that lung function is affected in most children with PTI. PFTs showed that peripheral airways are the major zone of functional impairment.
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Affiliation(s)
- Honorata Marczak
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Peradzyńska
- Department of Epidemiology and Biostatistics, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Lange
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Stanisław Bogusławski
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Krenke
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
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Long-term variability of impulse oscillometry and spirometry in stable COPD and asthma. Respir Res 2022; 23:262. [PMID: 36131305 PMCID: PMC9491004 DOI: 10.1186/s12931-022-02185-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 09/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background While optimizing spirometry is a challenge for lung function labs, long-term variability if any between IOS (impulse oscillometry) parameters and spirometry is not clearly known in stable COPD (chronic obstructive pulmonary disease) and chronic asthma. The forced oscillation technique is increasingly employed in routine lung function testing. Our aim in this study was to determine the variability in oscillometric parameters between clinic visits over weeks or months in two patient groups during a period of clinical stability. Moreover, the research assessed relationships between IOS parameters long-term variability and COPD severity.
Methods We used data from 73 patients with stable COPD and 119 patients with stable asthma at the Shanghai Pulmonary Hospital Affiliated to Tongji University. Patients were included if they had three or more clinic visits where spirometry and IOS were performed during a clinically stable period. Data recorded from the first three visits were used. The standard deviation (SDbv), the coefficient of variation (COV), intraclass correlation coefficient (ICC) and the coefficient of repeatability (COR) were calculated, Wilcoxon Mann–Whitney test was used for data that did not conform to normality of distributions, Kruskal Wallis test was used to compare with multiple groups, post hoc comparison was analyzed by Bonferroni, Spearman correlation coefficients for non-parametric data, the multiple regression analyses to determine the relationship between long-term variability and airflow obstruction. Results (1) The repeatability of IOS resistance parameters with ICC values > 0.8 was high in COPD and asthma. ICC values of IOS resistance parameters were higher than IOS reactance parameters; (2) the repeatability of spirometry parameters with ICC values < 0.8 was lower than IOS resistance parameters in different GOLD (the Global Initiative for Chronic Obstructive Lung Disease) stages, the higher the stage the worse the repeatability; (3) the severity of airflow obstruction was correlated with long-term variability of R5 (R at 5 Hz) (P < 0.05) in GOLD4, not with long-term variability of R20 (R at 20 Hz) (P > 0.05) and R5-R20 (P > 0.05). Conclusion IOS resistance parameters have good long-term repeatability in asthma and COPD. Additionally, repeatability of spirometry parameters is lower than IOS resistance parameters in different GOLD stages.
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Cottini M, Lombardi C, Passalacqua G, Bagnasco D, Berti A, Comberiati P, Imeri G, Landi M, Heffler E. Small Airways: The “Silent Zone” of 2021 GINA Report? Front Med (Lausanne) 2022; 9:884679. [PMID: 35677830 PMCID: PMC9168121 DOI: 10.3389/fmed.2022.884679] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 04/20/2022] [Indexed: 01/08/2023] Open
Abstract
Asthma is a chronic disease, affecting approximately 350 million people worldwide. Inflammation and remodeling in asthma involve the large airways, and it is now widely accepted that the small airways (those with an internal diameter <2 mm) are involved in the pathogenesis of asthma and are the major determinant of airflow obstruction in this disease. From a clinical perspective, small airways dysfunction (SAD) is associated with more severe bronchial hyperresponsiveness, worse asthma control and more exacerbations. Unlike the GOLD guidelines which, in their definition, identify COPD as a disease of the small airways, the Global Initiative for Asthma (GINA) guidelines do not refer to the prevalence and role of SAD in asthmatic patients. This decision seems surprising, given the growing body of compelling evidence accumulating pointing out the high prevalence of SAD in asthmatic patients and the importance of SAD in poor asthma control. Furthermore, and remarkably, SAD appears to possess the characteristics of a treatable pulmonary trait, making it certainly appealing for asthma control optimization and exacerbation rate reduction. In this mini-review article, we address the most recent evidence on the role of SAD on asthma control and critically review the possible inclusion of SAD among treatable pulmonary traits in international guidelines on asthma.
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Affiliation(s)
- Marcello Cottini
- Allergy and Pneumology Outpatient Clinic, Bergamo, Italy
- Marcello Cottini
| | - Carlo Lombardi
- Departmental Unit of Allergology, Immunology & Pulmonary Diseases, Fondazione Poliambulanza, Brescia, Italy
- *Correspondence: Carlo Lombardi
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genova, Italy
| | - Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genova, Italy
| | - Alvise Berti
- Ospedale Santa Chiara and Department of Cellular, Computational and Integrative Biology (CIBIO), Thoracic Disease Research, University of Trento, Trento, Italy
| | - Pasquale Comberiati
- Section of Pediatrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gianluca Imeri
- Respiratory Unit, Department of Medical Sciences, Papa Giovanni XXIII Hospital, University of Milan-Bergamo, Bergamo, Italy
| | - Massimo Landi
- Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
- Pediatric National Healthcare System, Turin, Italy
| | - Enrico Heffler
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Personalized Medicine, Asthma and Allergy - IRCCS Humanitas Research Hospital - Rozzano, Milan, Italy
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Ardura-Garcia C, Abellan A, Cuevas-Ocaña S, Freitag N, Lam YT, Makrinioti H, Slaats M, Storti M, Williams EE, Dassios T, Duijts L, Ersu RH, Fustik S, Morty RE, Proesmans M, Schramm D, Saglani S, Moeller A, Pijnenburg MW. ERS International Congress 2021: highlights from the Paediatric Assembly. ERJ Open Res 2022; 8:00643-2021. [PMID: 35615416 PMCID: PMC9125040 DOI: 10.1183/23120541.00643-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/02/2022] [Indexed: 11/26/2022] Open
Abstract
In this review, Early Career Members of the European Respiratory Society (ERS) and the Chairs of the ERS Assembly 7: Paediatrics present the highlights in paediatric respiratory medicine from the ERS International Congress 2021. The eight scientific Groups of this Assembly cover respiratory physiology and sleep, asthma and allergy, cystic fibrosis (CF), respiratory infection and immunology, neonatology and intensive care, respiratory epidemiology, bronchology, and lung and airway development. We here describe new developments in lung function testing and sleep-disordered breathing diagnosis, early life exposures affecting pulmonary function in children and effect of COVID-19 on sleep and lung function. In paediatric asthma, we present the important role of the exposome in asthma development, and how biologics can provide better outcomes. We discuss new methods to assess distal airways in children with CF, as some details remain blind when using the lung clearance index. Moreover, we summarise the new ERS guidelines for bronchiectasis management in children and adolescents. We present interventions to reduce morbidity and monitor pulmonary function in newborns at risk of bronchopulmonary dysplasia and long-term chronic respiratory morbidity of this disease. In respiratory epidemiology, we characterise primary ciliary dyskinesia, identify early life determinants of respiratory health and describe the effect of COVID-19 preventive measures on respiratory symptoms. Also, we describe the epidemiology of interstitial lung diseases, possible consequences of tracheomalacia and a classification of diffuse alveolar haemorrhage in children. Finally, we highlight that the characterisation of genes and pathways involved in the development of a disease is essential to identify new biomarkers and therapeutic targets.
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Affiliation(s)
| | - Alicia Abellan
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Sara Cuevas-Ocaña
- Nottingham Biodiscovery Institute, School of Medicine, University of Nottingham, Nottingham, UK
| | - Nadine Freitag
- Dept of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Yin Ting Lam
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Heidi Makrinioti
- West Middlesex University Hospital, Chelsea and Westminster Foundation Trust, London, UK
| | - Monique Slaats
- Dept of Paediatrics, Division of Paediatric Respiratory Medicine and Allergology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Matteo Storti
- Dept of Chemical and Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Emma E. Williams
- Dept of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Theodore Dassios
- Dept of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Liesbeth Duijts
- Dept of Paediatrics, Division of Paediatric Respiratory Medicine and Allergology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
- Division of Neonatology, Dept of Pediatrics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Refika H. Ersu
- Division of Respirology, University of Ottawa Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Stojka Fustik
- University Children's Hospital, Skopje, North Macedonia
| | - Rory E. Morty
- Dept of Lung Development and Remodelling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
- Dept of Translational Pulmonology and the Translational Lung Research Center Heidelberg, University Hospital Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Marijke Proesmans
- Division Woman and Child, Dept of Paediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Dirk Schramm
- Dept of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Sejal Saglani
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Alexander Moeller
- Division of Paediatric Pulmonology, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marielle W. Pijnenburg
- Dept of Paediatrics, Division of Paediatric Respiratory Medicine and Allergology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
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20
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Tan HS, McAnally HM, Dummer J, Hancox RJ. Lifetime cannabis exposure and small airway function in a population-based cohort study. ERJ Open Res 2022; 8:00688-2021. [PMID: 35509440 PMCID: PMC9062301 DOI: 10.1183/23120541.00688-2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/04/2022] [Indexed: 11/08/2022] Open
Abstract
Background and objective The long-term effects of cannabis on small airway function remain unclear. We investigated associations between cannabis use and small airway function in a general population sample. Methods Cannabis use was ascertained at multiple ages from age 18 to 45 years and quantified as joint-years among 895 participants in the Dunedin Multidisciplinary Health and Development Study. Small airway function at ages 38 and 45 years was measured using impulse oscillometry (IOS) before and after inhalation of salbutamol. Analyses used multiple linear regression adjusting for tobacco use, body mass index and height. Longitudinal analyses of cannabis use between 38 and 45 years also adjusted for IOS at age 38 years. Results Associations between lifetime cannabis joint-years and IOS differed between men and women: in women, cannabis use was associated with pre-bronchodilator resistance at 5 Hz (R5) and 20 Hz (R20), reactance at 5 Hz, area of reactance and resonant frequency, and marginally associated with the difference between R5 and R20. Cannabis use was only statistically significantly associated with pre-bronchodilator resonant frequency in men. Cannabis use between the ages of 38 and 45 years was associated with a similar pattern of changes in IOS measures. After salbutamol, cannabis use was only statistically significantly associated with R5 and R20 among women and none of the IOS measures among men. Conclusions Cannabis use is associated with small airway dysfunction at age 45 years, indicating an increase in peripheral airway resistance and reactance. These associations were greater and mostly only statistically significant among women. Associations were weaker and mostly nonsignificant after bronchodilator use, suggesting that cannabis-induced changes in small airways may be at least partially reversible. Lifetime cannabis exposure is associated with measures of small airway dysfunction indicating higher small airway resistance and greater reactancehttps://bit.ly/3pWnZTu
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21
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Kim JH, Kim JA, Ha EK, Jee HM, Lee SW, Jung MK, Lee S, Shin YH, Yoo EG, Han MY. Sex differences in body composition affect total airway resistance during puberty. BMC Pediatr 2022; 22:143. [PMID: 35300646 PMCID: PMC8928689 DOI: 10.1186/s12887-022-03198-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During puberty, changes in body composition due to sex hormones are associated with lung mechanics. However, little is known about the mediation effect of sex differences in body composition during puberty with total airway resistance. METHODS We prospectively recruited 620 children (10-12 years old) from the general population and conducted a cross-sectional study. This study assessed pubertal status according to the five Tanner stages using a questionnaire, line drawings, and each subject's blood sex hormone profile. Both the impulse oscillation system for total lung mechanics and multifrequency bioelectrical impedance for body composition analyses were conducted. The effects of puberty on body composition and subsequent total lung resistance were evaluated using mediation analysis. RESULTS Among the 503 children enrolled, there were 261 males (51.9%) and 242 females (48.1%). In males, higher testosterone levels corresponded with reduced total lung resistance (β = -0.13, 95% CI = -0.21 to -0.05, p < 0.001), and the proportion of the mediating effect through the muscle-fat ratio was 19% (95% CI = 4 to 59, p = 0.02). In contrast, in females, pubertal status reduced total lung resistance (β = -0.27, 95% CI = -0.58 to -0.05, p = 0.04), however, the proportion of the mediating effect through the body mass index was -51% (95% CI = -244 to -4%, p = 0.04). CONCLUSION The muscle-fat ratio in adolescent males had a synergistic effect with testosterone on improving total airway resistance, whereas improvements in lung resistance by pubertal status were partially masked by body mass index in adolescent females. In conclusion, body composition changes during puberty between males and females have differing effects on total airway resistance.
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Affiliation(s)
- Ju Hee Kim
- Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Jin Ah Kim
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Department of Pediatrics, Kangwon National University Hospital, Gangwon-do, Korea
| | - Eun Kyo Ha
- Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Hye Mi Jee
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Seung Won Lee
- Department of Data Science, Sejong University College of Software Convergence, Seoul, Korea.,Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Mo Kyung Jung
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Sanghoo Lee
- Center for Companion Biomarker, Seoul Clinical Laboratories Healthcare, Yongin, Korea
| | - Yoon Ho Shin
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Eun-Gyong Yoo
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
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22
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Lee J, Feng K, Conti DS, Walenga R, Wientjes M, Wang H, Newman B, Han L, Dhapare S, Bielski E, Babiskin A, Wu F, Donnelly M, Kim M, Jiang W, Luke MC, Fang L, Zhao L. Considerations for the Forced Expiratory Volume in 1 Second (FEV
1
)‐Based Comparative Clinical Endpoint Bioequivalence Studies for Orally Inhaled Drug Products. Clin Pharmacol Ther 2022; 112:982-989. [DOI: 10.1002/cpt.2553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 01/30/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Jieon Lee
- Office of Research and Standards Office of Generic Drugs Center for Drug Evaluation and Research (CDER) U.S. Food and Drug Administration (FDA) 10903 New Hampshire Avenue Silver Spring Maryland 20993 USA
| | - Kairui Feng
- Office of Research and Standards Office of Generic Drugs Center for Drug Evaluation and Research (CDER) U.S. Food and Drug Administration (FDA) 10903 New Hampshire Avenue Silver Spring Maryland 20993 USA
| | - Denise S. Conti
- Office of Research and Standards Office of Generic Drugs Center for Drug Evaluation and Research (CDER) U.S. Food and Drug Administration (FDA) 10903 New Hampshire Avenue Silver Spring Maryland 20993 USA
| | - Ross Walenga
- Office of Research and Standards Office of Generic Drugs Center for Drug Evaluation and Research (CDER) U.S. Food and Drug Administration (FDA) 10903 New Hampshire Avenue Silver Spring Maryland 20993 USA
| | - Michael Wientjes
- Office of Research and Standards Office of Generic Drugs Center for Drug Evaluation and Research (CDER) U.S. Food and Drug Administration (FDA) 10903 New Hampshire Avenue Silver Spring Maryland 20993 USA
| | - Hezhen Wang
- Office of Research and Standards Office of Generic Drugs Center for Drug Evaluation and Research (CDER) U.S. Food and Drug Administration (FDA) 10903 New Hampshire Avenue Silver Spring Maryland 20993 USA
| | - Bryan Newman
- Office of Research and Standards Office of Generic Drugs Center for Drug Evaluation and Research (CDER) U.S. Food and Drug Administration (FDA) 10903 New Hampshire Avenue Silver Spring Maryland 20993 USA
| | - Liangfeng Han
- Office of Research and Standards Office of Generic Drugs Center for Drug Evaluation and Research (CDER) U.S. Food and Drug Administration (FDA) 10903 New Hampshire Avenue Silver Spring Maryland 20993 USA
| | - Sneha Dhapare
- Office of Research and Standards Office of Generic Drugs Center for Drug Evaluation and Research (CDER) U.S. Food and Drug Administration (FDA) 10903 New Hampshire Avenue Silver Spring Maryland 20993 USA
| | - Elizabeth Bielski
- Office of Research and Standards Office of Generic Drugs Center for Drug Evaluation and Research (CDER) U.S. Food and Drug Administration (FDA) 10903 New Hampshire Avenue Silver Spring Maryland 20993 USA
| | - Andrew Babiskin
- Office of Research and Standards Office of Generic Drugs Center for Drug Evaluation and Research (CDER) U.S. Food and Drug Administration (FDA) 10903 New Hampshire Avenue Silver Spring Maryland 20993 USA
| | - Fang Wu
- Office of Research and Standards Office of Generic Drugs Center for Drug Evaluation and Research (CDER) U.S. Food and Drug Administration (FDA) 10903 New Hampshire Avenue Silver Spring Maryland 20993 USA
| | - Mark Donnelly
- Office of Research and Standards Office of Generic Drugs Center for Drug Evaluation and Research (CDER) U.S. Food and Drug Administration (FDA) 10903 New Hampshire Avenue Silver Spring Maryland 20993 USA
| | - Myong‐Jin Kim
- Office of Research and Standards Office of Generic Drugs Center for Drug Evaluation and Research (CDER) U.S. Food and Drug Administration (FDA) 10903 New Hampshire Avenue Silver Spring Maryland 20993 USA
| | - Wenlei Jiang
- Office of Research and Standards Office of Generic Drugs Center for Drug Evaluation and Research (CDER) U.S. Food and Drug Administration (FDA) 10903 New Hampshire Avenue Silver Spring Maryland 20993 USA
| | - Markham C. Luke
- Office of Research and Standards Office of Generic Drugs Center for Drug Evaluation and Research (CDER) U.S. Food and Drug Administration (FDA) 10903 New Hampshire Avenue Silver Spring Maryland 20993 USA
| | - Lanyan Fang
- Office of Research and Standards Office of Generic Drugs Center for Drug Evaluation and Research (CDER) U.S. Food and Drug Administration (FDA) 10903 New Hampshire Avenue Silver Spring Maryland 20993 USA
| | - Liang Zhao
- Office of Research and Standards Office of Generic Drugs Center for Drug Evaluation and Research (CDER) U.S. Food and Drug Administration (FDA) 10903 New Hampshire Avenue Silver Spring Maryland 20993 USA
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23
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Wu J, Zhang H, Shi Y, Wang J, Han Y, Zhang Q, Wang N, Liu S, Zhang Y, Zi H, Wang F, Liu A, Song Y, Jia C, Feng Y, Liu Q, Wan L, Ji M, Long Z, Huang J, Liu L, Sun Y, Tang S, Dong X, Zhou X, Jiang W, Shen L, Jiang H. Reference values of impulse oscillometry (IOS) for healthy Chinese children aged 4-17 years. Respir Res 2022; 23:182. [PMID: 35831898 PMCID: PMC9281015 DOI: 10.1186/s12931-022-02080-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/05/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To establish the predicted value of pulmonary function determined by impulse oscillometry (IOS) in children (4-17 years old) in China. METHODS A total of 6270 healthy children aged 4-17 years in China were included. The Master Screen IOS pulmonary function device (Jaeger Co, Germany) was used to detect the respiratory impedance (Zrs), resonant frequency (Fres), respiratory system resistance (Rrs) and respiratory system reactance (Xrs) at various oscillation frequencies, and the indices above were analysed. Stepwise multivariate regression was used to establish the regression equation of related parameters of IOS in different sexes, ages, height, and weight. RESULTS The differences in the main IOS parameters between different age stages were statistically significant regardless of sex (P < 0.05). The stepwise multivariate regression analysis showed that IOS parameters were related to height, age, and weight, and most IOS parameters were most closely related to height (the absolute value of the regression coefficient was the largest). With increasing age and height, the values of Z5, R5, R20, R5-R20, and Fres decreased, while the value of X5 increased. Through height, age, and weight, we obtained the normal predicted values equation of children's IOS parameters. Compared with the other reference equations, our reference equation is more suitable for Chinese children. CONCLUSIONS The study revealed the reference values of IOS parameters in healthy Chinese children. In the evaluation of results for lung function measurements, this predicted value equation is more consistent with the characteristics of Chinese children than other reference equations. CLINICAL TRIAL ChiCTR: 1800019029.
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Affiliation(s)
- Jinhong Wu
- grid.16821.3c0000 0004 0368 8293Department of Respiratory Medicine, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127 China
| | - Hao Zhang
- Department of Internal Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - Yongsheng Shi
- Department of Pediatric Respiratory, Maternity and Child-Care Hospital of Gansu Province, Lanzhou, 730050 China
| | - Jinrong Wang
- Department of Pediatric Respiratory, Affiliated Provincial Hospital of Shandong First Medical University, Jinan, 250021 China
| | - Yuling Han
- grid.27255.370000 0004 1761 1174Department of Respiratory, Qilu Children’s Hospital of Shandong University, Jinan, 250022 China
| | - Qiaoling Zhang
- Department of Pediatric Respiratory, Maternal and Child Health Hospital in Inner Mongolia Autonomous Region, Hohhot, 010020 China
| | - Ning Wang
- grid.452902.8Asthma Centre of Xi’an Children’s Hospital, Xi’an, 710003 China
| | - Sha Liu
- grid.488412.3Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, Chongqing, 400014 China
| | - Yuehua Zhang
- Pediatrics Infection Disease Ward, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, 570208 China
| | - Huifen Zi
- grid.489937.80000 0004 1757 8474Department of Pediatrics, Baotou Central Hospital, Baotou, 014040 China
| | - Fei Wang
- Department of Pediatric Respiratory, Guiyang Maternal and Child Health Hospital (Guiyang Children’s Hospital), Guiyang, 550003 China
| | - Aihong Liu
- Department of Respiratory Medicine, Children’s Hospital of Shanxi, Taiyuan, 030013 China
| | - Yuxin Song
- Department of Allergy, Harbin Children’s Hospital, Harbin, 150010 China
| | - ChunMei Jia
- Department of Pediatric Respiratory, The Fourth Hospital of Baotou (Baotou Children’s Hospital), Baotou, 014030 China
| | - Yong Feng
- grid.412467.20000 0004 1806 3501Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, 110004 China
| | - Quanhua Liu
- grid.412987.10000 0004 0630 1330Department of Pulmonology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092 China
| | - liya Wan
- grid.417022.20000 0004 1772 3918Respiratory department of Tianjin Children’s Hospital, Tianjin, 300074 China
| | - Minghong Ji
- grid.59053.3a0000000121679639Department of Pediatric, The First Affiliated Hospital of USTC Anhui Provincial Hospital, Hefei, 230001 China
| | - Zhen Long
- grid.33199.310000 0004 0368 7223Department of Pediatric Respiratory Medicine, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070 China
| | - Jianfeng Huang
- grid.411333.70000 0004 0407 2968Department of Pulmonology, Children’s Hospital of Fudan University, Shanghai, 201102 China
| | - Li Liu
- grid.430605.40000 0004 1758 4110Department of Pediatric Respiratory, The First Hospital of Jilin University, Changchun, 130021 China
| | - Yun Sun
- General Pediatric, Yinchuan Women and Children Healthcare Hospital, Yinchuan, 750001 China
| | - Suping Tang
- grid.256112.30000 0004 1797 9307Department of Asthma and Tracheitis, Fuzhou Children’s Hospital, Fujian Medical University, Fuzhou, 350000 China
| | - Xiaoyan Dong
- grid.16821.3c0000 0004 0368 8293Department of Pulmonology, Shanghai Children’s Hospital, Affiliated to Shanghai Jiao Tong University, Shanghai, 200040 China
| | - Xiaojian Zhou
- grid.16821.3c0000 0004 0368 8293Department of Pediatrics, Shanghai First People’s Hospital, Affiliated to Shanghai Jiao Tong University, Shanghai, 200080 China
| | - Wenhui Jiang
- grid.413428.80000 0004 1757 8466Department of Respiratory, Guangzhou Women and Children’s Medical Center, Guangzhou, 510623 China
| | - Li Shen
- grid.412524.40000 0004 0632 3994Department of Respiratory, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, Shanghai, 200025 China
| | - Haohua Jiang
- grid.412524.40000 0004 0632 3994Department of Respiratory, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, Shanghai, 200025 China
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24
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Marczak H, Peradzyńska J, Seidl E, Griese M, Urbankowski T, Lange J, Bogusławski S, Krenke K. The improved clinical course of persistent tachypnea of infancy with inhaled bronchodilators and corticosteroids. Pediatr Pulmonol 2021; 56:3952-3959. [PMID: 34520130 DOI: 10.1002/ppul.25674] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/31/2021] [Accepted: 09/11/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Persistent tachypnea of infancy (PTI) is the most common interstitial lung disease in young children. As no standardized therapeutic guidelines exist, different pharmaceuticals are used to treat PTI; inhaled corticosteroids (ICS) and bronchodilators being mostly used. This observation assessed the effectiveness of bronchodilators and ICS in children with PTI enrolled in the children's interstitial lung diseases (chILD)-EU Register. METHODS Symptomatic children with PTI were observed according to a predetermined stepwise protocol including bronchodilators as the first choice treatment (6 weeks). In patients with incomplete response, additionally, ICS was given (12 weeks). Signs, symptoms, and pulmonary function were evaluated at three time points: at baseline, 6 (±1) weeks after initiation of bronchodilators, and 12 (±1) weeks after bronchodilators/ICS. RESULTS Thirty-one children (median age: 44 months, interquartile range [IQR]: 15-67) were included. The therapy was associated with a significant reduction of tachypnea (53.3% of patients, p = 0.02), exercise intolerance (52.2% of patients, p < 0.001), chest retractions (43.8% of patients, p = 0.04), and crackles (29.2% of patients, p = 0.02). Also, a significant improvement in forced expiratory volume in 1 s (FEV1 ) (median z score: -2.21 vs. -0.47, p = 0.03), residual volume (RV) (median z score 5.28 vs. 1.07, p = 0.007), RV% total lung capacity (TLC) (median z score: 6.05 vs. 1.48, p = 0.01), sRaw (median z score: 6.6 vs. 4.64, p = 0.01), R5 (median z score: 1.27 vs. 0.31, p = 0.009), and R5-R20 (median: 0.58 vs. 0.26 kPa/(l/s), p = 0.002) was demonstrated. CONCLUSIONS Inhaled bronchodilators and ICS may exert a positive effect on the severity of symptoms and pulmonary function test (PFT) in symptomatic children with PTI. However, a randomized control trial should be conducted to confirm their effectiveness.
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Affiliation(s)
- Honorata Marczak
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Peradzyńska
- Department of Epidemiology and Biostatistics, Medical University of Warsaw, Warsaw, Poland
| | - Elias Seidl
- Department of Pediatric Pneumology, Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany
| | - Matthias Griese
- Department of Pediatric Pneumology, Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany
| | | | - Joanna Lange
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Stanisław Bogusławski
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Krenke
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
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25
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Respiratory morbidities and lung function abnormalities in survivors of Bhopal Gas Disaster: A cross-sectional study. Respir Investig 2021; 60:284-292. [PMID: 34756545 DOI: 10.1016/j.resinv.2021.09.008] [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: 08/24/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Respiratory morbidities remained significant for the last four decades among the survivors of the Bhopal gas disaster. We hypothesized that lung function abnormalities, especially small airway dysfunctions, were responsible for the ongoing respiratory morbidities. METHODS We conducted a cross-sectional study between 2018 and 2020 in the severely exposed cohort of the Bhopal gas disaster. A standardized questionnaire was used to record their respiratory symptoms. The forced oscillometry (FOT) and spirometry were utilized for assessing lung functions. Univariate and multivariate logistic regression analyses were used to examine the association. RESULTS Of 916 enrolled individuals (men: 442, mean age: 55.2 ± 12.3 years), 558 participated in lung function assessments. Breathlessness was the most common complaint (71.7%), followed by cough (15.1%). The R5 > upper limit of normal (ULN), R5-19 > ULN, and X5 < lower limit of normal (LLN) were observed in 29.3%, 23.3%, and 21.2% participants, respectively. Normal, obstructive, and restrictive spirometry was observed in 46.2%, 26.1%, and 27.7%, participants, respectively. FOT parameters were abnormal in 25.3% individuals with normal spirometry. Individuals with obstructive spirometry had the highest risk of having abnormal FOT parameters (adjusted odds ratio [adj OR]:3.93, 95% confidence interval [CI]: 2.24-6.89). Breathlessness showed a significant association with abnormal R5 (adj OR: 1.81; 95% CI: 1.13-2.91) and obstructive spirometry (adj OR: 2.26; 95% CI: 1.29-3.95). CONCLUSIONS Assessment of small airway functions along with spirometry are useful to identify complex lung function abnormalities in cases of toxic inhalation.
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26
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Chan R, Misirovs R, Lipworth B. Repeatability of impulse oscillometry in patients with severe asthma. Eur Respir J 2021; 59:13993003.01679-2021. [PMID: 34625483 DOI: 10.1183/13993003.01679-2021] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/29/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Rory Chan
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, UK
| | - Rasads Misirovs
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, UK
| | - Brian Lipworth
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, UK
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27
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Chen L, Wu L, Lu D, Zi M, Yu H. The Value of Fractional Exhaled Nitric Oxide and Impulse Oscillometric and Spirometric Parameters for Predicting Bronchial Hyperresponsiveness in Adults with Chronic Cough. J Asthma Allergy 2021; 14:1065-1073. [PMID: 34447255 PMCID: PMC8384260 DOI: 10.2147/jaa.s326879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/03/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the contribution of fractional exhaled nitric oxide (FeNO) and impulse oscillometry (IOS) and spirometric parameters in predicting bronchial hyperresponsiveness (BHR) in adults with chronic cough. Patients and Methods In total, 112 patients with chronic cough were enrolled in this prospective diagnostic study. Receiver operating characteristic (ROC) curves were generated to assess the diagnostic efficiency and optimal cut-off values of FeNO and IOS and spirometric parameters in predicting BHR. Optimal combinations of FeNO and IOS and spirometric parameters for BHR prediction were investigated using univariate and multivariate logistic regression models. Bootstrapping was employed for internal validation. Model discrimination and calibration were assessed using indices and calibration plots. Results Rhinitis and values of FeNO, IOS parameters (resonant frequency (Fres), reactance at 5 Hz (X5), and integrated area of low-frequency X (AX)) and spirometric parameters (FEV1, PEF, MEF75, MEF50, MEF25, MMEF) were significantly different between patients with BHR and those without BHR (P < 0.05). After adjusting for rhinitis, logistic analyses showed that FeNO combined with Fres, FeNO combined with MMEF, or the combination of FeNO, Fres and MMEF had high predictive value in diagnosing BHR; the areas under the ROC curves (AUCs) of the corresponding three models were 0.914, 0.919 and 0.927, respectively. In addition, the three models displayed good discrimination, with high C-index values and good calibration. Conclusion FeNO combined with Fres or MMEF or a combination of these three parameters may be conveniently used as indicators in BHR prediction.
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Affiliation(s)
- Lichang Chen
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Lingling Wu
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Dongzhu Lu
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Mei Zi
- Department of Respiratory and Critical Care Medicine, The Third People's Hospital of Shenzhen, Shenzhen, People's Republic of China
| | - Huapeng Yu
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
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28
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Koefoed HJL, Zwitserloot AM, Vonk JM, Koppelman GH. Asthma, bronchial hyperresponsiveness, allergy and lung function development until early adulthood: A systematic literature review. Pediatr Allergy Immunol 2021; 32:1238-1254. [PMID: 33835532 PMCID: PMC8453965 DOI: 10.1111/pai.13516] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND It is unclear in which periods of life lung function deficits develop, and whether these are affected by risk factors such as asthma, bronchial hyper-responsiveness (BHR) and allergic comorbidity. The goal of this systematic review was to identify temporal associations of asthma, BHR and allergic comorbidity with large and small lung function development from birth until peak function in early adulthood. METHODS We searched MEDLINE, EMBASE, Web of Science and CINAHL for papers published before 01.01.2020 on risk factors and lung function measurements of large and small airways. Studies were required to report lung function at any time point or interval from birth until peak lung function (age 21-26) and include at least one candidate risk factor. RESULTS Of the 45 papers identified, 44 investigated cohorts and one was a clinical trial with follow-up. Asthma, wheezing, BHR and allergic sensitization early in life and to multiple allergens were associated with a lower lung function growth of large and small airways during early childhood compared with the control populations. Lung function development after childhood in subjects with asthma or persistent wheeze, although continuing to grow at a lower level, largely tracked parallel to non-affected individuals until peak function was attained. CLINICAL IMPLICATIONS AND FUTURE RESEARCH Deficits in lung function growth develop in early childhood, and children with asthma, BHR and early-life IgE (poly)sensitization are at risk. This period is possibly a critical window of opportunity to identify at-risk subjects and provide treatment aimed at preventing long-term sequelae of lung function.
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Affiliation(s)
- Hans Jacob L. Koefoed
- Department of Pediatric Pulmonology and Pediatric AllergologyBeatrix Children’s HospitalUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC)University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Annelies M. Zwitserloot
- Department of Pediatric Pulmonology and Pediatric AllergologyBeatrix Children’s HospitalUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC)University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Judith M. Vonk
- Groningen Research Institute for Asthma and COPD (GRIAC)University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
- Department of EpidemiologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Gerard H. Koppelman
- Department of Pediatric Pulmonology and Pediatric AllergologyBeatrix Children’s HospitalUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC)University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
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29
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Cottini M, Licini A, Lombardi C, Bagnasco D, Comberiati P, Berti A. Small airway dysfunction and poor asthma control: a dangerous liaison. Clin Mol Allergy 2021; 19:7. [PMID: 34051816 PMCID: PMC8164746 DOI: 10.1186/s12948-021-00147-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/22/2021] [Indexed: 01/05/2023] Open
Abstract
Asthma is a common chronic condition, affecting approximately 339 million people worldwide. The main goal of the current asthma treatment guidelines is to achieve clinical control, encompassing both the patient symptoms and limitations and the future risk of adverse asthma outcomes. Despite randomized controlled trials showing that asthma control is an achievable target, a substantial proportion of asthmatics remain poorly controlled in real life. The involvement of peripheral small airways has recently gained greater recognition in asthma, and many studies suggest that the persistent inflammation at these sites leads to small airway dysfunction (SAD), strongly contributing to a worse asthma control. Overall, the impulse oscillometry (IOS), introduced in the recent years, seems to be able to sensitively assess small airways, while conventional spirometry does not. Therefore, IOS may be of great help in characterizing SAD and guiding therapy choice. The aim of this article is to review the literature on SAD and its influence on asthma control, emphasizing the most recent evidence.
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Affiliation(s)
| | - Anita Licini
- Allergy and Pneumology Outpatient Clinic, Bergamo, Italy
| | - Carlo Lombardi
- Departmental Unit of Allergology, Immunology and Pulmonary Diseases, Fondazione Poliambulanza, Brescia, Italy
| | - Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genova, Italy.
| | - Pasquale Comberiati
- Section of Pediatrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alvise Berti
- Ospedale Santa Chiara and Department of Cellular, Computational and Integrative Biology (CIBIO), University of Trento, Trento, Italy.,Thoracic Disease Research Unit, Mayo Clinic, Rochester, MN, USA
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Ishiyama H, Hideshima M, Inukai S, Tamaoka M, Nishiyama A, Miyazaki Y. Evaluation of Respiratory Resistance as a Predictor for Oral Appliance Treatment Response in Obstructive Sleep Apnea: A Pilot Study. J Clin Med 2021; 10:jcm10061255. [PMID: 33803610 PMCID: PMC8002844 DOI: 10.3390/jcm10061255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/06/2021] [Accepted: 03/16/2021] [Indexed: 01/06/2023] Open
Abstract
The aim of this study was to determine the utility of respiratory resistance as a predictor of oral appliance (OA) response in obstructive sleep apnea (OSA). Twenty-seven patients with OSA (mean respiratory event index (REI): 17.5 ± 6.5 events/h) were recruited. At baseline, the respiratory resistance (R20) was measured by impulse oscillometry (IOS) with a fitted nasal mask in the supine position, and cephalometric radiographs were obtained to analyze the pharyngeal airway space (SPAS: superior posterior airway space, MAS: middle airway space, IAS: inferior airway space). The R20 and radiographs after the OA treatment were evaluated, and the changes from the baseline were analyzed. A sleep test with OA was carried out using a portable device. The subjects were divided into Responders and Non-responders based on an REI improvement ≥ 50% from the baseline, or REI < 5 after treatment, and the R20 reduction rate between the two groups were compared. The subjects comprised 20 responders and 7 non-responders. The R20 reduction rate with OA in responders was significantly greater than it was in non-responders (14.4 ± 7.9 % versus 2.4 ± 9.8 %, p < 0.05). In responders, SPAS, MAS, and IAS were significantly widened and R20 was significantly decreased with OA (p < 0.05). There was no significant difference in non-responders (p > 0.05). A logistic multiple regression analysis showed that the R20 reduction rate was predictive for OA treatment responses (2% incremental odds ratio (OR), 24.5; 95% CI, 21.5–28.0; p = 0.018). This pilot study confirmed that respiratory resistance may have significant clinical utility in predicting OA treatment responses.
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Affiliation(s)
- Hiroyuki Ishiyama
- Dental Anesthesiology and Orofacial Pain Management, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan; (H.I.); (A.N.)
- Dental Clinic for Sleep Disorders (Apnea and Snoring), Oral and Maxillofacial Rehabilitation, Dental Hospital, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Masayuki Hideshima
- Dental Clinic for Sleep Disorders (Apnea and Snoring), Oral and Maxillofacial Rehabilitation, Dental Hospital, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
- Correspondence: ; Tel.: +81-3-5803-4551
| | - Shusuke Inukai
- Removable Partial Prosthodontics, Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan;
| | - Meiyo Tamaoka
- Department of Respiratory Physiology and Sleep Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan;
| | - Akira Nishiyama
- Dental Anesthesiology and Orofacial Pain Management, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan; (H.I.); (A.N.)
- Dental Clinic for Sleep Disorders (Apnea and Snoring), Oral and Maxillofacial Rehabilitation, Dental Hospital, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan;
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Li LY, Yan TS, Yang J, Li YQ, Fu LX, Lan L, Liang BM, Wang MY, Luo FM. Impulse oscillometry for detection of small airway dysfunction in subjects with chronic respiratory symptoms and preserved pulmonary function. Respir Res 2021; 22:68. [PMID: 33627138 PMCID: PMC7903610 DOI: 10.1186/s12931-021-01662-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/11/2021] [Indexed: 02/08/2023] Open
Abstract
Background Subjects with chronic respiratory symptoms and preserved pulmonary function (PPF) may have small airway dysfunction (SAD). As the most common means to detect SAD, spirometry needs good cooperation and its reliability is controversial. Impulse oscillometry (IOS) may complete the deficiency of spirometry and have higher sensitivity. We aimed to explore the diagnostic value of IOS to detect SAD in symptomatic subjects with PPF. Methods The evaluation of symptoms, spirometry and IOS results in 209 subjects with chronic respiratory symptoms and PPF were assessed. ROC curves of IOS to detect SAD were analyzed. Results 209 subjects with chronic respiratory symptoms and PPF were included. Subjects who reported sputum had higher R5–R20 and Fres than those who didn’t. Subjects with dyspnea had higher R5, R5–R20 and AX than those without. CAT and mMRC scores correlated better with IOS parameters than with spirometry. R5, R5–R20, AX and Fres in subjects with SAD (n = 42) significantly increased compared to those without. Cutoff values for IOS parameters to detect SAD were 0.30 kPa/L s for R5, 0.015 kPa/L s for R5–R20, 0.30 kPa/L for AX and 11.23 Hz for Fres. Fres has the largest AUC (0.665, P = 0.001) among these parameters. Compared with spirometry, prevalence of SAD was higher when measured with IOS. R5 could detect the most SAD subjects with a prevalence of 60.77% and a sensitivity of 81% (AUC = 0.659, P = 0.002). Conclusion IOS is more sensitive to detect SAD than spirometry in subjects with chronic respiratory symptoms and PPF, and it correlates better with symptoms. IOS could be an additional method for SAD detection in the early stage of diseases.
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Affiliation(s)
- Liang-Yuan Li
- Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, China
| | - Tian-Sheng Yan
- Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, China
| | - Jing Yang
- Department of Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yu-Qi Li
- Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, China
| | - Lin-Xi Fu
- Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, China
| | - Lan Lan
- Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, China
| | - Bin-Miao Liang
- Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, China
| | - Mao-Yun Wang
- Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, China
| | - Feng-Ming Luo
- Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, China.
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Vij N. Prognosis-Based Early Intervention Strategies to Resolve Exacerbation and Progressive Lung Function Decline in Cystic Fibrosis. J Pers Med 2021; 11:jpm11020096. [PMID: 33546140 PMCID: PMC7913194 DOI: 10.3390/jpm11020096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 12/14/2022] Open
Abstract
Cystic fibrosis (CF) is a genetic disease caused by a mutation(s) in the CF transmembrane regulator (CFTR), where progressive decline in lung function due to recurring exacerbations is a major cause of mortality. The initiation of chronic obstructive lung disease in CF involves inflammation and exacerbations, leading to mucus obstruction and lung function decline. Even though clinical management of CF lung disease has prolonged survival, exacerbation and age-related lung function decline remain a challenge for controlling the progressive lung disease. The key to the resolution of progressive lung disease is prognosis-based early therapeutic intervention; thus, the development of novel diagnostics and prognostic biomarkers for predicting exacerbation and lung function decline will allow optimal management of the lung disease. Hence, the development of real-time lung function diagnostics such as forced oscillation technique (FOT), impulse oscillometry system (IOS), and electrical impedance tomography (EIT), and novel prognosis-based intervention strategies for controlling the progression of chronic obstructive lung disease will fulfill a significant unmet need for CF patients. Early detection of CF lung inflammation and exacerbations with the timely resolution will not only prolong survival and reduce mortality but also improve quality of life while reducing significant health care costs due to recurring hospitalizations.
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Affiliation(s)
- Neeraj Vij
- Precision Theranostics Inc., Baltimore, MD 21202, USA; or or ; Tel.: +1-240-623-0757
- VIJ Biotech, Baltimore, MD 21202, USA
- Department of Pediatrics & Pulmonary Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Calzetta L, Aiello M, Frizzelli A, Bertorelli G, Chetta A. Small airways in asthma: from bench-to-bedside. Minerva Med 2021; 113:79-93. [PMID: 33496163 DOI: 10.23736/s0026-4806.21.07268-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Historically, asthma was considered a disease predominantly of the large airways, but gradually small airways have been recognized as the major site of airflow obstruction. Small airway dysfunction (SAD) significantly contributes to the pathophysiology of asthma and it is present across all asthma severities. Promising pre-clinical findings documented enhanced beneficial effects of combination therapies on small airways compared to monocomponents, thus it was questioned whether this could translate into further clinical implications from bench-to-bedside. The aim of this review was to systematically assess the state of the art of small airway involvement in asthma, especially in response to different pharmacological treatments acting on the respiratory system. EVIDENCE ACQUISITION A comprehensive literature search was performed in MEDLINE for randomized controlled trials (RCTs) characterizing the impact on small airways of different pharmacological treatments acting on the respiratory system. The results were extracted and reported via qualitative synthesis. EVIDENCE SYNTHESIS Overall, 63 studies were identified from the literature search, whereas 23 RCTs met the inclusion criteria. Evidence confirms that both drug particle size and the type of inhalation devices represent two of the most important variables for an effective peripheral lung distribution. CONCLUSIONS Despite the numerous methodological tools to detect SAD, there is still no gold standard diagnostic method to assess small airways, especially in severe asthma. Further research should be directed to improve primary and secondary prevention strategies by supporting the combined approach of different non-invasive techniques for an early detection of peripheral abnormalities and optimization of asthma therapy.
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Affiliation(s)
- Luigino Calzetta
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy -
| | - Marina Aiello
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Annalisa Frizzelli
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Giuseppina Bertorelli
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Alfredo Chetta
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
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Porojan-Suppini N, Fira-Mladinescu O, Marc M, Tudorache E, Oancea C. Lung Function Assessment by Impulse Oscillometry in Adults. Ther Clin Risk Manag 2020; 16:1139-1150. [PMID: 33273817 PMCID: PMC7705955 DOI: 10.2147/tcrm.s275920] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/08/2020] [Indexed: 11/23/2022] Open
Abstract
Over the past decades, impulse oscillometry (IOS) has gained ground in the battery of pulmonary function tests. Performing the test requires minimal cooperation of the patient; therefore, it is a useful tool, especially in evaluating lung mechanics in children, elderly patients, and those who cannot perform spirometry. Oscillometry has also been used in both clinical and research departments. Studies were published mainly in asthma regarding detection of bronchodilator response and the therapeutic response to different drugs. Furthermore, it has been shown to be a sensitive technique to evaluate disease control. Other studied diseases were COPD, interstitial lung diseases, small airway disease, impairment of lung function due to exposure to occupational hazards or smoking, central airways obstruction, cystic fibrosis, monitoring lung mechanics during mechanical ventilation and sleep, neuromuscular diseases, lung transplant, and graft function. The aim of this review is to present the utility of oscillometry on the previously mentioned clinical fields.
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Affiliation(s)
- Noemi Porojan-Suppini
- Department of Pulmonology, Center for Research and Innovation in Personalized Medicine of Respiratory Diseases, University of Medicine and Pharmacy "Victor Babeș", Timișoara, Romania
| | - Ovidiu Fira-Mladinescu
- Department of Pulmonology, Center for Research and Innovation in Personalized Medicine of Respiratory Diseases, University of Medicine and Pharmacy "Victor Babeș", Timișoara, Romania
| | - Monica Marc
- Department of Pulmonology, Center for Research and Innovation in Personalized Medicine of Respiratory Diseases, University of Medicine and Pharmacy "Victor Babeș", Timișoara, Romania
| | - Emanuela Tudorache
- Department of Pulmonology, Center for Research and Innovation in Personalized Medicine of Respiratory Diseases, University of Medicine and Pharmacy "Victor Babeș", Timișoara, Romania
| | - Cristian Oancea
- Department of Pulmonology, Center for Research and Innovation in Personalized Medicine of Respiratory Diseases, University of Medicine and Pharmacy "Victor Babeș", Timișoara, Romania
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Flow Cytometry: From Experimental Design to Its Application in the Diagnosis and Monitoring of Respiratory Diseases. Int J Mol Sci 2020; 21:ijms21228830. [PMID: 33266385 PMCID: PMC7700151 DOI: 10.3390/ijms21228830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 12/12/2022] Open
Abstract
Recent advances in the field of flow cytometry (FCM) have highlighted the importance of incorporating it as a basic analysis tool in laboratories. FCM not only allows the identification of cell subpopulations by detecting the expression of molecules in the cell membrane or cytoplasm, but it can also quantify and identify soluble molecules. The proper functioning of the FCM requires six fundamental systems, from those related to the transport of events to the systems dedicated to the analysis of information. In this review, we have identified the main considerations that every FCM user must know for an optimal antibody panel design, the quality systems that must govern the FCM protocols to guarantee reproducible results in research or clinical laboratories. Finally, we have introduced the current evidence that highlights the relevance of FCM in the investigation and clinical diagnosis of respiratory diseases, establishing important advances in the basic and clinical study of diseases as old as Tuberculosis along with the recent proposals for the monitoring and classification of patients infected with the new SARS-CoV2 virus.
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