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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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Ding F, Han L, Yin D, Zhou Y, Ji Y, Zhang P, Wu W, Chen J, Wang Z, Fan X, Zhang G, Zhang M. Development and validation of a simple tool composed of items on dyspnea, respiration rates, and C-reactive protein for pneumonia prediction among acute febrile respiratory illness patients in primary care settings. BMC Med 2022; 20:360. [PMID: 36253753 PMCID: PMC9576309 DOI: 10.1186/s12916-022-02552-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 09/05/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Acute febrile respiratory illness (AFRI) patients are susceptible to pneumonia and suffer from significant morbidity and mortality throughout the world. In primary care settings, the situation is worse. Limited by computerized tomography resources and physician experiences, AFRI patients in primary care settings may not be diagnosed appropriately, which would affect following treatment. In this study, we aimed to develop and validate a simple prediction model to help physicians quickly identify AFRI patients of pneumonia risk in primary care settings. METHODS A total of 1977 AFRI patients were enrolled at two fever clinics in Shanghai, China, and among them, 727 patients who underwent CT scans were included in the analysis. Acute alveolar or interstitial infiltrates found on CT images were diagnosed with pneumonia. Characteristics and blood parameters were compared between pneumonia and non-pneumonia patients. Then a multivariable model for pneumonia prediction was developed through logistic regression analysis. Its value for pneumonia prediction was prospectively assessed in an external multi-center population, which included 1299 AFRI patients in primary settings from 5 different provinces throughout China. RESULTS In the model development population, pneumonia patients (n = 227) had a longer duration of fever; higher frequencies of purulent sputum, dyspnea, and thoracic pain; and higher levels of respiration rates and C-reactive protein (CRP) than non-pneumonia patients (n = 500). Logistic regression analysis worked out a model composed of items on dyspnea, respiration rates > 20/min, and CRP > 20 mg/l (DRC) for pneumonia prediction with an area under curve (AUC) of 0.8506. In the external validation population, the predictive accuracy of the DRC model was the highest when choosing at least one positive item (1 score) as a cut-off point with a sensitivity of 87.0% and specificity of 80.5%. DRC scores increased with pneumonia severity and lung lobe involvement and showed good performance for both bacterial and viral pneumonia. For viral pneumonia, dyspnea plus respiration rates > 20/min had good predictive capacity regardless of CRP concentration. CONCLUSIONS DRC model is a simple tool that predicts pneumonia among AFRI patients, which would help physicians utilize medical resources rationally in primary care settings.
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Affiliation(s)
- Fengming Ding
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Infectious Disease, Leishenshan Hospital, Wuhan, Hubei Province, China
| | - Lei Han
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dongning Yin
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Zhou
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Infectious Disease, Leishenshan Hospital, Wuhan, Hubei Province, China
| | - Yong Ji
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Infectious Disease, Leishenshan Hospital, Wuhan, Hubei Province, China
| | - Pengyu Zhang
- Department of Infectious Disease, Leishenshan Hospital, Wuhan, Hubei Province, China.,Department of Infectious Disease, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wensheng Wu
- Department of Internal Medicine, People's Hospital of Wannian County, Shangrao, Jiangxi Province, China
| | - Jijing Chen
- Department of Internal Medicine, Dongfang People's Hospital, Dongfang, Hainan Province, China
| | - Zufang Wang
- Department of General Medicine, Zhongzhuang Town Health Center of Honghuagang District, Zunyi, Guizhou Province, China
| | - Xinxin Fan
- Department of Tuberculosis, Fuzhou Pulmonary Hospital, Fuzhou, Fujian Province, China
| | - Guoqing Zhang
- Department of Respiratory Medicine, Jiangqiao Hospital of Jiading District, Shanghai, China
| | - Min Zhang
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Araújo NPDS, de Matos NA, Oliveira M, de Souza ABF, Castro TDF, Machado-Júnior PA, de Souza DMS, Talvani A, Cangussú SD, de Menezes RCA, Bezerra FS. Quercetin Improves Pulmonary Function and Prevents Emphysema Caused by Exposure to Cigarette Smoke in Male Mice. Antioxidants (Basel) 2022; 11:antiox11020181. [PMID: 35204064 PMCID: PMC8868486 DOI: 10.3390/antiox11020181] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/22/2021] [Accepted: 01/05/2022] [Indexed: 12/12/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is the major cause of morbidity and mortality worldwide, and cigarette smoke is a key factor in the development of COPD. Thus, the development of effective therapies to prevent the advancement of COPD has become increasingly essential. We hypothesized that quercetin protects lungs in mice exposed to long-term cigarette smoke. Thirty-five C57BL/6 mice were exposed to cigarette smoke (12 cigarettes per day) for 60 days and pretreated with 10 mg/kg/day of quercetin via orogastric gavage. After the experimental protocol, the animals were euthanized and samples were collected for histopathological, antioxidant defense, oxidative stress and inflammatory analysis. The animals exposed to cigarette smoke showed an increase in respiratory rate and hematological parameters, cell influx into the airways, oxidative damage and inflammatory mediators, besides presenting with alterations in the pulmonary histoarchitecture. The animals receiving 10 mg/kg/day of quercetin that were exposed to cigarette smoke presented a reduction in cellular influx, less oxidative damage, reduction in cytokine levels, improvement in the histological pattern and improvement in pulmonary emphysema compared to the group that was only exposed to cigarette smoke. These results suggest that quercetin may be an agent in preventing pulmonary emphysema induced by cigarette smoke.
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Affiliation(s)
- Natália Pereira da Silva Araújo
- Laboratory of Experimental Pathophysiology, Department of Biological Sciences and Center of Research in Biological Sciences, Federal University of Ouro Preto (UFOP), Ouro Preto 35400-000, Brazil; (N.P.d.S.A.); (N.A.d.M.); (M.O.); (A.B.F.d.S.); (T.d.F.C.); (P.A.M.-J.); (S.D.C.)
| | - Natália Alves de Matos
- Laboratory of Experimental Pathophysiology, Department of Biological Sciences and Center of Research in Biological Sciences, Federal University of Ouro Preto (UFOP), Ouro Preto 35400-000, Brazil; (N.P.d.S.A.); (N.A.d.M.); (M.O.); (A.B.F.d.S.); (T.d.F.C.); (P.A.M.-J.); (S.D.C.)
| | - Michel Oliveira
- Laboratory of Experimental Pathophysiology, Department of Biological Sciences and Center of Research in Biological Sciences, Federal University of Ouro Preto (UFOP), Ouro Preto 35400-000, Brazil; (N.P.d.S.A.); (N.A.d.M.); (M.O.); (A.B.F.d.S.); (T.d.F.C.); (P.A.M.-J.); (S.D.C.)
| | - Ana Beatriz Farias de Souza
- Laboratory of Experimental Pathophysiology, Department of Biological Sciences and Center of Research in Biological Sciences, Federal University of Ouro Preto (UFOP), Ouro Preto 35400-000, Brazil; (N.P.d.S.A.); (N.A.d.M.); (M.O.); (A.B.F.d.S.); (T.d.F.C.); (P.A.M.-J.); (S.D.C.)
| | - Thalles de Freitas Castro
- Laboratory of Experimental Pathophysiology, Department of Biological Sciences and Center of Research in Biological Sciences, Federal University of Ouro Preto (UFOP), Ouro Preto 35400-000, Brazil; (N.P.d.S.A.); (N.A.d.M.); (M.O.); (A.B.F.d.S.); (T.d.F.C.); (P.A.M.-J.); (S.D.C.)
| | - Pedro Alves Machado-Júnior
- Laboratory of Experimental Pathophysiology, Department of Biological Sciences and Center of Research in Biological Sciences, Federal University of Ouro Preto (UFOP), Ouro Preto 35400-000, Brazil; (N.P.d.S.A.); (N.A.d.M.); (M.O.); (A.B.F.d.S.); (T.d.F.C.); (P.A.M.-J.); (S.D.C.)
| | - Débora Maria Soares de Souza
- Laboratory of Immunobiology of Inflammation, Department of Biological Sciences, Institute of Exact and Biological Sciences, Federal University of Ouro Preto (UFOP), Ouro Preto 35400-000, Brazil; (D.M.S.d.S.); (A.T.)
| | - André Talvani
- Laboratory of Immunobiology of Inflammation, Department of Biological Sciences, Institute of Exact and Biological Sciences, Federal University of Ouro Preto (UFOP), Ouro Preto 35400-000, Brazil; (D.M.S.d.S.); (A.T.)
| | - Sílvia Dantas Cangussú
- Laboratory of Experimental Pathophysiology, Department of Biological Sciences and Center of Research in Biological Sciences, Federal University of Ouro Preto (UFOP), Ouro Preto 35400-000, Brazil; (N.P.d.S.A.); (N.A.d.M.); (M.O.); (A.B.F.d.S.); (T.d.F.C.); (P.A.M.-J.); (S.D.C.)
| | - Rodrigo Cunha Alvim de Menezes
- Laboratory of Cardiovascular Physiology, Department of Biological Sciences and Center of Research in Biological Sciences, Federal University of Ouro Preto (UFOP), Ouro Preto 35400-000, Brazil;
| | - Frank Silva Bezerra
- Laboratory of Experimental Pathophysiology, Department of Biological Sciences and Center of Research in Biological Sciences, Federal University of Ouro Preto (UFOP), Ouro Preto 35400-000, Brazil; (N.P.d.S.A.); (N.A.d.M.); (M.O.); (A.B.F.d.S.); (T.d.F.C.); (P.A.M.-J.); (S.D.C.)
- Correspondence:
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Moroli RG, Santos DOD, Souza HCDD, Perossi L, Ribeiro MA, Perossi J, Baddini-Martinez JA, Gastaldi AC. Effects of Controlled Voluntary Increase in the Ventilatory Demand on Respiratory System Resistance in Healthy and Non-Cystic Fibrosis Bronchiectasis Subjects: A Cross-Sectional Study. Arch Bronconeumol 2021; 57:528-532. [PMID: 35699030 DOI: 10.1016/j.arbr.2020.04.015] [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: 12/02/2019] [Accepted: 04/08/2020] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Bronchiectasis patients may present a reduced functional capacity due to an increase in the ventilatory demand during exercise. OBJECTIVE To evaluate the effects of controlled voluntary hyperinflation and increased respiratory rate on the mechanics of the respiratory system, simulating what happens during exercise, in bronchiectasis and healthy subjects. METHODS Bronchiectasis (n=30) and healthy (n=16) subjects were evaluated by impulse oscillometry (IOS) during a baseline condition, and in controlled conditions with baseline (b) tidal volume (V) and hyperinflation (H), with respiratory rates at 30(R30) and 40(R40) bpm, in a random order. The mixed effects and a significance level at 0.05 were used for comparisons. RESULTS Resistance at 5Hz (R5), and at minus 20Hz (R5-R20), in kPa/L/s, were higher in subjects with bronchiectasis in all experimental conditions (p<0.05). For the bronchiectasis group, R5 and R5-20 increased with R increase at V (VRb versus VR30 and VR40; VR30 versus VR40; R5, R20 and R5-20 increased with R increase at H (HRb versus HR40; HR30 versus HR40). For the same R, there was a decrease with H compared to V (HRb versus VR30 and VR40; and HR30 versus VR30 and VR40). For the healthy group, only R20 showed differences (HR30 versus HR40; HR40 versus VR40). CONCLUSION The tachypnea increases the resistance and reactance of the respiratory system in bronchiectasis patients, and the voluntary hyperinflation caused attenuates this increase. These results can guide the development of strategies to reduce the limitation of physical activity in patients with bronchiectasis.
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Affiliation(s)
- Ricardo Grassi Moroli
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
| | - Daniele Oliveira Dos Santos
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
| | - Hugo Celso Dutra de Souza
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
| | - Larissa Perossi
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
| | - Maytê Assunção Ribeiro
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
| | - Jéssica Perossi
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
| | | | - Ada Clarice Gastaldi
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil.
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Urban MH, Mayr AK, Schmidt I, Margulies E, Grasmuk-Siegl E, Burghuber OC, Funk GC. Induction of dynamic hyperinflation by expiratory resistance breathing in healthy subjects - an efficacy and safety study. Exp Physiol 2020; 106:532-543. [PMID: 33174314 PMCID: PMC7894562 DOI: 10.1113/ep088439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 11/09/2020] [Indexed: 12/19/2022]
Abstract
New Findings What is the central question of this study? The study aimed to establish a novel model to study the chronic obstructive pulmonary disease (COPD)‐related cardiopulmonary effects of dynamic hyperinflation in healthy subjects. What is the main finding and its importance? A model of expiratory resistance breathing (ERB) was established in which dynamic hyperinflation was induced in healthy subjects, expressed both by lung volumes and intrathoracic pressures. ERB outperformed existing methods and represents an efficacious model to study cardiopulmonary mechanics of dynamic hyperinflation without potentially confounding factors as present in COPD.
Abstract Dynamic hyperinflation (DH) determines symptoms and prognosis of chronic obstructive pulmonary disease (COPD). The induction of DH is used to study cardiopulmonary mechanics in healthy subjects without COPD‐related confounders like inflammation, hypoxic vasoconstriction and rarefication of pulmonary vasculature. Metronome‐paced tachypnoea (MPT) has proven effective in inducing DH in healthy subjects, but does not account for airflow limitation. We aimed to establish a novel model incorporating airflow limitation by combining tachypnoea with an expiratory airway stenosis. We investigated this expiratory resistance breathing (ERB) model in 14 healthy subjects using different stenosis diameters to assess a dose–response relationship. Via cross‐over design, we compared ERB to MPT in a random sequence. DH was quantified by inspiratory capacity (IC, litres) and intrinsic positive end‐expiratory pressure (PEEPi, cmH2O). ERB induced a stepwise decreasing IC (means (95% CI): tidal breathing: 3.66 (3.45–3.88), ERB 3 mm: 3.33 (1.75–4.91), 2 mm: 2.05 (0.76–3.34), 1.5 mm: 0.73 (0.12–1.58) litres) and increasing PEEPi (tidal breathing: 0.70 (0.50–0.80), ERB 3 mm: 11.1 (7.0–15.2), 2 mm: 22.3 (17.1–27.6), 1.5 mm: 33.4 (3.40–63) cmH2O). All three MPT patterns increased PEEPi, but to a far lesser extent than ERB. No adverse events during ERB were noted. In conclusion, ERB was proven to be a safe and efficacious model for the induction of DH and might be used for the investigation of cardiopulmonary interaction in healthy subjects.
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Affiliation(s)
- Matthias Helmut Urban
- Department of Internal and Respiratory Medicine, Krankenhaus Nord - Klinik Floridsdorf, Vienna, Austria.,Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna, Austria.,Ludwig-Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Anna Katharina Mayr
- Department of Internal and Respiratory Medicine, Krankenhaus Nord - Klinik Floridsdorf, Vienna, Austria.,Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna, Austria
| | - Ingrid Schmidt
- Department of Internal and Respiratory Medicine, Krankenhaus Nord - Klinik Floridsdorf, Vienna, Austria
| | | | - Erwin Grasmuk-Siegl
- Department of Internal and Respiratory Medicine, Krankenhaus Nord - Klinik Floridsdorf, Vienna, Austria.,Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna, Austria
| | - Otto Chris Burghuber
- Ludwig-Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria.,Medical School, Sigmund Freud University, Vienna, Austria
| | - Georg-Christian Funk
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna, Austria.,Department of Internal and Respiratory Medicine, Wilhelminenspital, Vienna, Austria
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6
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Moroli RG, Santos DOD, Souza HCDD, Perossi L, Ribeiro MA, Perossi J, Baddini-Martinez JA, Gastaldi AC. Effects of Controlled Voluntary Increase in the Ventilatory Demand on Respiratory System Resistance in Healthy and Non-Cystic Fibrosis Bronchiectasis Subjects: A Cross-Sectional Study. Arch Bronconeumol 2020; 57:S0300-2896(20)30125-3. [PMID: 32593534 DOI: 10.1016/j.arbres.2020.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/11/2020] [Accepted: 04/08/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Bronchiectasis patients may present a reduced functional capacity due to an increase in the ventilatory demand during exercise. OBJECTIVE To evaluate the effects of controlled voluntary hyperinflation and increased respiratory rate on the mechanics of the respiratory system, simulating what happens during exercise, in bronchiectasis and healthy subjects. METHODS Bronchiectasis (n=30) and healthy (n=16) subjects were evaluated by impulse oscillometry (IOS) during a baseline condition, and in controlled conditions with baseline (b) tidal volume (V) and hyperinflation (H), with respiratory rates at 30(R30) and 40(R40) bpm, in a random order. The mixed effects and a significance level at 0.05 were used for comparisons. RESULTS Resistance at 5Hz (R5), and at minus 20Hz (R5-R20), in kPa/L/s, were higher in subjects with bronchiectasis in all experimental conditions (p<0.05). For the bronchiectasis group, R5 and R5-20 increased with R increase at V (VRb versus VR30 and VR40; VR30 versus VR40; R5, R20 and R5-20 increased with R increase at H (HRb versus HR40; HR30 versus HR40). For the same R, there was a decrease with H compared to V (HRb versus VR30 and VR40; and HR30 versus VR30 and VR40). For the healthy group, only R20 showed differences (HR30 versus HR40; HR40 versus VR40). CONCLUSION The tachypnea increases the resistance and reactance of the respiratory system in bronchiectasis patients, and the voluntary hyperinflation caused attenuates this increase. These results can guide the development of strategies to reduce the limitation of physical activity in patients with bronchiectasis.
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Affiliation(s)
- Ricardo Grassi Moroli
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
| | - Daniele Oliveira Dos Santos
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
| | - Hugo Celso Dutra de Souza
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
| | - Larissa Perossi
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
| | - Maytê Assunção Ribeiro
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
| | - Jéssica Perossi
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil
| | | | - Ada Clarice Gastaldi
- Department of Health Sciences, Graduate Program in Functional Performance, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil.
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King GG, Bates J, Berger KI, Calverley P, de Melo PL, Dellacà RL, Farré R, Hall GL, Ioan I, Irvin CG, Kaczka DW, Kaminsky DA, Kurosawa H, Lombardi E, Maksym GN, Marchal F, Oppenheimer BW, Simpson SJ, Thamrin C, van den Berge M, Oostveen E. Technical standards for respiratory oscillometry. Eur Respir J 2020; 55:13993003.00753-2019. [PMID: 31772002 DOI: 10.1183/13993003.00753-2019] [Citation(s) in RCA: 273] [Impact Index Per Article: 68.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 10/15/2019] [Indexed: 12/11/2022]
Abstract
Oscillometry (also known as the forced oscillation technique) measures the mechanical properties of the respiratory system (upper and intrathoracic airways, lung tissue and chest wall) during quiet tidal breathing, by the application of an oscillating pressure signal (input or forcing signal), most commonly at the mouth. With increased clinical and research use, it is critical that all technical details of the hardware design, signal processing and analyses, and testing protocols are transparent and clearly reported to allow standardisation, comparison and replication of clinical and research studies. Because of this need, an update of the 2003 European Respiratory Society (ERS) technical standards document was produced by an ERS task force of experts who are active in clinical oscillometry research.The aim of the task force was to provide technical recommendations regarding oscillometry measurement including hardware, software, testing protocols and quality control.The main changes in this update, compared with the 2003 ERS task force document are 1) new quality control procedures which reflect use of "within-breath" analysis, and methods of handling artefacts; 2) recommendation to disclose signal processing, quality control, artefact handling and breathing protocols (e.g. number and duration of acquisitions) in reports and publications to allow comparability and replication between devices and laboratories; 3) a summary review of new data to support threshold values for bronchodilator and bronchial challenge tests; and 4) updated list of predicted impedance values in adults and children.
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Affiliation(s)
- Gregory G King
- Dept of Respiratory Medicine and Airway Physiology and Imaging Group, Royal North Shore Hospital and The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Jason Bates
- Dept of Medicine, Pulmonary/Critical Care Division, University of Vermont, Larner College of Medicine, Burlington, VT, USA
| | - Kenneth I Berger
- Division of Pulmonary, Critical Care, and Sleep Medicine, NYU School of Medicine and André Cournand Pulmonary Physiology Laboratory, Belleuve Hospital, New York, NY, USA
| | - Peter Calverley
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Pedro L de Melo
- Institute of Biology and Faculty of Engineering, Department of Physiology, Biomedical Instrumentation Laboratory, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Raffaele L Dellacà
- Dipartimento di Elettronica, Informazione e Bioingegneria - DEIB, Politecnico di Milano University, Milano, Italy
| | - Ramon Farré
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona-IDIBAPS, Barcelona, Spain.,CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Graham L Hall
- Children's Lung Health, Telethon Kids Institute, School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Iulia Ioan
- Dept of Pediatric Lung Function Testing, Children's Hospital, Vandoeuvre-lès-Nancy, France.,EA 3450 DevAH - Laboratory of Physiology, Faculty of Medicine, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Charles G Irvin
- Dept of Medicine, Pulmonary/Critical Care Division, University of Vermont, Larner College of Medicine, Burlington, VT, USA
| | - David W Kaczka
- Depts of Anesthesia, Biomedical Engineering and Radiology, University of Iowa, Iowa City, IA, USA
| | - David A Kaminsky
- Dept of Medicine, Pulmonary/Critical Care Division, University of Vermont, Larner College of Medicine, Burlington, VT, USA
| | - Hajime Kurosawa
- Dept of Occupational Health, Tohoku University School of Medicine, Sendai, Japan
| | - Enrico Lombardi
- Pediatric Pulmonary Unit, Meyer Pediatric University Hospital, Florence, Italy
| | - Geoffrey N Maksym
- School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
| | - François Marchal
- Dept of Pediatric Lung Function Testing, Children's Hospital, Vandoeuvre-lès-Nancy, France.,EA 3450 DevAH - Laboratory of Physiology, Faculty of Medicine, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Beno W Oppenheimer
- Division of Pulmonary, Critical Care, and Sleep Medicine, NYU School of Medicine and André Cournand Pulmonary Physiology Laboratory, Belleuve Hospital, New York, NY, USA
| | - Shannon J Simpson
- Children's Lung Health, Telethon Kids Institute, School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Cindy Thamrin
- Dept of Respiratory Medicine and Airway Physiology and Imaging Group, Royal North Shore Hospital and The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Maarten van den Berge
- University of Groningen, University Medical Center Groningen, Dept of Pulmonary Diseases, Groningen, The Netherlands
| | - Ellie Oostveen
- Dept of Respiratory Medicine, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
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Fiorelli A, Poggi C, Ardò NP, Messina G, Andreetti C, Venuta F, Rendina EA, Santini M, Loizzi M, Serra N, Sollitto F, Loizzi D. Flow-Volume Curve Analysis for Predicting Recurrence After Endoscopic Dilation of Airway Stenosis. Ann Thorac Surg 2019; 108:203-210. [PMID: 30872098 DOI: 10.1016/j.athoracsur.2019.01.075] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/23/2018] [Accepted: 01/29/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The flow-volume curve is a simple test for diagnosing upper airway obstruction. We evaluated its use to predict recurrence in patients undergoing endoscopic dilation for treatment of benign upper airway stenosis. METHODS The data of 89 consecutive patients undergoing endoscopic dilation of simple upper airway stenosis were retrospectively reviewed. Morphologic distortion of flow-volume loop (visual analysis) and quantitative criteria, including maximal expiratory flow rate at 50% of the vital capacity (MEF50%)/maximal inspiratory flow rate at 50% of the vital capacity (MIF50%) of less than 0.3 or more than 1.0, forced expiratory volume in 1 second/MEF exceeding 10, and forced expiratory volume in 1 second/forced expiratory volume in .05 second exceeding 1.5, were considered predictive of recurrence. In all cases, the recurrence was confirmed by radiologic or bronchoscopic findings, or both. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of visual, quantitative, and aggregate criteria for detecting recurrence were computed and compared. RESULTS Of 89 patients treated, 27 (30%) had a recurrence. Visual analysis presented a sensitivity, specificity, PPV, NPV, and accuracy of 63%, 83.9%, 63%, 83.9%, and 77.5%, respectively. Among the quantitative criterion, the MEF50%/MIF50% was the most accurate, having a sensitivity, specificity, PPV, NPV, and accuracy of 77.8%, 79%, 61.8%, and 89.1%, and 78.7%, respectively. Aggregate criterion presented the best yield compared with other criteria in sensitivity (81.5%), specificity (91.9%), PPV (81.5%), NPV (91.9%), and accuracy (88.8%). CONCLUSIONS The flow-volume curve is a simple and noninvasive method to monitor patients undergoing endoscopic dilation of upper airway stenosis. Morphologic changes in the flow-volume loop and in the MEF50%/MIF50% ratio are suggestive of recurrence and guide the physician to implement the follow-up with further diagnostic (non)invasive examinations.
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Affiliation(s)
- Alfonso Fiorelli
- Thoracic Surgery Unit, University Campania "Luigi Vanvitelli," Naples, Italy.
| | - Camilla Poggi
- Thoracic Surgery Unit, University La Sapienza, Policlinico Hospital, Rome, Italy
| | | | - Gaetana Messina
- Thoracic Surgery Unit, University Campania "Luigi Vanvitelli," Naples, Italy
| | - Claudio Andreetti
- Thoracic Surgery Unit, University La Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Federico Venuta
- Thoracic Surgery Unit, University La Sapienza, Policlinico Hospital, Rome, Italy
| | - Erino Angelo Rendina
- Thoracic Surgery Unit, University La Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Mario Santini
- Thoracic Surgery Unit, University Campania "Luigi Vanvitelli," Naples, Italy
| | | | - Nicola Serra
- Statistic Unit, Department of Public Health, University of Federico II, Naples, Italy
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9
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Su ZQ, Guan WJ, Li SY, Ding M, Chen Y, Jiang M, Chen XB, Zhong CH, Tang CL, Zhong NS. Significances of spirometry and impulse oscillometry for detecting small airway disorders assessed with endobronchial optical coherence tomography in COPD. Int J Chron Obstruct Pulmon Dis 2018; 13:3031-3044. [PMID: 30319251 PMCID: PMC6171757 DOI: 10.2147/copd.s172639] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Spirometry confers limited value for identifying small-airway disorders (SADs) in early-stage COPD, which can be detected with impulse oscillometry (IOS) and endobronchial optical coherence tomography (EB-OCT). Whether IOS is useful for reflecting small-airway morphological abnormalities in COPD remains unclear. Objectives To compare the diagnostic value of spirometry and IOS for identifying SADs in heavy-smokers and COPD based on the objective assessment with EB-OCT. Methods We recruited 59 COPD patients (stage I, n=17; stage II, n=18; stage III-IV, n=24), 26 heavy-smokers and 21 never-smokers. Assessments of clinical characteristics, spirometry, IOS and EB-OCT were performed. Receiver operation characteristic curve was employed to demonstrate the diagnostic value of IOS and spirometric parameters. Results More advanced staging of COPD was associated with greater abnormality of IOS and spirometric parameters. Resonant frequency (Fres) and peripheral airway resistance (R5-R20) conferred greater diagnostic values than forced expiratory volume in one second (FEV1%) and maximal (mid-)expiratory flow (MMEF%) predicted in discriminating SADs in never-smokers from heavy-smokers (area under curve [AUC]: 0.771 and 0.753 vs 0.570 and 0.558, respectively), and heavy-smokers from patients with stage I COPD (AUC: 0.726 and 0.633 vs 0.548 and 0.567, respectively). The combination of IOS (Fres and R5-R20) and spirometric parameters (FEV1% and MMEF% predicted) contributed to a further increase in the diagnostic value for identifying SADs in early-stage COPD. Small airway wall area percentage (Aw% 7-9), an EB-OCT parameter, correlated significantly with Fres and R5-R20 in COPD and heavy-smokers, whereas EB-OCT parameters correlated with FEV1% and MMEF% in advanced, rather than early-stage, COPD. Conclusions IOS parameters correlated with the degree of morphologic abnormalities of small airways assessed with EB-OCT in COPD and heavy-smokers. Fres and R5-R20 might be sensitive parameters that reliably reflect SADs in heavy-smokers and early-stage COPD.
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Affiliation(s)
- Zhu-Quan Su
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China,
| | - Wei-Jie Guan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China,
| | - Shi-Yue Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China,
| | - Ming Ding
- Department of Respiratory Medicine, The Affiliated Zhongda Hospital of Southeast University, Medical School of Southeast University, Nanjing, People's Republic of China
| | - Yu Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China,
| | - Mei Jiang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China,
| | - Xiao-Bo Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China,
| | - Chang-Hao Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China,
| | - Chun-Li Tang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China,
| | - Nan-Shan Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China,
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Muñoz IC, Hernández AM, Ortega YM, Mañanas MÁ. Respiratory muscular response to obstructive maneuvers in non-invasively ventilated healthy subjects. Respir Physiol Neurobiol 2018; 258:76-81. [PMID: 29886247 DOI: 10.1016/j.resp.2018.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/27/2018] [Accepted: 06/05/2018] [Indexed: 10/14/2022]
Abstract
The hypothesis of this study is that muscular activity measured through surface electromyography (sEMG) is useful to estimate the work of breathing (WOB) and respiratory mechanics. Thirty-two healthy volunteers were non-invasively ventilated, and an airflow resistor was attached to the airway circuit. sEMG signals from diaphragm, intercostal and sternocleidomastoid muscles were processed and compared with WOB changes. The airway resistance was increased from a median of 9.58 to 22.51 cmH2O/L/s adding a resistance of 20 cmH2O/L/s, achieving the lower compliance too. The respiratory mechanics changes implied linear increases in WOB, with Pearson correlation of 88.43% respect to changes in resistance. Muscles increased their activity in agreement with changes of WOB, being higher the increment in diaphragm followed by sternocleidomastoid. The non-invasively monitored respiratory muscles activity allowed evaluating the changes in WOB when it depends on addition of obstructive loads, confirming that it could be used to improve the available respiratory mechanics and WOB monitoring tools.
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Affiliation(s)
- Isabel Cristina Muñoz
- Bioinstrumentation and Clinical Engineering Research Group, Bioengineering Department, Engineering Faculty, Universidad de Antioquia, Calle 70 # 52-21, Medellín, Colombia
| | - Alher Mauricio Hernández
- Bioinstrumentation and Clinical Engineering Research Group, Bioengineering Department, Engineering Faculty, Universidad de Antioquia, Calle 70 # 52-21, Medellín, Colombia.
| | - Yessika María Ortega
- Bioinstrumentation and Clinical Engineering Research Group, Bioengineering Department, Engineering Faculty, Universidad de Antioquia, Calle 70 # 52-21, Medellín, Colombia
| | - Miguel Ángel Mañanas
- Department of Automatic Control and the Biomedical Engineering Research Centre of the Universitat Politècnica de Catalunya, Calle Jordi Girona 31, 08034, Barcelona, Spain
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11
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Liu L, Liu W, Liu C, Wang D, Zhao J, Wang J, Wu J, Liu T, Zhang Y, Liu Y, Cao L, Dong L. Study on small airway function in asthmatics with fractional exhaled nitric oxide and impulse oscillometry. CLINICAL RESPIRATORY JOURNAL 2016; 12:483-490. [PMID: 27606596 DOI: 10.1111/crj.12548] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 07/08/2016] [Accepted: 08/30/2016] [Indexed: 01/12/2023]
Abstract
OBJECTIVES The invasive techniques can be direct and objective to assess small airway function, but they have significant risks and inconveniences for patients and cannot be repeated often. Some sophisticated techniques such as fractional exhaled nitric oxide (FeNO) and impulse oscillometry (IOS) may surmount such restrictions. Therefore, we investigated the relation among FeNO, IOS, and small airway function in asthmatic patients. METHODS We recruited 140 asthmatic patients including 69 patients with small airway normal function and 71 patients with small airway dysfunction. FeNO, eosinophil(EOS)count and total immunoglobulin E (IgE) in peripheral blood, pulmonary function, as well as IOS were measured. RESULTS The levels of FeNO, the reactance area (AX), the resonant frequency Fres and EOS were significantly increased in small airway dysfunction group compared with small airway normal function group (P < 0.01 respectively). A multiple regression model showed that FeNO, AX and Fres were correlative factors of mid forced expiratory flow of percentages of predicted values [FEF25-75 (%pred)] (P < 0.01, respectively). A receiver operating characteristic (ROC) analysis showed that the combination of FeNO, AX and Fres had a greater area under the ROC curve (AUC) than each of them (AUC: 0.881, P < .001, 95%CI: 0.815-0.929). CONCLUSION FeNO and IOS are helpful in diagnosis of small airway dysfunction with high sensitivity and specificity, and FeNO combined with IOS can better evaluate the small airway function in asthmatic patients.
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Affiliation(s)
- Lin Liu
- Department of Pulmonary Medicine, Qilu Hospital of Shandong University, Jinan, 250012, P.R. China
| | - Wen Liu
- Department of Pulmonary Medicine, Qilu Hospital of Shandong University, Jinan, 250012, P.R. China.,Department of Cadre Health Care, The Second Hospital of Shandong University, Jinan, 250033, P.R. China
| | - Chunhong Liu
- Department of Pulmonary Medicine, Qilu Hospital of Shandong University, Jinan, 250012, P.R. China
| | - Dexiang Wang
- Department of Pulmonary Medicine, Qilu Hospital of Shandong University, Jinan, 250012, P.R. China
| | - Jiping Zhao
- Department of Pulmonary Medicine, Qilu Hospital of Shandong University, Jinan, 250012, P.R. China
| | - Junfei Wang
- Department of Pulmonary Medicine, Qilu Hospital of Shandong University, Jinan, 250012, P.R. China
| | - Jinxiang Wu
- Department of Pulmonary Medicine, Qilu Hospital of Shandong University, Jinan, 250012, P.R. China
| | - Tian Liu
- Department of Pulmonary Medicine, Qilu Hospital of Shandong University, Jinan, 250012, P.R. China
| | - Yuanyuan Zhang
- Department of Pulmonary Medicine, Qilu Hospital of Shandong University, Jinan, 250012, P.R. China
| | - Yahui Liu
- Department of Pulmonary Medicine, Qilu Hospital of Shandong University, Jinan, 250012, P.R. China
| | - Liuzhao Cao
- Department of Pulmonary Medicine, Qilu Hospital of Shandong University, Jinan, 250012, P.R. China
| | - Liang Dong
- Department of Pulmonary Medicine, Qilu Hospital of Shandong University, Jinan, 250012, P.R. China
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12
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Ding Y, Yang D, He P, Yao J, Sun P, Li Q, Xie P, Lin D, Sun D, Niu H, Tian Z. Prevalence and risk factors of chronic obstructive pulmonary diseases in a Hlai community in Hainan Island of China. CLINICAL RESPIRATORY JOURNAL 2016; 12:126-133. [PMID: 27216214 DOI: 10.1111/crj.12497] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 04/30/2016] [Accepted: 05/13/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Yipeng Ding
- Department of Emergency; People's Hospital of Hainan Province; Haikou Hainan People's Republic of China
| | - Danlei Yang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital; Tongji Medical College, Huazhong University of Science and Technology; Wuhan Hubei People's Republic of China
| | - Ping He
- Department of Emergency; People's Hospital of Hainan Province; Haikou Hainan People's Republic of China
| | - Jinjian Yao
- Department of Emergency; People's Hospital of Hainan Province; Haikou Hainan People's Republic of China
| | - Pei Sun
- Department of Emergency; People's Hospital of Hainan Province; Haikou Hainan People's Republic of China
| | - Quanni Li
- Department of Emergency; People's Hospital of Hainan Province; Haikou Hainan People's Republic of China
| | - Pingdong Xie
- Department of Emergency; People's Hospital of Hainan Province; Haikou Hainan People's Republic of China
| | - Daobo Lin
- Department of Emergency; People's Hospital of Hainan Province; Haikou Hainan People's Republic of China
| | - Dingwei Sun
- Department of Emergency; People's Hospital of Hainan Province; Haikou Hainan People's Republic of China
| | - Huan Niu
- Department of Emergency; People's Hospital of Hainan Province; Haikou Hainan People's Republic of China
| | - Zhongjie Tian
- Department of Emergency; People's Hospital of Hainan Province; Haikou Hainan People's Republic of China
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13
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Grainge C, Thomas PS, Mak JCW, Benton MJ, Lim TK, Ko FWS. Year in review 2015: Asthma and chronic obstructive pulmonary disease. Respirology 2016; 21:765-75. [PMID: 27028730 DOI: 10.1111/resp.12771] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 02/15/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Chris Grainge
- School of Medicine and Public Health, Centre for Asthma and Respiratory Disease, The University of Newcastle.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle
| | - Paul S Thomas
- Inflammation and Infection Research Centre and Prince of Wales' Hospital Clinical School, Faculty of Medicine, University of New South Wales, Kensington.,Department of Respiratory Medicine, Prince of Wales' Hospital, Randwick, New South Wales, Australia
| | - Judith C W Mak
- Department of Medicine and Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China
| | - Melissa J Benton
- Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences, University of Colorado Colorado Springs, Colorado, USA
| | - Tow Keang Lim
- Department of Medicine, National University Hospital, Singapore
| | - Fanny W S Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
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14
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Abstract
The forced oscillation technique (FOT) is a noninvasive method with which to measure respiratory system resistance and reactance during tidal breathing. Recently, its clinical application has spread worldwide with the expansion of commercially available broadband frequency FOT devices, including MostGraph and Impulse Oscillometry. An increasing number of reports have supported the usefulness of the FOT in the management of asthma and chronic obstructive pulmonary disease (COPD). However, the FOT is not a surrogate test for spirometry, but should be used complementarily. Furthermore, reference values are not necessarily available and the interpretation of some measured data is controversial. There is a need to update the international statement for not only technical aspects but also the clinical use of the FOT. In this review, we summarize the previously published studies and discuss how to use the FOT in a clinical setting.
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Affiliation(s)
- Toshihiro Shirai
- Department of Respiratory Medicine, Shizuoka General Hospital, Japan
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15
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Ishikawa N, Hattori N, Kohno N, Kobayashi A, Hayamizu T, Johnson M. Airway inflammation in Japanese COPD patients compared with smoking and nonsmoking controls. Int J Chron Obstruct Pulmon Dis 2015; 10:185-92. [PMID: 25670894 PMCID: PMC4315175 DOI: 10.2147/copd.s74557] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE To assess the importance of inflammation in chronic obstructive pulmonary disease (COPD) by measuring airway and systemic inflammatory biomarkers in Japanese patients with the disease and relevant control groups. PATIENTS AND METHODS This was the first study of its type in Japanese COPD patients. It was a non-treatment study in which 100 participants were enrolled into one of three groups: nonsmoking controls, current or ex-smoking controls, and COPD patients. All participants underwent standard lung function assessments and provided sputum and blood samples from which the numbers of inflammatory cells and concentrations of biomarkers were measured, using standard procedures. RESULTS The overall trends observed in levels of inflammatory cells and biomarkers in sputum and blood in COPD were consistent with previous reports in Western studies. Increasing levels of neutrophils, interleukin 8 (IL-8), surfactant protein D (SP-D), and Krebs von den Lungen 6 (KL-6) in sputum and clara cell 16 (CC-16), high-sensitivity C-reactive protein (hs-CRP), and KL-6 in serum and plasma fibrinogen were seen in the Japanese COPD patients compared with the non-COPD control participants. In sputum, significant correlations were seen between total cell count and matrix metalloproteinase 9 (MMP-9; P<0.001), neutrophils and MMP-9 (P<0.001), macrophages and KL-6 (P<0.01), total cell count and IL-8 (P<0.05), neutrophils and IL-8 (P<0.05), and macrophages and MMP-9 (P<0.05). Significant correlations were also observed between some inflammatory cells in sputum and biomarkers in serum, with the most significant between serum CC-16 and both total cell count (P<0.005) and neutrophils (P<0.005) in sputum. CONCLUSION These results provide evidence for the first time that COPD in Japanese patients is a multicomponent disease, involving both airway and systemic inflammation, in addition to airway obstruction. Therefore, intervention with anti-inflammatory therapy may provide additional benefit in disease management of COPD in Japan.
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Affiliation(s)
- Nobuhisa Ishikawa
- Department of Respiratory Medicine, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Noboru Hattori
- Department of Molecular and Internal Medicine, Hiroshima University, Hiroshima, Japan
| | - Nobuoki Kohno
- Department of Molecular and Internal Medicine, Hiroshima University, Hiroshima, Japan
| | - Akihiro Kobayashi
- Biomedical Data Science Department, GlaxoSmithKline Shibuya-ku, Tokyo, Japan
| | - Tomoyuki Hayamizu
- Medical Affairs Respiratory Department, GlaxoSmithKline Shibuya-ku, Tokyo, Japan
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