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Sharpe AL, Reibman J, Oppenheimer BW, Goldring RM, Liu M, Shao Y, Bohart I, Kwok B, Weinstein T, Addrizzo-Harris D, Sterman DH, Berger KI. Role of small airway dysfunction in unexplained exertional dyspnoea. ERJ Open Res 2023; 9:00603-2022. [PMID: 37284422 PMCID: PMC10240305 DOI: 10.1183/23120541.00603-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/01/2023] [Indexed: 06/08/2023] Open
Abstract
Background Isolated small airway abnormalities may be demonstrable at rest in patients with normal spirometry; however, the relationship of these abnormalities to exertional symptoms remains uncertain. This study uses an augmented cardiopulmonary exercise test (CPET) to include evaluation of small airway function during and following exercise to unmask abnormalities not evident with standard testing in individuals with dyspnoea and normal spirometry. Methods Three groups of subjects were studied: 1) World Trade Center (WTC) dust exposure (n=20); 2) Clinical Referral (n=15); and Control (n=13). Baseline evaluation included respiratory oscillometry. Airway function during an incremental workload CPET was assessed by: 1) tidal flow versus volume curves during exercise to assess for dynamic hyperinflation and expiratory flow limitation; and 2) post-exercise spirometry and oscillometry to evaluate for airway hyperreactivity. Results All subjects demonstrated normal baseline forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC). Dyspnoea was reproduced during CPET in WTC and Clinical Referral groups versus Control without abnormality in respiratory pattern and minute ventilation. Tidal flow-volume curves uncovered expiratory flow limitation and/or dynamic hyperinflation with increased prevalence in WTC and Clinical Referral versus Control (55%, 87% versus 15%; p<0.001). Post-exercise oscillometry uncovered small airway hyperreactivity with increased prevalence in WTC and Clinical Referral versus Control (40%, 47% versus 0%, p<0.05). Conclusions We uncovered mechanisms for exertional dyspnoea in subject with normal spirometry that was attributable to either small airway dysfunction during exercise and/or small airway hyperreactivity following exercise. The similarity of findings in WTC environmentally exposed and clinically referred cohorts suggests broad relevance for these evaluations.
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Affiliation(s)
- Alexis L. Sharpe
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
- André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA
| | - Joan Reibman
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Beno W. Oppenheimer
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
- André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA
| | - Roberta M. Goldring
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
- André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA
| | - Mengling Liu
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Yongzhao Shao
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Isaac Bohart
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
- André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA
| | - Benjamin Kwok
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
- André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA
| | - Tatiana Weinstein
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
- André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA
| | - Doreen Addrizzo-Harris
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Daniel H. Sterman
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Kenneth I. Berger
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
- André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA
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Viegas P, Ageno E, Corsi G, Tagariello F, Razakamanantsoa L, Vilde R, Ribeiro C, Heunks L, Patout M, Fisser C. Highlights from the Respiratory Failure and Mechanical Ventilation 2022 Conference. ERJ Open Res 2023; 9:00467-2022. [PMID: 36949961 PMCID: PMC10026011 DOI: 10.1183/23120541.00467-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/10/2022] [Indexed: 11/25/2022] Open
Abstract
The Respiratory Intensive Care Assembly of the European Respiratory Society gathered in Berlin to organise the second Respiratory Failure and Mechanical Ventilation Conference in June 2022. The conference covered several key points of acute and chronic respiratory failure in adults. During the 3-day conference, ventilatory strategies, patient selection, diagnostic approaches, treatment and health-related quality of life topics were addressed by a panel of international experts. Lectures delivered during the event have been summarised by Early Career Members of the Assembly and take-home messages highlighted.
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Affiliation(s)
- Pedro Viegas
- Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Elisa Ageno
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi, Bologna, Italy
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Gabriele Corsi
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi, Bologna, Italy
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Federico Tagariello
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi, Bologna, Italy
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Léa Razakamanantsoa
- Unité Ambulatoire d'Appareillage Respiratoire de Domicile (UAARD), Service de Pneumologie (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Paris, France
| | - Rudolfs Vilde
- Centre of Pulmonology and Thoracic Surgery, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
- Riga Stradiņš University, Riga, Latvia
| | - Carla Ribeiro
- Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Leo Heunks
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maxime Patout
- Service des Pathologies du Sommeil (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Christoph Fisser
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
- Corresponding author: Christoph Fisser ()
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3
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Ghilain A, Marchand E. [The forced oscillation technique in the functional evaluation of COPD dyspnea]. Rev Mal Respir 2022; 39:659-668. [PMID: 36041937 DOI: 10.1016/j.rmr.2022.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/08/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION The goal of the present study is to assess the relationship between functional respiratory parameters measured by the forced oscillation technique (FOT) in COPD patients and (1) dyspnea; (2) inspiratory capacity (IC), along with the variations occurring subsequent to bronchodilation. METHODS This cross-sectional study analyzed 40 stable COPD patients. Dyspnea was assessed by means of the San Diego Shortness of Breath Questionnaire. Forced oscillations were measured before and after bronchodilation by means of routine pulmonary function tests (PFTs). RESULTS The reactance parameters measured by the FOT correlated with dyspnea (AX5: r=0.46; P=0.003) similarly to IC (r=-0.46; P=0.003). Changes in AX5 following bronchodilation led to a predicted 12% and 200mL improvement in IC, AX5 (area under the ROC curve=0.85, P<0.001). CONCLUSIONS Forced oscillation technique (FOT) appears to be an interesting complement to routine PFTs in COPD assessment. Reactance parameters are correlated with dyspnea and their response to bronchodilators is a predictor of significantly improved inspiratory capacity (IC). All in all, FOT may be considered as a functional test with regard to pulmonary hyperinflation, a critical determinant of dyspnea.
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Affiliation(s)
- Arnaud Ghilain
- Service de pneumologie, CHU UCL Namur - Site Godinne, 5530 Yvoir, Belgique
| | - Eric Marchand
- Service de pneumologie, CHU UCL Namur - Site Godinne, 5530 Yvoir, Belgique; Institut de Recherche Expérimentale et Clinique (IREC), UCLouvain, Belgique; NAmur Research Institute for LIfe Sciences (NARILIS) et Unité de recherche en physiologie moléculaire (URPhyM), UNamur, 5000 Namur, Belgique.
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4
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Hawthorne G, Richardson M, Greening NJ, Esliger D, Briggs-Price S, Chaplin EJ, Clinch L, Steiner MC, Singh SJ, Orme MW. A proof of concept for continuous, non-invasive, free-living vital signs monitoring to predict readmission following an acute exacerbation of COPD: a prospective cohort study. Respir Res 2022; 23:102. [PMID: 35473718 PMCID: PMC9044843 DOI: 10.1186/s12931-022-02018-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background The use of vital signs monitoring in the early recognition of an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) post-hospital discharge is limited. This study investigated whether continuous vital signs monitoring could predict an AECOPD and readmission. Methods 35 people were recruited at discharge following hospitalisation for an AECOPD. Participants were asked to wear an Equivital LifeMonitor during waking hours for 6 weeks and to complete the Exacerbations of Chronic Pulmonary Disease Tool (EXACT), a 14-item symptom diary, daily. The Equivital LifeMonitor recorded respiratory rate (RR), heart rate (HR), skin temperature (ST) and physical activity (PA) every 15-s. An AECOPD was classified as mild (by EXACT score), moderate (prescribed oral steroids/antibiotics) or severe (hospitalisation). Results Over the 6-week period, 31 participants provided vital signs and symptom data and 14 participants experienced an exacerbation, of which, 11 had sufficient data to predict an AECOPD. HR and PA were associated with EXACT score (p < 0.001). Three days prior to an exacerbation, RR increased by mean ± SD 2.0 ± 0.2 breaths/min for seven out of 11 exacerbations and HR increased by 8.1 ± 0.7 bpm for nine of these 11 exacerbations. Conclusions Increased heart rate and reduced physical activity were associated with worsening symptoms. Even with high-resolution data, the variation in vital signs data remains a challenge for predicting AECOPDs. Respiratory rate and heart rate should be further explored as potential predictors of an impending AECOPD. Trial registration: ISRCTN registry; ISRCTN12855961. Registered 07 November 2018—Retrospectively registered, https://www.isrctn.com/ISRCTN12855961 Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02018-5.
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Affiliation(s)
- Grace Hawthorne
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.
| | - Matthew Richardson
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Neil J Greening
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Dale Esliger
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Samuel Briggs-Price
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Emma J Chaplin
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Lisa Clinch
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Michael C Steiner
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Sally J Singh
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Mark W Orme
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,Department of Respiratory Sciences, University of Leicester, Leicester, UK
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5
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Kaminsky DA, Simpson SJ, Berger KI, Calverley P, de Melo PL, Dandurand R, Dellacà RL, Farah CS, Farré R, Hall GL, Ioan I, Irvin CG, Kaczka DW, King GG, Kurosawa H, Lombardi E, Maksym GN, Marchal F, Oostveen E, Oppenheimer BW, Robinson PD, van den Berge M, Thamrin C. Clinical significance and applications of oscillometry. Eur Respir Rev 2022; 31:31/163/210208. [PMID: 35140105 PMCID: PMC9488764 DOI: 10.1183/16000617.0208-2021] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/29/2021] [Indexed: 12/28/2022] Open
Abstract
Recently, “Technical standards for respiratory oscillometry” was published, which reviewed the physiological basis of oscillometric measures and detailed the technical factors related to equipment and test performance, quality assurance and reporting of results. Here we present a review of the clinical significance and applications of oscillometry. We briefly review the physiological principles of oscillometry and the basics of oscillometry interpretation, and then describe what is currently known about oscillometry in its role as a sensitive measure of airway resistance, bronchodilator responsiveness and bronchial challenge testing, and response to medical therapy, particularly in asthma and COPD. The technique may have unique advantages in situations where spirometry and other lung function tests are not suitable, such as in infants, neuromuscular disease, sleep apnoea and critical care. Other potential applications include detection of bronchiolitis obliterans, vocal cord dysfunction and the effects of environmental exposures. However, despite great promise as a useful clinical tool, we identify a number of areas in which more evidence of clinical utility is needed before oscillometry becomes routinely used for diagnosing or monitoring respiratory disease. This paper provides a current review of the interpretation, clinical significance and application of oscillometry in respiratory medicine, with special emphasis on limitations of evidence and suggestions for future research.https://bit.ly/3GQPViA
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Affiliation(s)
- David A Kaminsky
- Dept of Medicine, Pulmonary and Critical Care Medicine, University of Vermont, Larner College of Medicine, Burlington, VT, USA.,These authors have contributed equally to this manuscript
| | - Shannon J Simpson
- Children's Lung Health, Telethon Kids Institute, School of Allied Health, Curtin University, Perth, Australia.,These authors have contributed equally to this manuscript
| | - 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
- Dept of Physiology, Biomedical Instrumentation Laboratory, Institute of Biology and Faculty of Engineering, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ronald Dandurand
- Lakeshore General Hospital, Pointe-Claire, QC, Canada.,Montreal Chest Institute, Meakins-Christie Labs, Oscillometry Unit of the Centre for Innovative Medicine, McGill University Health Centre and Research Institute, and McGill University, Montreal, QC, Canada
| | - Raffaele L Dellacà
- Dipartimento di Elettronica, Informazione e Bioingegneria - DEIB, Politecnico di Milano University, Milan, Italy
| | - Claude S Farah
- Dept of Respiratory Medicine, Concord Repatriation General Hospital, Sydney, Australia
| | - 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 Allied Health, Curtin University, Perth, Australia
| | - Iulia Ioan
- Dept of Paediatric 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 and Critical Care Medicine, University of Vermont, Larner College of Medicine, Burlington, VT, USA
| | - David W Kaczka
- Depts of Anaesthesia, Biomedical Engineering and Radiology, University of Iowa, Iowa City, IA, USA
| | - Gregory G King
- Dept of Respiratory Medicine and Airway Physiology and Imaging Group, Royal North Shore Hospital, St Leonards, Australia.,Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Hajime Kurosawa
- Dept of Occupational Health, Tohoku University School of Medicine, Sendai, Japan
| | - Enrico Lombardi
- Paediatric Pulmonary Unit, Meyer Paediatric University Hospital, Florence, Italy
| | - Geoffrey N Maksym
- School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
| | - François Marchal
- Dept of Paediatric 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
| | - Ellie Oostveen
- Dept of Respiratory Medicine, Antwerp University Hospital and University of Antwerp, Belgium
| | - 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
| | - Paul D Robinson
- Woolcock Institute of Medical Research, Children's Hospital at Westmead, Sydney, Australia
| | - Maarten van den Berge
- Dept of Pulmonary Diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Cindy Thamrin
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
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Alqahtani JS, Al Rajeh AM, Aldhahir AM, Aldabayan YS, Hurst JR, Mandal S. The clinical utility of forced oscillation technique during hospitalisation in patients with exacerbation of COPD. ERJ Open Res 2021; 7:00448-2021. [PMID: 34938802 PMCID: PMC8685513 DOI: 10.1183/23120541.00448-2021] [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: 07/05/2021] [Accepted: 10/16/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Forced Oscillation Technique (FOT) is an innovative tool to measure within-breath reactance at 5 Hz (ΔXrs5Hz) but its feasibility and utility in acute exacerbations of COPD (AECOPD) is understudied. METHODS A prospective observational study was conducted in 82 COPD patients admitted due to AECOPD. FOT indices were measured and the association between these indices and spirometry, peak inspiratory flow rate, blood inflammatory biomarkers and patient-reported outcomes including assessment of dyspnoea, quality of life, anxiety and depression and frailty at admission and discharge were explored. RESULTS All patients were able to perform FOT in both sitting and supine position. The prevalence of expiratory flow limitation (EFL) in the upright position was 39% (32 out of 82) and increased to 50% (41 out of 82) in the supine position. EFL (measured by ΔXrs5Hz) and resistance at 5 Hz (Rrs5Hz) negatively correlated with forced expiratory volume in 1 s (FEV1); those with EFL had lower FEV1 (0.74±0.30 versus 0.94±0.36 L, p = 0.01) and forced vital capacity (1.7±0.55 versus 2.1±0.63 L, p = 0.009) and higher body mass index (27 (21-36) versus 23 (19-26) kg·m-2, p = 0.03) compared to those without EFL. During recovery from AECOPD, changes in EFL were observed in association with improvement in breathlessness. CONCLUSION FOT was easily used to detect EFL during hospitalisation due to AECOPD. The prevalence of EFL increased when patients moved from a seated to a supine position and EFL was negatively correlated with airflow limitation. Improvements in EFL were associated with a reduction in breathlessness. FOT is of potential clinical value by providing a noninvasive, objective and effort-independent technique to measure lung function parameters during AECOPD requiring hospital admission.
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Affiliation(s)
- Jaber S. Alqahtani
- UCL Respiratory, University College London, London, UK
- Dept of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Ahmad M. Al Rajeh
- Respiratory Care Dept, College of Applied Medical Sciences, King Faisal University, Al-Hasa, Saudi Arabia
| | - Abdulelah M. Aldhahir
- Respiratory Care Dept, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Yousef S. Aldabayan
- Respiratory Care Dept, College of Applied Medical Sciences, King Faisal University, Al-Hasa, Saudi Arabia
| | - John R. Hurst
- UCL Respiratory, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
- These authors contributed equally
| | - Swapna Mandal
- UCL Respiratory, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
- These authors contributed equally
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Kamal F, Kumar S, Edwards MR, Veselkov K, Belluomo I, Kebadze T, Romano A, Trujillo-Torralbo MB, Shahridan Faiez T, Walton R, Ritchie AI, Wiseman DJ, Laponogov I, Donaldson G, Wedzicha JA, Johnston SL, Singanayagam A, Hanna GB. Virus-induced Volatile Organic Compounds are Detectable in Exhaled Breath During Pulmonary Infection. Am J Respir Crit Care Med 2021; 204:1075-1085. [PMID: 34319857 DOI: 10.1164/rccm.202103-0660oc] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a condition punctuated by acute exacerbations commonly triggered by viral and/or bacterial infection. Early identification of exacerbation trigger is important to guide appropriate therapy but currently available tests are slow and imprecise. Volatile organic compounds (VOCs) can be detected in exhaled breath and have the potential to be rapid tissue-specific biomarkers of infection aetiology. METHODS We used serial sampling within in vitro and in vivo studies to elucidate the dynamic changes that occur in VOC production during acute respiratory viral infection. Highly sensitive gas-chromatography mass spectrometry (GC-MS) techniques were used to measure VOC production from infected airway epithelial cell cultures and in exhaled breath samples of healthy subjects experimentally challenged with rhinovirus A16 and COPD subjects with naturally-occurring exacerbations. RESULTS We identified a novel VOC signature comprising of decane and other related long chain alkane compounds that is induced during rhinovirus infection of cultured airway epithelial cells and is also increased in the exhaled breath of healthy subjects experimentally challenged with rhinovirus and of COPD patients during naturally-occurring viral exacerbations. These compounds correlated with magnitude of anti-viral immune responses, virus burden and exacerbation severity but were not induced by bacterial infection, suggesting they represent a specific virus-inducible signature. CONCLUSION Our study highlights the potential for measurement of exhaled breath VOCs as rapid, non-invasive biomarkers of viral infection. Further studies are needed to determine whether measurement of these signatures could be used to guide more targeted therapy with antibiotic/antiviral agents for COPD exacerbations.
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Affiliation(s)
- Faisal Kamal
- Imperial College London, 4615, London, United Kingdom of Great Britain and Northern Ireland
| | - Sacheen Kumar
- Imperial College, London, Airway Disease Infection Section, National Heart and Lung Institute, London, United Kingdom of Great Britain and Northern Ireland
| | - Michael R Edwards
- Imperial College London, Airway Disease Infection, London, United Kingdom of Great Britain and Northern Ireland
| | - Kirill Veselkov
- Imperial College, London, Airway Disease Infection Section, National Heart and Lung Institute, London, United Kingdom of Great Britain and Northern Ireland
| | - Ilaria Belluomo
- Imperial College, London, Airway Disease Infection Section, National Heart and Lung Institute, London, United Kingdom of Great Britain and Northern Ireland
| | - Tatiana Kebadze
- National Heart & Lung and Wright Felming Institute of Infection & Immunity, Respiratory Medicine, London, United Kingdom of Great Britain and Northern Ireland
| | - Andrea Romano
- Imperial College London, 4615, London, United Kingdom of Great Britain and Northern Ireland
| | - Maria-Belen Trujillo-Torralbo
- Imperial College London, National Heart and Lung Institute, London, United Kingdom of Great Britain and Northern Ireland
| | - Tasnim Shahridan Faiez
- Imperial College London, 4615, London, United Kingdom of Great Britain and Northern Ireland
| | - Ross Walton
- Imperial College London, 4615, London, United Kingdom of Great Britain and Northern Ireland
| | - Andrew I Ritchie
- Imperial College London, Airway Disease Infection, London, United Kingdom of Great Britain and Northern Ireland
| | - Dexter J Wiseman
- Imperial College London, Airway Diseases Section, London, United Kingdom of Great Britain and Northern Ireland
| | - Ivan Laponogov
- Imperial College London, 4615, London, United Kingdom of Great Britain and Northern Ireland
| | - Gavin Donaldson
- Imperial College London, Airways Disease Section, London, United Kingdom of Great Britain and Northern Ireland
| | - Jadwiga A Wedzicha
- Imperial College London, National Heart and Lung Institute, London, United Kingdom of Great Britain and Northern Ireland
| | - Sebastian L Johnston
- National Heart & Lung and Wright Felming Institute of Infection & Immunity, Respiratory Medicine, London, United Kingdom of Great Britain and Northern Ireland
| | - Aran Singanayagam
- Imperial College, London, London, United Kingdom of Great Britain and Northern Ireland
| | - George B Hanna
- Imperial College London, 4615, London, United Kingdom of Great Britain and Northern Ireland;
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8
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D'Cruz RF, Suh ES, Kaltsakas G, Dewar A, Shah NM, Priori R, Douiri A, Rose L, Hart N, Murphy PB. Home parasternal electromyography tracks patient-reported and physiological measures of recovery from severe COPD exacerbation. ERJ Open Res 2021; 7:00709-2020. [PMID: 33937390 PMCID: PMC8071974 DOI: 10.1183/23120541.00709-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/15/2021] [Indexed: 11/11/2022] Open
Abstract
Exacerbations of COPD remain a leading cause of emergency hospitalisations worldwide, and up to 28% of patients are readmitted within 30 days of discharge [1]. Recent analyses of more than 2.3 million COPD hospitalisations highlight the dynamic and time-dependent nature of readmission risk, which peaks within the first 72 h of discharge [2, 3]. Effective readmission prevention strategies remain elusive and recognition of re-exacerbations beyond daily symptom variability is challenging for both patients and clinicians. Promotion of transitional care services and 30-day readmission penalties implemented by policymakers worldwide have had limited impact [4]. Telemonitoring strategies incorporating symptom and vital observation monitoring (peripheral oxygen saturation (SpO2), heart rate, respiratory frequency) have consistently failed to demonstrate beneficial effects on hospitalisation risk [5]. Objective physiological monitoring has been explored using the forced oscillation technique. However, this also failed to prolong time to first hospitalisation [6]. Physiological phenotyping using daily home-based assessments reveals early improvement in load–capacity–drive imbalance following #AECOPD and feasibility of home parasternal electromyography measurement, which tracks symptoms, health status and spirometryhttps://bit.ly/3o6I0Ty
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Affiliation(s)
- Rebecca Francesca D'Cruz
- Lane Fox Clinical Respiratory Physiology Research Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Eui-Sik Suh
- Lane Fox Clinical Respiratory Physiology Research Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Georgios Kaltsakas
- Lane Fox Clinical Respiratory Physiology Research Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Amy Dewar
- Dept of Respiratory Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Neeraj Mukesh Shah
- Lane Fox Clinical Respiratory Physiology Research Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Rita Priori
- Philips Research, Eindhoven, The Netherlands
| | - Abdel Douiri
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Louise Rose
- Lane Fox Clinical Respiratory Physiology Research Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Nicholas Hart
- Lane Fox Clinical Respiratory Physiology Research Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Patrick Brian Murphy
- Lane Fox Clinical Respiratory Physiology Research Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences, King's College London, London, UK
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9
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Avdeev SN, Nuralieva GS, Soe AK, Gainitdinova VV, Fink JB. Comparison of Vibrating Mesh and Jet Nebulizers During Noninvasive Ventilation in Acute Exacerbation of Chronic Obstructive Pulmonary Disease. J Aerosol Med Pulm Drug Deliv 2021; 34:358-365. [PMID: 33848441 DOI: 10.1089/jamp.2020.1665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Advances in aerosol technology have improved drug delivery efficiency during noninvasive ventilation (NIV). Clinical evaluation of the efficacy of aerosol therapy during NIV in the treatment of acute exacerbation of chronic obstructive pulmonary disease (COPD) is very limited. The aim of our study was to compare the efficacy of bronchodilators administered through a vibrating mesh nebulizer (VMN) and jet nebulizer (JN) during NIV in patients with acute exacerbation of COPD. Methods: Prospective randomized cross-over study included 30 patients treated with NIV for acute exacerbation of COPD in an acute care hospital. Patients were consented and enrolled after stabilization of acute exacerbation (3-5 days after admission). Subjects were randomly assigned into two treatment arms receiving salbutamol (2.5 mg): with VMN (Aerogen Solo) and JN (Sidestream) positioned between the leak port and the nonvented oronasal mask during bilevel ventilation with a single-limb circuit. Measurements (clinical data, pulmonary function tests [PFTs], and arterial blood gases) were performed at baseline, 1, and 2 hours after treatment. Results: All measured PFT parameters significantly increased in both groups, but numerically results were better after inhalation with VMN than with JN: for forced expiratory volume in 1 second (FEV1) (mean increase from baseline to 120 minutes-165 ± 64 mL vs. 116 ± 46 mL, p = 0.001) and for forced vital capacity (FVC) (mean increase-394 ± 154 mL vs. 123 ± 57 mL, p < 0.001). There was also a statistically significant reduction in respiratory rate and in Borg dyspnea score after therapy with VMN in comparison with the conventional JN. In both groups, there were improvements in PaCO2, but with VMN these changes were significantly higher. Conclusion: Bronchodilator administration in patients with acute exacerbation of COPD during NIV with VMN resulted in clinically significant improvements in FVC and in Borg dyspnea score. Additional studies required to determine the impact on clinical outcomes.
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Affiliation(s)
- Sergey N Avdeev
- Sechenov First Moscow State Medical University, Healthcare Ministry of Russia, Moscow, Russia.,Federal Pulmonology Research Institute, Moscow, Federal Medical and Biological Agency of Russia, Moscow, Russia
| | - Galia S Nuralieva
- Sechenov First Moscow State Medical University, Healthcare Ministry of Russia, Moscow, Russia.,Federal Pulmonology Research Institute, Moscow, Federal Medical and Biological Agency of Russia, Moscow, Russia
| | - Aung Kyaw Soe
- Federal Pulmonology Research Institute, Moscow, Federal Medical and Biological Agency of Russia, Moscow, Russia
| | - Viliya V Gainitdinova
- Sechenov First Moscow State Medical University, Healthcare Ministry of Russia, Moscow, Russia
| | - James B Fink
- Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center, Chicago, Illinois, USA.,Aerogen Pharma Corp., San Mateo, California, USA
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10
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Igarashi A, Inoue S, Shibata Y, Nunomiya K, Ota T, Ishibashi Y, Murano H, Furuyam K, Yang S, Machida H, Nakano H, Sato K, Sato M, Nemoto T, Nishiwaki M, Yamauchi K, Suzuki J, Sadahiro M, Watanabe M. Examination of predictable factors of perioperative respiratory complications by preoperative forced oscillation technique parameters. EXCLI JOURNAL 2020; 19:1610-1614. [PMID: 33437226 PMCID: PMC7798088 DOI: 10.17179/excli2020-3087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/10/2020] [Indexed: 11/10/2022]
Abstract
In this study, we investigated whether pulmonary function tests such as forced oscillation technique parameters could predict perioperative respiratory complications. In the results of our study, perioperative respiratory complications cannot be predicted using the results of preoperative pulmonary function tests and forced oscillation technique parameters. Patients who are judged by comprehensive preoperative judgment to be suitable for general anesthesia may not need to consider the risk of perioperative complications using pulmonary function test.
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Affiliation(s)
- Akira Igarashi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Sumito Inoue
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Yoko Shibata
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Keiko Nunomiya
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Takahito Ota
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Yu Ishibashi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hiroaki Murano
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Kodai Furuyam
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Sujeong Yang
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hiroyoshi Machida
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hiroshi Nakano
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Kento Sato
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Masamichi Sato
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Takako Nemoto
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Michiko Nishiwaki
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Keiko Yamauchi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Jun Suzuki
- Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Mitsuaki Sadahiro
- Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
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11
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Alobaidi NY, Almeshari M, Stockley JA, Sapey E, Edgar RG. A Systematic Review of the Use of Physiological Tests Assessing the Acute Response to Treatment During Exacerbations of COPD (with a Focus on Small Airway Function). COPD 2020; 17:711-720. [PMID: 33183078 DOI: 10.1080/15412555.2020.1815183] [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] [Indexed: 12/20/2022]
Abstract
Exacerbations are prevalent in Chronic Obstructive Pulmonary Disease (COPD) patients and associated with poor clinical outcomes. Currently, there is a lack of sensitive and specific tools that can objectively identify exacerbations and assess their progress or treatment response. FEV1 is often reported as a study outcome, but it has significant limitations. Studies have suggested that small airways measures might provide physiological biomarkers during exacerbations. Therefore, this study was done to assess which physiological tests of small airways function have been used in the acute setting during exacerbations of COPD and the evidence to support their use. An electronic databases search was conducted in April 2019. A standard systematic review methodology was used. Eligible studies were those of ≥10 participants that compared at least one small airway test with FEV1 to assess response to treatment with baseline and a follow-up measurement ≤2 months after. Analyses were narrative. Of 1436 screened studies, seven studies were eligible. There was heterogeneity in which tests of small airways were used and three different small airways measures were reported. Studies were small (including 20 to 87 subjects). Six articles reported improvements in small airway measurements during the recovery from exacerbation which correlated with FEV1. Included studies varied in their timing and duration of the assessment. There is some evidence to support the use of small airway tests in acute exacerbations of COPD. However, studies have been small with different tests being utilized. Further studies to determine the usefulness of each test may be of interest.
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Affiliation(s)
- Nowaf Y Alobaidi
- Institute of Inflammation and Ageing University of Birmingham, Edgbaston, Birmingham, UK.,Respiratory Therapy Department, College of Applied Medical Sciences, King Saud Bin Abdul-Aziz University for Health Sciences, Al Ahsa, Saudi Arabia
| | - Mohammed Almeshari
- Institute of Inflammation and Ageing University of Birmingham, Edgbaston, Birmingham, UK.,Rehabilitation Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - James A Stockley
- Department of Lung Function and Sleep, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
| | - Elizabeth Sapey
- Institute of Inflammation and Ageing University of Birmingham, Edgbaston, Birmingham, UK
| | - Ross G Edgar
- Institute of Applied Health Research, University of Birmingham, Edgbaston, UK.,Therapy Services, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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12
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de Barros CF, Felisberto RM, Nucci KCA, de Albuquerque ALP, Paulin E, de Brito CMM, Yamaguti WP. Dynamic hyperinflation induced by the 6-minute pegboard and ring test in hospitalized patients with exacerbated COPD. PLoS One 2020; 15:e0241639. [PMID: 33170878 PMCID: PMC7654830 DOI: 10.1371/journal.pone.0241639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/30/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The six-minute pegboard and ring test (6-PBRT) has been used to evaluate functional capacity of the upper limbs in stable chronic obstructive pulmonary disease (COPD) patients. To the best of our knowledge, no studies have evaluated dynamic hyperinflation (DH) during exercise with upper limbs in the hospital setting. The aim of this study was to evaluate physiological responses and DH induced by 6-PBRT in hospitalized patients with acute exacerbation of COPD (AECOPD). METHODS A cross-sectional study was conducted in a tertiary hospital enrolling patients who were hospitalized due to AECOPD. All included participants underwent an evaluation of lung function and 6-PBRT when they reached minimum clinical criteria. Ventilatory and hemodynamics parameters were monitored during 6-PBRT and until 6 minutes of rest after the test. Symptoms of dyspnea and upper limb fatigue were also measured. RESULTS Eighteen patients (71.3±5.1 years) with a mean FEV1 of 43.2±18.3% were included in the study (11 females). Prevalence of DH after 6-PBRT was 50% (considering the drop of 150 ml or 10% of inspiratory capacity, immediately after the end of the test). There was a significant increase in respiratory rate, minute volume, dyspnea, and upper limb fatigue after the end of 6-PBRT (p<0.05). Dyspnea recovered more precociously than the perception of fatigue, being reestablished within four minutes of rest. An increase in heart rate, systolic and diastolic blood pressures was also induced by 6-PBRT (p<0.05), requiring 6 minutes of recovery to return to baseline. No adverse events were observed during 6-PBRT. We concluded that 6-PBRT induces physiological changes during its execution, at safe levels, requiring a maximum of 6 minutes for recovery. Finally, the test proved to be safe and applicable for patients hospitalized due to AECOPD.
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Affiliation(s)
| | | | | | | | - Elaine Paulin
- Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brasil
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13
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Calverley PMA, Farré R. Oscillometry: old physiology with a bright future. Eur Respir J 2020; 56:56/3/2001815. [PMID: 32912925 DOI: 10.1183/13993003.01815-2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/15/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Peter M A Calverley
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Ramon Farré
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.,CIBER de Enfermedades Respiratorias, Madrid, Spain.,Institut d'Investigacions Biomediques August Pi Sunyer, Barcelona, Spain
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14
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Peñuelas Ó, Frutos-Vivar F, Mancebo J. Invasive Mechanical Ventilation in Chronic Obstructive Pulmonary Disease Exacerbations. Semin Respir Crit Care Med 2020; 41:798-805. [PMID: 32746470 DOI: 10.1055/s-0040-1714396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) continues to be an important cause of morbidity, mortality, and health care costs worldwide. Although there exist some heterogeneity between patients, the course of COPD is characterized by recurrent acute exacerbations, which are among the most common causes of medical admission to hospital. Patients with frequent exacerbations have accelerated lung function decline, worse quality of life, and greater mortality. Therefore, interest is growing in assessing the effectiveness of interventions used to treat exacerbations. The present review summarizes the current evidence regarding the use of ventilatory management to treat COPD and the implementation of novel cost-effective strategies, such as high-flow oxygenation or extracorporeal carbon dioxide removal to improve clinical outcomes and functional recovery in this disease and to reduce the associated costs.
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Affiliation(s)
- Óscar Peñuelas
- Intensive Care Unit, Hospital Universitario de Getafe, CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain
| | - Fernando Frutos-Vivar
- Intensive Care Unit, Hospital Universitario de Getafe, CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain
| | - Jordi Mancebo
- Intensive Care Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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15
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Alobaidi NY, Stockley JA, Stockley RA, Sapey E. An overview of exacerbations of chronic obstructive pulmonary disease: Can tests of small airways' function guide diagnosis and management? Ann Thorac Med 2020; 15:54-63. [PMID: 32489439 PMCID: PMC7259399 DOI: 10.4103/atm.atm_323_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/20/2019] [Indexed: 12/14/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is common and debilitating. Most patients with COPD experience intermittent, acute deterioration in symptoms which require additional therapy, termed exacerbations. Exacerbations are prevalent in COPD and are associated with poor clinical outcomes including death, a faster decline in lung health, and a reduced quality of life. Current guidelines highlight the need to treat exacerbations promptly and then mitigate future risk. However, exacerbations are self-reported, difficult to diagnose and are treated with pharmacological therapies which have largely been unchanged over 30 years. Recent research has highlighted how exacerbations vary in their underlying cause, with specific bacteria, viruses, and cell types implicated. This variation offers the opportunity for new targeted therapies, but to develop these new therapies requires sensitive tools to reliably identify the cause, the start, and end of an exacerbation and assess the response to treatment. Currently, COPD is diagnosed and monitored using spirometric measures, principally the forced expiratory volume in 1 s and forced vital capacity, but these tests alone cannot reliably diagnose an exacerbation. Measures of small airways' function appear to be an early marker of COPD, and some studies have suggested that these tests might also provide physiological biomarkers for exacerbations. In this review, we will discuss how exacerbations of COPD are currently defined, stratified, monitored, and treated and review the current literature to determine if tests of small airways' function might improve diagnostic accuracy or the assessment of response to treatment.
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Affiliation(s)
- Nowaf Y Alobaidi
- Centre for Translational Inflammation Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Respiratory Therapy Department, College of Applied Medical Sciences, King Saud Bin Abdul-Aziz University for Health Sciences, Al Ahsa, Saudi Arabia
| | - James A Stockley
- Department of Lung Function and Sleep, University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK
| | - Robert A Stockley
- Department of Respiratory Medicine, University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK
| | - Elizabeth Sapey
- Centre for Translational Inflammation Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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16
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Walker PP, Pompilio PP, Zanaboni P, Bergmo TS, Prikk K, Malinovschi A, Montserrat JM, Middlemass J, Šonc S, Munaro G, Marušič D, Sepper R, Rosso R, Siriwardena AN, Janson C, Farré R, Calverley PMA, Dellaca' RL. Telemonitoring in Chronic Obstructive Pulmonary Disease (CHROMED). A Randomized Clinical Trial. Am J Respir Crit Care Med 2019; 198:620-628. [PMID: 29557669 DOI: 10.1164/rccm.201712-2404oc] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Early detection of chronic obstructive pulmonary disease (COPD) exacerbations using telemonitoring of physiological variables might reduce the frequency of hospitalization. OBJECTIVES To evaluate the efficacy of home monitoring of lung mechanics by the forced oscillation technique and cardiac parameters in older patients with COPD and comorbidities. METHODS This multicenter, randomized clinical trial recruited 312 patients with Global Initiative for Chronic Obstructive Lung Disease grades II to IV COPD (median age, 71 yr [interquartile range, 66-76 yr]; 49.6% grade II, 50.4% grades III-IV), with a history of exacerbation in the previous year and at least one nonpulmonary comorbidity. Patients were randomized to usual care (n = 158) or telemonitoring (n = 154) and followed for 9 months. All telemonitoring patients self-assessed lung mechanics daily, and in a subgroup with congestive heart failure (n = 37) cardiac parameters were also monitored. An algorithm identified deterioration, triggering a telephone contact to determine appropriate interventions. MEASUREMENTS AND MAIN RESULTS Primary outcomes were time to first hospitalization (TTFH) and change in the EuroQoL EQ-5D utility index score. Secondary outcomes included: rate of antibiotic/corticosteroid prescription; hospitalization; the COPD Assessment Tool, Patient Health Questionnaire-9, and Minnesota Living with Heart Failure questionnaire scores; quality-adjusted life years; and healthcare costs. Telemonitoring did not affect TTFH, EQ-5D utility index score, antibiotic prescriptions, hospitalization rate, or questionnaire scores. In an exploratory analysis, telemedicine was associated with fewer repeat hospitalizations (-54%; P = 0.017). CONCLUSIONS In older patients with COPD and comorbidities, remote monitoring of lung function by forced oscillation technique and cardiac parameters did not change TTFH and EQ-5D. Clinical trial registered with www.clinicaltrials.gov (NCT 01960907).
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Affiliation(s)
- Paul P Walker
- 1 University Hospital Aintree, Liverpool, United Kingdom.,2 School of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom
| | | | - Paolo Zanaboni
- 4 Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Trine S Bergmo
- 4 Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Kaiu Prikk
- 5 Technomedicum, Tallinn University of Technology, Tallinn, Estonia
| | | | - Josep M Montserrat
- 7 Hospital Clinic and.,8 Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Jo Middlemass
- 9 Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, United Kingdom
| | | | - Giulia Munaro
- 11 Elettronica Bio Medicale S.p.a., Foligno, Italy; and
| | | | - Ruth Sepper
- 5 Technomedicum, Tallinn University of Technology, Tallinn, Estonia
| | - Roberto Rosso
- 11 Elettronica Bio Medicale S.p.a., Foligno, Italy; and
| | - A Niroshan Siriwardena
- 9 Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, United Kingdom
| | - Christer Janson
- 12 Department of Medical Sciences: Respiratory, Sleep, and Allergy Research, Uppsala University, Uppsala, Sweden
| | - Ramon Farré
- 13 Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona-Institut Investigacions Biomediques August Pi Sunyer, Barcelona, Spain.,8 Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Peter M A Calverley
- 2 School of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom
| | - Raffaele L Dellaca'
- 3 Restech s.r.l., Milano, Italy.,14 Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano University, Milano, Italy
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17
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A Qualitative Study to Inform a More Acceptable Pulmonary Rehabilitation Program after Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2019; 16:1158-1164. [DOI: 10.1513/annalsats.201812-854oc] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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18
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Pulliam KE, Pritts TA. Non-Invasive Ventilatory Support In the Elderly. CURRENT GERIATRICS REPORTS 2019; 8:153-159. [PMID: 32509503 PMCID: PMC7274080 DOI: 10.1007/s13670-019-00287-5] [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] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW The first description of non-invasive ventilation use began in the 1920s. Since then, its role in patient care has evolved through increased clinical knowledge and scientific advancements. The utilization of non-invasive ventilation has broadened from initial application in acute in-hospital ICU settings to now include the outpatient settings. This review discusses the history of non-invasive ventilation and its role in acute in-hospital chronic obstructive pulmonary disease (COPD) exacerbations, cardiogenic pulmonary edema, and weaning from mechanical ventilation in the elderly. The elderly population represents a significant portion of patients hospitalized for the aforementioned conditions. These groups often have more limitations related to the use of invasive mechanical ventilation (IMV), therefore, it is essential to understand the impact of non-invasive ventilation on hospital outcomes. RECENT FINDINGS There is strong clinical evidence supporting the use of non-invasive ventilation in patients with respiratory failure secondary to acute COPD exacerbations and cardiogenic pulmonary edema. When compared to standard medical management of these conditions, there is a consistent and significant reduction in the rate of endotracheal intubation and in-hospital mortality. SUMMARY The basis of noninvasive ventilation applicability has been determined by significant reduction in mortality and intubation rates. Although survival benefits have been observed, there still remain limitations to the clinical applicability of non-invasive ventilation in certain patient populations and conditions that require further investigation.
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Affiliation(s)
- Kasiemobi E Pulliam
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Mail Location 0558, Cincinnati, Ohio 45267-0558
| | - Timothy A Pritts
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Mail Location 0558, Cincinnati, Ohio 45267-0558
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19
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Lanclus M, Clukers J, Van Holsbeke C, Vos W, Leemans G, Holbrechts B, Barboza K, De Backer W, De Backer J. Machine Learning Algorithms Utilizing Functional Respiratory Imaging May Predict COPD Exacerbations. Acad Radiol 2019; 26:1191-1199. [PMID: 30477949 DOI: 10.1016/j.acra.2018.10.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/23/2018] [Accepted: 10/28/2018] [Indexed: 12/21/2022]
Abstract
RATIONALE AND OBJECTIVES Acute chronic obstructive pulmonary disease exacerbations (AECOPD) have a significant negative impact on the quality of life and accelerate progression of the disease. Functional respiratory imaging (FRI) has the potential to better characterize this disease. The purpose of this study was to identify FRI parameters specific to AECOPD and assess their ability to predict future AECOPD, by use of machine learning algorithms, enabling a better understanding and quantification of disease manifestation and progression. MATERIALS AND METHODS A multicenter cohort of 62 patients with COPD was analyzed. FRI obtained from baseline high resolution CT data (unenhanced and volume gated), clinical, and pulmonary function test were analyzed and incorporated into machine learning algorithms. RESULTS A total of 11 baseline FRI parameters could significantly distinguish ( p < 0.05) the development of AECOPD from a stable period. In contrast, no baseline clinical or pulmonary function test parameters allowed significant classification. Furthermore, using Support Vector Machines, an accuracy of 80.65% and positive predictive value of 82.35% could be obtained by combining baseline FRI features such as total specific image-based airway volume and total specific image-based airway resistance, measured at functional residual capacity. Patients who developed an AECOPD, showed significantly smaller airway volumes and (hence) significantly higher airway resistances at baseline. CONCLUSION This study indicates that FRI is a sensitive tool (PPV 82.35%) for predicting future AECOPD on a patient specific level in contrast to classical clinical parameters.
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Affiliation(s)
| | - Johan Clukers
- Faculty of Medicine and Health Sciences, University of Antwerp (UAntwerpen), Antwerpen, Belgium
| | | | - Wim Vos
- FluidDA nv, Groeningenlei 132, 2550 Kontich, Belgium
| | - Glenn Leemans
- FluidDA nv, Groeningenlei 132, 2550 Kontich, Belgium
| | - Birgit Holbrechts
- Faculty of Medicine and Health Sciences, University of Antwerp (UAntwerpen), Antwerpen, Belgium
| | | | - Wilfried De Backer
- FluidDA nv, Groeningenlei 132, 2550 Kontich, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp (UAntwerpen), Antwerpen, Belgium
| | - Jan De Backer
- FluidDA nv, Groeningenlei 132, 2550 Kontich, Belgium
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20
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Wageck B, Cox NS, Holland AE. Recovery Following Acute Exacerbations of Chronic Obstructive Pulmonary Disease – A Review. COPD 2019; 16:93-103. [DOI: 10.1080/15412555.2019.1598965] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Bruna Wageck
- Discipline of Physiotherapy, La Trobe University, Melbourne, VIC, Australia
| | - Narelle S. Cox
- Discipline of Physiotherapy, La Trobe University, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Melbourne, VIC, Australia
| | - Anne E. Holland
- Discipline of Physiotherapy, La Trobe University, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Melbourne, VIC, Australia
- Department of Physiotherapy, Alfred Hospital, Melbourne, VIC, Australia
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21
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Zimmermann SC, Tonga KO, Thamrin C. Dismantling airway disease with the use of new pulmonary function indices. Eur Respir Rev 2019; 28:28/151/180122. [PMID: 30918023 PMCID: PMC9488242 DOI: 10.1183/16000617.0122-2018] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 02/15/2019] [Indexed: 11/27/2022] Open
Abstract
We are currently limited in our abilities to diagnose, monitor disease status and manage chronic airway disease like asthma and chronic obstructive pulmonary disease (COPD). Conventional lung function measures often poorly reflect patient symptoms or are insensitive to changes, particularly in the small airways where disease may originate or manifest. Novel pulmonary function tests are becoming available which help us better characterise and understand chronic airway disease, and their translation and adoption from the research arena would potentially enable individualised patient care. In this article, we aim to describe two emerging lung function tests yielding novel pulmonary function indices, the forced oscillation technique (FOT) and multiple breath nitrogen washout (MBNW). With a particular focus on asthma and COPD, this article demonstrates how chronic airway disease mechanisms have been dismantled with the use of the FOT and MBNW. We describe their ability to assess detailed pulmonary mechanics for diagnostic and management purposes including response to bronchodilation and other treatments, relationship with symptoms, evaluation of acute exacerbations and recovery, and telemonitoring. The current limitations of both tests, as well as open questions/directions for further research, are also discussed. Spirometry is used to diagnose and manage airway disease such as asthma and COPD, but relates poorly to symptoms, lacks sensitivity and is effort dependent. FOT and MBNW are emerging clinical lung function tests that help us dismantle disease mechanisms.http://ow.ly/nM0G30nS6Ct
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Affiliation(s)
- Sabine C Zimmermann
- Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia.,Dept of Respiratory Medicine, Royal North Shore Hospital, Sydney, Australia.,Sydney Medical School Northern, The University of Sydney, Sydney, Australia.,Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Katrina O Tonga
- Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia.,Dept of Respiratory Medicine, Royal North Shore Hospital, Sydney, Australia.,Sydney Medical School Northern, The University of Sydney, Sydney, Australia.,Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia.,Dept of Thoracic and Transplant Medicine, St Vincent's Hospital, Sydney, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Cindy Thamrin
- Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia .,Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
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22
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Milne S, Jetmalani K, Chapman DG, Duncan JM, Farah CS, Thamrin C, King GG. Respiratory system reactance reflects communicating lung volume in chronic obstructive pulmonary disease. J Appl Physiol (1985) 2019; 126:1223-1231. [PMID: 30763164 DOI: 10.1152/japplphysiol.00503.2018] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Respiratory system reactance (Xrs) measured by the forced oscillation technique (FOT) is theoretically and experimentally related to lung volume. In chronic obstructive pulmonary disease (COPD), the absolute volume measured by body plethysmography includes a proportion that is inaccessible to pressure oscillations applied via the mouth, that is, a "noncommunicating" lung volume. We hypothesized that in COPD the presence of noncommunicating lung would disrupt the expected Xrs-volume relationship compared with plethysmographic functional residual capacity (FRCpleth). Instead, Xrs would relate to estimates of communicating volume, namely, expiratory reserve volume (ERV) and single-breath alveolar volume (VaSB). We examined FOT and lung function data from people with COPD (n = 51) and from healthy volunteers (n = 40). In healthy volunteers, we observed an expected inverse relationship between reactance at 5 Hz (X5) and FRCpleth. In contrast, there was no such relationship between X5 and FRCpleth in COPD subjects. However, there was an inverse relationship between X5 and both ERV and VaSB. Hence the theoretical Xrs-volume relationship is present in COPD but only when considering the communicating volume rather than the absolute lung volume. These findings confirm the role of reduced communicating lung volume as an important determinant of Xrs and therefore advance our understanding and interpretation of FOT measurements in COPD. NEW & NOTEWORTHY To investigate the determinants of respiratory system reactance (Xrs) measured by the forced oscillation technique (FOT) in chronic obstructive pulmonary disease (COPD), we examine the relationship between Xrs and lung volume. We show that Xrs does not relate to absolute lung volume (functional residual capacity) in COPD but instead relates only to the volume of lung in communication with the airway opening. This communicating volume may therefore be fundamental to our interpretation of FOT measurements in COPD and other pulmonary diseases.
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Affiliation(s)
- Stephen Milne
- The Woolcock Emphysema Centre and Airway Physiology and Imaging Group, Woolcock Institute of Medical Research and Sydney Medical School, University of Sydney, Glebe, New South Wales , Australia.,Department of Respiratory Medicine, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales , Australia.,Department of Respiratory Medicine, Concord Repatriation General Hospital, Sydney Local Health District, Concord, New South Wales , Australia
| | - Kanika Jetmalani
- The Woolcock Emphysema Centre and Airway Physiology and Imaging Group, Woolcock Institute of Medical Research and Sydney Medical School, University of Sydney, Glebe, New South Wales , Australia
| | - David G Chapman
- The Woolcock Emphysema Centre and Airway Physiology and Imaging Group, Woolcock Institute of Medical Research and Sydney Medical School, University of Sydney, Glebe, New South Wales , Australia.,Translational Airways Group, School of Life Sciences, University of Technology Sydney , Ultimo, New South Wales , Australia
| | - Joseph M Duncan
- Department of Respiratory Medicine, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales , Australia
| | - Claude S Farah
- The Woolcock Emphysema Centre and Airway Physiology and Imaging Group, Woolcock Institute of Medical Research and Sydney Medical School, University of Sydney, Glebe, New South Wales , Australia.,Department of Respiratory Medicine, Concord Repatriation General Hospital, Sydney Local Health District, Concord, New South Wales , Australia.,Faculty of Medicine and Health Sciences, Macquarie University , North Ryde, New South Wales , Australia
| | - Cindy Thamrin
- The Woolcock Emphysema Centre and Airway Physiology and Imaging Group, Woolcock Institute of Medical Research and Sydney Medical School, University of Sydney, Glebe, New South Wales , Australia
| | - Gregory G King
- The Woolcock Emphysema Centre and Airway Physiology and Imaging Group, Woolcock Institute of Medical Research and Sydney Medical School, University of Sydney, Glebe, New South Wales , Australia.,Department of Respiratory Medicine, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales , Australia.,Centre of Research Excellence in Severe Asthma, New Lambton, New South Wales , Australia
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23
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Watz H, Tetzlaff K, Magnussen H, Mueller A, Rodriguez-Roisin R, Wouters EFM, Vogelmeier C, Calverley PMA. Spirometric changes during exacerbations of COPD: a post hoc analysis of the WISDOM trial. Respir Res 2018; 19:251. [PMID: 30545350 PMCID: PMC6293570 DOI: 10.1186/s12931-018-0944-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with loss of lung function and poor outcomes for patients. However, there are limited data on the time course of changes in forced expiratory volume in 1 s (FEV1) preceding the first reported symptom and after the start of an exacerbation. METHODS WISDOM was a multinational, randomized, double-blind, active-controlled, 52-week study in patients with severe-to-very severe COPD. Patients received triple therapy (long-acting muscarinic antagonist and long-acting β2-agonist/inhaled corticosteroid [ICS]) for 6 weeks, and were randomized to continue triple therapy or stepwise withdrawal of the ICS (dual bronchodilator group). After suitable training, patients performed daily spirometry at home using a portable, battery-operated spirometer. In the present post hoc analysis, patients who continued to perform daily home spirometry and completed at least one measurement per week for a 56-day period before and after the start of a moderate or severe exacerbation were included. Missing values were imputed by linear interpolation (intermittent), backfilling (beginning) or carry forward (end). Exacerbation onset was the first day of a reported symptom of exacerbation. RESULTS Eight hundred and eighty-eight patients in the WISDOM study had a moderate/severe exacerbation after the complete ICS withdrawal visit; 360 of them contributed at least one FEV1 measure per week for the 8 weeks before and after the event and are included in this analysis. Mean daily FEV1 began to decline from approximately 2 weeks before the onset of symptoms of an exacerbation, dropping from 0.907 L (mean Days - 56 to - 36 before the exacerbation) to 0.860 L on the first day of the exacerbation. After the exacerbation, mean FEV1 improved but did not return to pre-exacerbation levels (mean Days 36-56 after the exacerbation, 0.875 L). The pattern of FEV1 changes around exacerbations was similar in the triple therapy and dual bronchodilator groups, and a similar pattern was seen in moderate and severe exacerbations when analysed separately. CONCLUSIONS Mean lung function starts to decline prior to the first reported symptoms of an exacerbation, and does not recover to pre-exacerbation levels 8 weeks after the event. TRIAL REGISTRATION WISDOM (ClinicalTrials.gov number, NCT00975195 ).
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Affiliation(s)
- Henrik Watz
- Pulmonary Research Institute at Lungen Clinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Wöhrendamm 80, 22927, Grosshansdorf, Germany.
| | - Kay Tetzlaff
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany.,Department of Sports Medicine, University of Tübingen, Tübingen, Germany
| | - Helgo Magnussen
- Pulmonary Research Institute at Lungen Clinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Wöhrendamm 80, 22927, Grosshansdorf, Germany
| | - Achim Mueller
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | | | - Emiel F M Wouters
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Claus Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Peter M A Calverley
- Institute of Ageing and Chronic Disease, Clinical Science Centre, University Hospital Aintree, Liverpool, UK
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24
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Kim V, Aaron SD. What is a COPD exacerbation? Current definitions, pitfalls, challenges and opportunities for improvement. Eur Respir J 2018; 52:13993003.01261-2018. [PMID: 30237306 DOI: 10.1183/13993003.01261-2018] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/12/2018] [Indexed: 01/02/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic illness that can be periodically punctuated by exacerbations, characterised by acute worsening of symptoms, including increased dyspnoea, cough, sputum production and sputum purulence. COPD exacerbations are common and have important clinical and economic consequences, including lost work productivity, increased utilisation of healthcare resources, temporary or permanent reductions in lung function and exercise capacity, hospitalisation, and sometimes death. Over the past two decades, clinicians and researchers have broadened their treatment goals for COPD to extend beyond improving lung function and symptoms, and have begun to address the importance of preventing and reducing exacerbations. However, despite the best efforts of clinicians and guideline committees, current definitions of COPD exacerbations are imperfect and fraught with problems. The cardinal symptoms of a COPD exacerbation are nonspecific and can result from acute cardiorespiratory illnesses other than COPD. A proposed definition, which may be more specific than current definitions, suggests that COPD exacerbation be defined as an acute or subacute worsening of dyspnoea (≥5 on a visual analogue scale that ranges from 0 to 10) sometimes but not necessarily accompanied by increased cough, sputum volume and/or sputum purulence. Necessary laboratory criteria for an exacerbation include oxygen desaturation ≤4% below that of stable state, elevated levels of circulating blood neutrophils or eosinophils (≥9000 neutrophils·mm-3 or ≥2% blood eosinophils) and elevated C-reactive protein (≥3 mg·L-1), without evidence of pneumonia or pulmonary oedema on chest radiography and with negative laboratory test results for other aetiologies. Herein, we discuss the current state of the art with respect to how we define COPD exacerbations, associated pitfalls and challenges, and opportunities for improvement.
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Affiliation(s)
- Victor Kim
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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25
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van Geffen WH, Hajian B, Vos W, De Backer J, Cahn A, Usmani OS, Van Holsbeke C, Pistolesi M, Kerstjens HA, De Backer W. Functional respiratory imaging: heterogeneity of acute exacerbations of COPD. Int J Chron Obstruct Pulmon Dis 2018; 13:1783-1792. [PMID: 29881268 PMCID: PMC5985851 DOI: 10.2147/copd.s152463] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Exacerbations of COPD are a major burden to patients, and yet little is understood about heterogeneity. It contributes to the current persistent one-size-fits-all treatment. To replace this treatment by more personalized, precision medicine, new insights are required. We assessed the heterogeneity of exacerbations by functional respiratory imaging (FRI) in 3-dimensional models of airways and lungs. Methods The trial was designed as a multicenter trial of patients with an acute exacerbation of COPD who were assessed by FRI, pulmonary function tests, and patient-reported outcomes, both in the acute stage and during resolution. Results Forty seven patients were assessed. FRI analyses showed significant improvements in hyperinflation (a decrease in total volume at functional residual capacity of −0.25±0.61 L, p≤0.01), airway volume at total lung capacity (+1.70±4.65 L, p=0.02), and airway resistance. As expected, these improvements correlated partially with changes in the quality of life and in conventional lung function test parameters. Patients with the same changes in pulmonary function differ in regional disease activity measured by FRI. Conclusion FRI is a useful tool to get a better insight into exacerbations of COPD, and significant improvements in its indices can be demonstrated from the acute phase to resolution even in relatively small groups. It clearly visualizes the marked variability within and between individuals in ventilation and resistance during exacerbations and is a tool for the assessment of the heterogeneity of COPD exacerbations.
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Affiliation(s)
- Wouter H van Geffen
- Department of Respiratory Medicine, Medical Centre Leeuwarden, Leeuwarden, the Netherlands.,Department of Pulmonary Diseases, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, University of Groningen, the Netherlands
| | - Bita Hajian
- Department of Pulmonary Diseases, Antwerp University Hospital, Antwerp, Belgium
| | - Wim Vos
- FLUIDDA nv, Kontich, Belgium
| | | | | | - Omar S Usmani
- Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, UK
| | | | - Massimo Pistolesi
- Department of Experimental and Clinical Medicine, Section of Respiratory Medicine, University of Florence, Florence, Italy
| | - Huib Am Kerstjens
- Department of Pulmonary Diseases, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, University of Groningen, the Netherlands
| | - Wilfried De Backer
- Department of Pulmonary Diseases, Antwerp University Hospital, Antwerp, Belgium
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26
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van Geffen WH, Kerstjens HA. Static and dynamic hyperinflation during severe acute exacerbations of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2018; 13:1269-1277. [PMID: 29713160 PMCID: PMC5912369 DOI: 10.2147/copd.s154878] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Static hyperinflation is known to be increased during moderate acute exacerbations of chronic obstructive pulmonary disease (COPD) (AECOPD), but few data exist in patients with severe exacerbations of COPD. The role of dynamic hyperinflation during exacerbations is unclear. Methods In a prospective, observational cohort study, we recruited patients admitted to hospital for AECOPD. The following measurements were performed upon admission and again after resolution (stable state) at least 42 days later: inspiratory capacity (IC), body plethysmography, dynamic hyperinflation by metronome-paced IC measurement, health-related quality of life and dyspnea. Results Forty COPD patients were included of whom 28 attended follow-up. The IC was low at admission (2.05±0.11 L) and increased again during resolution by 15.6%±23.1% or 0.28±0.08 L (mean ± standard error of the mean, p<0.01). Testing of metronome-paced changes in IC was feasible, and it decreased by 0.74±0.06 L at admission, similarly to at stable state. Clinical COPD Questionnaire score was 3.7±0.2 at admission and improved by 1.7±0.2 points (p<0.01), and the Borg dyspnea score improved by 2.2±0.5 points from 4.4±0.4 at admission (p<0.01). Conclusion Static hyperinflation is increased during severe AECOPD requiring hospitalization compared with stable state. We could measure metronome-paced dynamic hyperinflation during severe AECOPD but found no increase.
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Affiliation(s)
- Wouter H van Geffen
- Department of Respiratory Medicine, Medical Centre Leeuwarden, Leeuwarden, the Netherlands.,Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Huib Am Kerstjens
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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27
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Yamagami H, Tanaka A, Kishino Y, Mikuni H, Kawahara T, Ohta S, Yamamoto M, Suzuki S, Ohnishi T, Sagara H. Association between respiratory impedance measured by forced oscillation technique and exacerbations in patients with COPD. Int J Chron Obstruct Pulmon Dis 2017; 13:79-89. [PMID: 29317813 PMCID: PMC5744737 DOI: 10.2147/copd.s146669] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background It is well known that increased airflow limitation as measured by spirometry is associated with the risk of exacerbation in patients with COPD. The forced oscillation technique (FOT) is a noninvasive method used to assess respiratory impedance (resistance and reactance) with minimal patient cooperation required. The clinical utility of the FOT in assessing the risk of exacerbations of COPD is yet to be determined. We examined the relationship between respiratory impedance as measured by FOT and exacerbations in patients with COPD. Materials and methods Among 310 patients with COPD (Global Initiative for Chronic Obstructive Lung Disease stages I-IV) who presented at the outpatient clinic of the Showa University Hospital from September 2014 through January 2015, 119 were collected and assigned into 2 groups according to their history of exacerbation: exacerbators and nonexacerbators. Respiratory resistance components and respiratory reactance components, as measured by FOT, were compared between the two groups. Results Exacerbators were significantly older and had a higher white blood cell count than nonexacerbators. Resistance at 20 Hz, reactance at 5 Hz (X5), resonant frequency (Fres), and area of low reactance (ALX) differed significantly between the two groups. In addition, among patients with stage II COPD, there were significant differences in X5, Fres, and ALX between the two groups despite no significant differences in respiratory function as assessed by spirometry. Finally, receiver operating characteristic curve analysis revealed that the reactance components rather than the resistance components were associated with the risk of exacerbation. Conclusion There were significant differences in respiratory impedance between exacerbators and nonexacerbators in patients with moderate COPD. FOT is a promising tool for assessing future exacerbations in patients with COPD.
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Affiliation(s)
- Hitomi Yamagami
- Division of Respiratory Medicine and Allergology, Department of Medicine, School of Medicine, Showa University, Tokyo, Japan
| | - Akihiko Tanaka
- Division of Respiratory Medicine and Allergology, Department of Medicine, School of Medicine, Showa University, Tokyo, Japan
| | - Yasunari Kishino
- Division of Respiratory Medicine and Allergology, Department of Medicine, School of Medicine, Showa University, Tokyo, Japan
| | - Hatsuko Mikuni
- Division of Respiratory Medicine and Allergology, Department of Medicine, School of Medicine, Showa University, Tokyo, Japan
| | - Tomoko Kawahara
- Division of Respiratory Medicine and Allergology, Department of Medicine, School of Medicine, Showa University, Tokyo, Japan
| | - Shin Ohta
- Division of Respiratory Medicine and Allergology, Department of Medicine, School of Medicine, Showa University, Tokyo, Japan
| | - Mayumi Yamamoto
- Division of Respiratory Medicine and Allergology, Department of Medicine, School of Medicine, Showa University, Tokyo, Japan
| | - Shintaro Suzuki
- Division of Respiratory Medicine and Allergology, Department of Medicine, School of Medicine, Showa University, Tokyo, Japan
| | - Tsukasa Ohnishi
- Division of Respiratory Medicine and Allergology, Department of Medicine, School of Medicine, Showa University, Tokyo, Japan
| | - Hironori Sagara
- Division of Respiratory Medicine and Allergology, Department of Medicine, School of Medicine, Showa University, Tokyo, Japan
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28
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Papaioannou AI, Herodotou Y, Tomos I, Apollonatou V, Verykokou G, Papathanasiou E, Manali ED, Loukides S, Papiris SA. Ability of using different dry powder inhalers during COPD exacerbations. Pulm Pharmacol Ther 2017; 48:211-216. [PMID: 29277688 DOI: 10.1016/j.pupt.2017.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/03/2017] [Accepted: 12/18/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Guidelines suggest that patients hospitalized for acute COPD exacerbations (AECOPD) are treated with short acting bronchodilators. Long acting bronchodilators, offer longer symptom relief but since they are usually administered via Dry Powder Inhalers (DPIs) it is considered that during AECOPD patients would not be able to achieve appropriate inspiratory flow (IF) to receive appropriate drug doses. The aim of the present study was to evaluate whether patients admitted to the hospital for AECOPD, are able to achieve the necessary IF using different DPIs. METHODS IF was measured daily in patients admitted for AECOPD with a portable IF meter (In-Check Oral inhaler assessment kit), containing a series of adapters that simulate the resistance of 4 DPIs [Turbuhaler (T), Breezhaler/Aerolizer (B/F), Discus (A/A/D) and Handinhaler (HH)]. Dyspnea, spirometry and arterial blood gases were also recorded daily. RESULTS 44 consecutive patients were included in the study. The majority of patients were able to achieve an IF over 30 L/min with all four device resistances. This minimum required IF was achieved in 90.9%, 100%, 95.5% and 81.8% of patients on admission and in 100%, 100%, 97.7%, and 95.5% of patients on discharge for T, B/F, A/A/D and HH respectively. No functional characteristic was able to predict the achievement of this minimum necessary IF. CONCLUSION Most patients hospitalized for AECOPD, are able to receive treatment with long acting bronchodilators administered via DPIs. The possible beneficial effects of such an intervention should be tested in further studies.
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Affiliation(s)
- Andriana I Papaioannou
- 2nd Respiratory Medicine Department, "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece.
| | - Yiolanda Herodotou
- 2nd Respiratory Medicine Department, "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece
| | - Ioannis Tomos
- 2nd Respiratory Medicine Department, "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece
| | - Vasiliki Apollonatou
- 2nd Respiratory Medicine Department, "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece
| | - Galateia Verykokou
- 2nd Respiratory Medicine Department, "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece
| | - Evgenia Papathanasiou
- 2nd Respiratory Medicine Department, "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece
| | - Effrosyni D Manali
- 2nd Respiratory Medicine Department, "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece
| | - Stelios Loukides
- 2nd Respiratory Medicine Department, "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece
| | - Spyros A Papiris
- 2nd Respiratory Medicine Department, "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece
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29
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Halpin DMG, Miravitlles M, Metzdorf N, Celli B. Impact and prevention of severe exacerbations of COPD: a review of the evidence. Int J Chron Obstruct Pulmon Dis 2017; 12:2891-2908. [PMID: 29062228 PMCID: PMC5638577 DOI: 10.2147/copd.s139470] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Severe exacerbations of COPD, ie, those leading to hospitalization, have profound clinical implications for patients and significant economic consequences for society. The prevalence and burden of severe COPD exacerbations remain high, despite recognition of the importance of exacerbation prevention and the availability of new treatment options. Severe COPD exacerbations are associated with high mortality, have negative impact on quality of life, are linked to cardiovascular complications, and are a significant burden on the health-care system. This review identified risk factors that contribute to the development of severe exacerbations, treatment options (bronchodilators, antibiotics, corticosteroids [CSs], oxygen therapy, and ventilator support) to manage severe exacerbations, and strategies to prevent readmission to hospital. Risk factors that are amenable to change have been highlighted. A number of bronchodilators have demonstrated successful reduction in risk of severe exacerbations, including long-acting muscarinic antagonist or long-acting β2-agonist mono- or combination therapies, in addition to vaccination, mucolytic and antibiotic therapy, and nonpharmacological interventions, such as pulmonary rehabilitation. Recognition of the importance of severe exacerbations is an essential step in improving outcomes for patients with COPD. Evidence-based approaches to prevent and manage severe exacerbations should be implemented as part of targeted strategies for disease management.
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Affiliation(s)
- David MG Halpin
- Department of Respiratory Medicine, Royal Devon and Exeter Hospital, Exeter, UK
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d’Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Norbert Metzdorf
- Respiratory Medicine, Boehringer Ingelheim Pharma GmBH & Co KG, Ingelheim am Rhein, Germany
| | - Bartolomé Celli
- Pulmonary Division, Brigham and Women’s Hospital, Boston, MA, USA
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30
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Cortopassi F, Gurung P, Pinto-Plata V. Chronic Obstructive Pulmonary Disease in Elderly Patients. Clin Geriatr Med 2017; 33:539-552. [PMID: 28991649 DOI: 10.1016/j.cger.2017.06.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is prevalent in the elderly population, with high impact on quality of life, morbidity, and mortality. The diagnosis is usually made based on symptoms and spirometry values that support the presence of airflow obstruction. However, the condition is frequently underdiagnosed. COPD is associated with premature aging and several other medical conditions that can partially explain its underdiagnosis and management. There are several pharmacologic and nonpharmacologic interventions proven to be effective in ameliorating the symptoms of COPD. Appropriate drug delivery and reduction of side effects is also pivotal in the management of patients with COPD.
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Affiliation(s)
- Felipe Cortopassi
- Pulmonary Department, Hospital Universitario Pedro Ernesto, State University of Rio de Janeiro, Avenida Vinte e oito de Setembro, 77, Segundo andar, Vila Isabel, Rio de Janeiro, Rio de Janeiro 20551-30, Brazil
| | - Puncho Gurung
- Pulmonary-Critical Care Medicine Division, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199, USA
| | - Victor Pinto-Plata
- Pulmonary-Critical Care Medicine Division, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199, USA.
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31
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Oliveira CC, Lee AL, McGinley J, Anderson GP, Clark RA, Thompson M, Clarke S, Baker T, Irving LB, Denehy L. Balance and Falls in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Prospective Study. COPD 2017; 14:518-525. [DOI: 10.1080/15412555.2017.1342232] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Cristino C. Oliveira
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
- Department of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, Brazil
| | - Annemarie L. Lee
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Jennifer McGinley
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Gary P. Anderson
- Lung Health Research Centre and Department of Pharmacology and Therapeutics, The University of Melbourne, Melbourne, Australia
| | - Ross A. Clark
- School of Exercise Science, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Michelle Thompson
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Melbourne, Australia
| | - Sandy Clarke
- Statistical Consulting Centre, The University of Melbourne, Melbourne, Australia
| | - Tamara Baker
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Melbourne, Australia
| | - Louis B. Irving
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Melbourne, Australia
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
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32
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Rubio N, Parker RA, Drost EM, Pinnock H, Weir CJ, Hanley J, Mantoani LC, MacNee W, McKinstry B, Rabinovich RA. Home monitoring of breathing rate in people with chronic obstructive pulmonary disease: observational study of feasibility, acceptability, and change after exacerbation. Int J Chron Obstruct Pulmon Dis 2017; 12:1221-1231. [PMID: 28458534 PMCID: PMC5404493 DOI: 10.2147/copd.s120706] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Telehealth programs to promote early identification and timely self-management of acute exacerbations of chronic obstructive pulmonary diseases (AECOPDs) have yielded disappointing results, in part, because parameters monitored (symptoms, pulse oximetry, and spirometry) are weak predictors of exacerbations.
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Affiliation(s)
- Noah Rubio
- Edinburgh Lung and the Environment Group Initiative (ELEGI) Colt Laboratory, Centre for Inflammation Research
| | - Richard A Parker
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh
| | - Ellen M Drost
- Edinburgh Lung and the Environment Group Initiative (ELEGI) Colt Laboratory, Centre for Inflammation Research
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School, Teviot Place.,EHealth group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh
| | - Christopher J Weir
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh
| | - Janet Hanley
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, Lothian, UK
| | - Leandro C Mantoani
- Edinburgh Lung and the Environment Group Initiative (ELEGI) Colt Laboratory, Centre for Inflammation Research
| | - William MacNee
- Edinburgh Lung and the Environment Group Initiative (ELEGI) Colt Laboratory, Centre for Inflammation Research
| | - Brian McKinstry
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh.,EHealth group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh
| | - Roberto A Rabinovich
- Edinburgh Lung and the Environment Group Initiative (ELEGI) Colt Laboratory, Centre for Inflammation Research
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33
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Öncü E, Zincir H. The effect of transcutaneous electrical nerve stimulation in patients with acute exacerbation of chronic obstructive pulmonary disease: randomised controlled trial. J Clin Nurs 2017; 26:1834-1844. [DOI: 10.1111/jocn.13450] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Emine Öncü
- Community Health Nursing Department; School of Health Sciences; Mersin University; Mersin Turkey
| | - Handan Zincir
- Community Health Nursing Department; Faculty of Health Sciences; Erciyes University; Kayseri Turkey
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34
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Ceriana P, Vitacca M, Carlucci A, Paneroni M, Pisani L, Nava S. Changes of Respiratory Mechanics in COPD Patients from Stable State to Acute Exacerbations with Respiratory Failure. COPD 2016; 14:150-155. [PMID: 27997251 DOI: 10.1080/15412555.2016.1254173] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Symptoms, clinical course, functional and biological data during an exacerbation of chronic obstructive pulmonary disease (EXCOPD) have been investigated, but data on physiological changes of respiratory mechanics during a severe exacerbation with respiratory acidosis requiring noninvasive mechanical ventilation (NIMV) are scant. The aim of this study was to evaluate changes of respiratory mechanics in COPD patients comparing data observed during EXCOPD with those observed during stable state in the recovery phase. In 18 COPD patients having severe EXCOPD requiring NIMV for global respiratory failure, we measured respiratory mechanics during both EXCOPD (T0) and once the patients achieved a stable state (T1). The diaphragm and inspiratory muscles effort was significantly increased under relapse, as well as the pressure-time product of the diaphragm and the inspiratory muscle (PTPdi and PTPes). The resistive loads to breathe (i.e., PEEPi,dyn, compliance and inspiratory resistances) were also markedly increased, while the maximal pressures generated by the diaphragm and the inspiratory muscles, together with forced expired volumes were decreased. All these indices statistically improved but with a great intrasubject variability in stable condition. Moreover, tension-time index (TTdi) significantly improved from the EXCOPD state to the condition of clinical stability (0.156 ± 0.04 at T0 vs. 0.082 ± 0.02 at T1 p < 0.001). During an EXCOPD, the load/capacity of the respiratory pump is impaired, and although the patients exhibit a rapid shallow breathing pattern, this does not necessarily correlate with a TTdi ≥ 0.15. These changes are reverted once they recover from the EXCOPD, despite a large variability between patients.
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Affiliation(s)
- Piero Ceriana
- a Respiratory Rehabilitation Division, Salvatore Maugeri Foundation IRCCS, Institute of Pavia , Pavia , Italy
| | - Michele Vitacca
- b Respiratory Rehabilitation Division, Salvatore Maugeri Foundation IRCCS, Institute of Lumezzane , Lumezzane , Italy
| | - Annalisa Carlucci
- a Respiratory Rehabilitation Division, Salvatore Maugeri Foundation IRCCS, Institute of Pavia , Pavia , Italy
| | - Mara Paneroni
- b Respiratory Rehabilitation Division, Salvatore Maugeri Foundation IRCCS, Institute of Lumezzane , Lumezzane , Italy
| | - Lara Pisani
- c Institute of Respiratory Diseases, Policlinico S. Orsola and Alma Mater University , Bologna , Italy
| | - Stefano Nava
- c Institute of Respiratory Diseases, Policlinico S. Orsola and Alma Mater University , Bologna , Italy
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35
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Wise RA, Acevedo RA, Anzueto AR, Hanania NA, Martinez FJ, Ohar JA, Tashkin DP. Guiding Principles for the Use of Nebulized Long-Acting Beta2-Agonists in Patients with COPD: An Expert Panel Consensus. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2016; 4:7-20. [PMID: 28848907 DOI: 10.15326/jcopdf.4.1.2016.0141] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Determining which patients with COPD may benefit from a nebulized long-acting beta2-agonist (LABA) is a challenge in current practice. In the absence of strong clinical guidelines addressing this issue, an expert panel convened to develop guiding principles for the use of nebulized LABA therapy in patients with COPD. This article summarizes these guiding principles and other practical issues discussed during a roundtable meeting.
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Affiliation(s)
- Robert A Wise
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Antonio R Anzueto
- University of Texas Health Science Center, and South Texas Veterans Health Care System, San Antonio, Texas
| | - Nicola A Hanania
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Jill A Ohar
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Donald P Tashkin
- David Geffen School of Medicine at the University of California, Los Angeles
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36
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Cushen B, McCormack N, Hennigan K, Sulaiman I, Costello RW, Deering B. A pilot study to monitor changes in spirometry and lung volume, following an exacerbation of Chronic Obstructive Pulmonary Disease (COPD), as part of a supported discharge program. Respir Med 2016; 119:55-62. [PMID: 27692148 DOI: 10.1016/j.rmed.2016.08.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 08/16/2016] [Accepted: 08/21/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND One-third of patients with an exacerbation of Chronic Obstructive Pulmonary Disease(COPD) are re-hospitalised at 90 days. Exacerbation recovery is associated with reductions in lung hyperinflation and improvements in symptoms and physical activity. We assessed the feasibility of monitoring these clinical parameters in the home. We hypothesised that the degree of change in spirometry and lung volumes differs between those who had an uneventful recovery and those who experienced a further exacerbation. METHODS Hospitalised patients with an acute exacerbation of COPD referred for a supported discharge program participated in the study. Spirometry and Inspiratory Vital Capacity(IVC) were measured in the home at Days 1, 14 and 42 post-discharge. Patients also completed Medical Research Council(MRC), Borg and COPD Assessment Test(CAT) scores and were provided with a tri-axial accelerometer. Any new exacerbation events were recorded. RESULTS Sixty-five patients with 72 exacerbation episodes were recruited. Fifty percent experienced a second exacerbation. Adequate IVC measurements were achieved by 90%, while only 70% completed spirometry. Uneventful recovery was accompanied by significant improvements in physiological measurements at day14, improved symptom scores and step count, p < 0.05. Failure of MRC to improve was predictive of re-exacerbation(Area Under Receiver Operating Curve(AUROC) 0.6713) with improvements in FEV1≥100 ml(AUROC 0.6613) and mean daily step count ≥396 steps(AUROC 0.6381) predictive of recovery. CONCLUSION Monitoring the pattern of improvement in spirometry, lung volumes, symptoms and step count following a COPD exacerbation may help to identify patients at risk of re-exacerbation. It is feasible to carry out these assessments in the home as part of a supported discharge programme.
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Affiliation(s)
- Breda Cushen
- Royal College of Surgeons in Ireland (RCSI), Beaumont Hospital, Dublin, Ireland.
| | - Niamh McCormack
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Kerrie Hennigan
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Imran Sulaiman
- Royal College of Surgeons in Ireland (RCSI), Beaumont Hospital, Dublin, Ireland
| | - Richard W Costello
- Royal College of Surgeons in Ireland (RCSI), Beaumont Hospital, Dublin, Ireland
| | - Brenda Deering
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
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37
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Leitão Filho FS, Hang Chen H, Ngan DA, Tam A, Kirby M, Sin DD. Current methods to diagnose small airway disease in patients with COPD. Expert Rev Respir Med 2016; 10:417-429. [PMID: 26890226 DOI: 10.1586/17476348.2016.1155455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The small airways are characterized by an internal diameter < 2 mm and absence of cartilage. Approximately 10-25% of total airway resistance in healthy lungs is due to the small airways, with their contribution to total airway resistance increasing substantially in chronic obstructive pulmonary disease (COPD). As the small airways are located in the lung periphery, they are not easily evaluable, which can potentially interfere with the diagnosis (especially at early stages), monitoring, detection of responses to clinical interventions, and prognostic evaluation in COPD. Here, we will discuss the currently available methods in clinical practice to evaluate small airway disease in COPD, focusing on the concept, advantages, and disadvantages of each method.
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Affiliation(s)
- Fernando Sergio Leitão Filho
- a Centre for Heart Lung Innovation, St. Paul´s Hospital, & Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| | - Hao Hang Chen
- a Centre for Heart Lung Innovation, St. Paul´s Hospital, & Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| | - David A Ngan
- a Centre for Heart Lung Innovation, St. Paul´s Hospital, & Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| | - Anthony Tam
- a Centre for Heart Lung Innovation, St. Paul´s Hospital, & Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| | - Miranda Kirby
- a Centre for Heart Lung Innovation, St. Paul´s Hospital, & Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| | - Don D Sin
- a Centre for Heart Lung Innovation, St. Paul´s Hospital, & Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
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38
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Calverley PM, Postma DS, Anzueto AR, Make BJ, Eriksson G, Peterson S, Jenkins CR. Early response to inhaled bronchodilators and corticosteroids as a predictor of 12-month treatment responder status and COPD exacerbations. Int J Chron Obstruct Pulmon Dis 2016; 11:381-90. [PMID: 26952309 PMCID: PMC4772946 DOI: 10.2147/copd.s93303] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Early treatment response markers, for example, improvement in forced expiratory volume in 1 second (FEV1) and St George’s Respiratory Questionnaire (SGRQ) total score, may help clinicians to better manage patients with chronic obstructive pulmonary disease (COPD). We investigated the prevalence of clinically important improvements in FEV1 and SGRQ scores after 2-month budesonide/formoterol or formoterol treatment and whether such improvements predict subsequent improvements and exacerbation rates. Methods This post hoc analysis is based on data from three double-blind, randomized studies in patients with moderate-to-very-severe COPD receiving twice-daily budesonide/formoterol or formoterol alone for 6 or 12 months. Prebronchodilator FEV1 and SGRQ total score were measured before treatment and at 2 and 12 months; COPD exacerbation rates were measured during months 2–12. Responders were defined by ≥100 mL improvement in prebronchodilator FEV1 and ≥4-point decrease in SGRQ total score. Results Overall, 2,331 and 1,799 patients were included in the 0–2- and 0–12-month responder analyses, respectively, and 2,360 patients in the 2–12-month exacerbation rate analysis. At 2 months, 35.1% of patients were FEV1 responders and 44.3% were SGRQ responders. The probability of response was significantly greater with budesonide/formoterol than with formoterol or placebo for both parameters. Two-month responders had a greater chance of 12-month response than 2-month nonresponders for both FEV1 (odds ratio, 5.57; 95% confidence interval, 4.14–7.50) and SGRQ (odds ratio, 3.87; 95% confidence interval, 2.83–5.31). Two-month response in FEV1 (P<0.001), but not SGRQ (P=0.11), was associated with greater reductions in exacerbation risk. Conclusion Early FEV1 and SGRQ treatment responses relate to their changes at 12 months. FEV1 response, but not SGRQ response, at 2 months predicts the risk of a future COPD exacerbation in some, but not all patients. This is potentially useful in clinical practice, although more sensitive and specific markers of favorable treatment response are required.
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Affiliation(s)
- Peter M Calverley
- Pulmonary and Rehabilitation Research Group, University Hospital Aintree, Liverpool, UK
| | - Dirkje S Postma
- Department of Pulmonary Medicine and Tuberculosis, Gronigen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Antonio R Anzueto
- Division of Pulmonary Diseases and Critical Care Medicine, University of Texas Health Sciences Center, School of Medicine, University of Texas, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Barry J Make
- Division of Pulmonary Sciences and Critical Care Medicine, National Jewish Health, University of Colorado, Denver, CO, USA
| | - Göran Eriksson
- Department of Respiratory Medicine and Allergology, University Hospital, Lund, Sweden
| | | | - Christine R Jenkins
- George Institute for Global Health, Concord Clincal School, The University of Sydney, Sydney, NSW, Australia
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39
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Costello RW, Cushen B. A risk stratification tool for exacerbations of COPD: time to switch to DECAF. Thorax 2016; 71:489-90. [PMID: 26883673 DOI: 10.1136/thoraxjnl-2015-208053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Richard W Costello
- Department of Respiratory Medicine, Royal College of Surgeons in Ireland (RCSI), Beaumont Hospital, Dublin, Ireland
| | - Breda Cushen
- Department of Respiratory Medicine, Royal College of Surgeons in Ireland (RCSI), Beaumont Hospital, Dublin, Ireland
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40
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Buchs C, Coutier L, Vrielynck S, Jubin V, Mainguy C, Reix P. An impulse oscillometry system is less efficient than spirometry in tracking lung function improvements after intravenous antibiotic therapy in pediatric patients with cystic fibrosis. Pediatr Pulmonol 2015; 50:1073-81. [PMID: 26340567 DOI: 10.1002/ppul.23301] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 08/10/2015] [Accepted: 08/22/2015] [Indexed: 11/08/2022]
Abstract
A literature search identified one retrospective study on the responsiveness of impulse oscillometry (IOS) in pediatric patients with cystic fibrosis. The aim of this prospective observational study was to assess this property in an adequately powered study after intravenous antibiotic therapy (IVAT) administered for an acute episode of pulmonary exacerbation. Spirometry and IOS were done on the same day as the start and the end of IVAT. Data from 34 patients' of mean age 11.9 years (range, 5-17 years) were studied. The mean FEV1 at the start and at the end of the IVAT was 73.1 ± 23.8% (range, 23.4-122%) and 88.3 ± 21.3% (range, 29.4-131%), respectively. The mean relative change (mean ± SD) was 20.2 ± 14.2% for FEV1 (ΔFEV1 ), -21.9 ± 23.8% for reactance at 5 Hz (ΔX5) and -13.4 ± 18.9% for resistance at 5 Hz (Δ R5) (all P-values <0.05). There was a weak but significant correlation between ΔFEV1 and ΔX5 (r =-0.473; p = 0.01). The magnitude of improvement of ΔX5 was not statistically different between patients with normal versus abnormal lung function at the start of IVAT. Furthermore, using ΔX5 alone as an outcome measure of IVAT efficiency resulted in a significant improvement in 44% of the patients, while it was 79% with ΔFEV1 . These results indicate that IOS may track changes after IVAT, but that this improvement may be insufficiently evaluated using IOS alone.
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Affiliation(s)
- Clélia Buchs
- Centre de ressources et de compétences de la mucoviscidose, Lyon, France
| | - Laurianne Coutier
- Service d'exploration fonctionnelle respiratoire, Vandoeuvre les Nancy, France
| | - Stéphanie Vrielynck
- Centre de ressources et de compétences de la mucoviscidose, Lyon, France.,Centre de référence de la mucoviscidose, Lyon, France
| | - Virginie Jubin
- Centre de ressources et de compétences de la mucoviscidose, Lyon, France.,Centre de référence de la mucoviscidose, Lyon, France
| | - Catherine Mainguy
- Centre de ressources et de compétences de la mucoviscidose, Lyon, France.,Centre de référence de la mucoviscidose, Lyon, France
| | - Philippe Reix
- Centre de ressources et de compétences de la mucoviscidose, Lyon, France.,Centre de référence de la mucoviscidose, Lyon, France.,Service d'exploration fonctionnelle respiratoire, Lyon, France.,Université Claude Bernard Lyon 1, UMR 5558, Equipe EMET, Lyon, France
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41
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Suh ES, Mandal S, Harding R, Ramsay M, Kamalanathan M, Henderson K, O'Kane K, Douiri A, Hopkinson NS, Polkey MI, Rafferty G, Murphy PB, Moxham J, Hart N. Neural respiratory drive predicts clinical deterioration and safe discharge in exacerbations of COPD. Thorax 2015. [PMID: 26194996 PMCID: PMC4680187 DOI: 10.1136/thoraxjnl-2015-207188] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Rationale Hospitalised patients with acute exacerbation of COPD may deteriorate despite treatment, with early readmission being common. Objectives To investigate whether neural respiratory drive, measured using second intercostal space parasternal muscle electromyography (EMGpara), would identify worsening dyspnoea and physician-defined inpatient clinical deterioration, and predict early readmission. Methods Patients admitted to a single-site university hospital with exacerbation of COPD were enrolled. Spirometry, inspiratory capacity (IC), EMGpara, routine physiological parameters, modified early warning score (MEWS), modified Borg scale for dyspnoea and physician-defined episodes of deterioration were recorded daily until discharge. Readmissions at 14 and 28 days post discharge were recorded. Measurements and main results 120 patients were recruited (age 70±9 years, forced expiratory volume in 1 s (FEV1) of 30.5±11.2%). Worsening dyspnoea, defined as at least one-point increase in Borg scale, was associated with increases in EMGpara%max and MEWS, whereas an increase in EMGpara%max alone was associated with physician-defined inpatient clinical deterioration. Admission-to-discharge change (Δ) in the normalised value of EMGpara (ΔEMGpara%max) was inversely correlated with ΔFEV1 (r=−0.38, p<0.001) and ΔIC (r=−0.44, p<0.001). ΔEMGpara%max predicted 14-day readmission (OR 1.13, 95% 1.03 to 1.23) in the whole cohort and 28-day readmission in patients under 85 years (OR 1.09, 95% CI 1.01 to 1.18). Age (OR 1.08, 95% CI 1.03 to 1.14) and 12-month admission frequency (OR 1.29, 1.01 to 1.66), also predicted 28-day readmission in the whole cohort. Conclusions Measurement of neural respiratory drive by EMGpara represents a novel physiological biomarker that may be helpful in detecting inpatient clinical deterioration and identifying the risk of early readmission among patients with exacerbations of COPD. Trial registration NCT01361451.
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Affiliation(s)
- Eui-Sik Suh
- Lane Fox Respiratory Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
| | - Swapna Mandal
- Lane Fox Respiratory Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
| | - Rachel Harding
- Lane Fox Respiratory Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Michelle Ramsay
- Lane Fox Respiratory Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
| | - Meera Kamalanathan
- Lane Fox Respiratory Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Kevin O'Kane
- Department of Acute Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Abdel Douiri
- Division of Health and Social Care Research, King's College London, London, UK
| | - Nicholas S Hopkinson
- NIHR Respiratory Biomedical Research Unit at the Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Michael I Polkey
- NIHR Respiratory Biomedical Research Unit at the Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Gerrard Rafferty
- Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
| | - Patrick B Murphy
- Lane Fox Respiratory Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
| | - John Moxham
- Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
| | - Nicholas Hart
- Lane Fox Respiratory Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
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42
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Rossi A, Aisanov Z, Avdeev S, Di Maria G, Donner CF, Izquierdo JL, Roche N, Similowski T, Watz H, Worth H, Miravitlles M. Mechanisms, assessment and therapeutic implications of lung hyperinflation in COPD. Respir Med 2015; 109:785-802. [DOI: 10.1016/j.rmed.2015.03.010] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 03/04/2015] [Accepted: 03/23/2015] [Indexed: 02/05/2023]
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43
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Jetmalani K, Timmins S, Brown NJ, Diba C, Berend N, Salome CM, Wen FQ, Chen P, King GG, Farah CS. Expiratory flow limitation relates to symptoms during COPD exacerbations requiring hospital admission. Int J Chron Obstruct Pulmon Dis 2015; 10:939-45. [PMID: 25999709 PMCID: PMC4437522 DOI: 10.2147/copd.s78332] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Expiratory flow limitation (EFL) is seen in some patients presenting with a COPD exacerbation; however, it is unclear how EFL relates to the clinical features of the exacerbation. We hypothesized that EFL when present contributes to symptoms and duration of recovery during a COPD exacerbation. Our aim was to compare changes in EFL with symptoms in subjects with and without flow-limited breathing admitted for a COPD exacerbation. Subjects and methods A total of 29 subjects with COPD were recruited within 48 hours of admission to West China Hospital for an acute exacerbation. Daily measurements of post-bronchodilator spirometry, resistance, and reactance using the forced oscillation technique and symptom (Borg) scores until discharge were made. Flow-limited breathing was defined as the difference between inspiratory and expiratory respiratory system reactance (EFL index) greater than 2.8 cmH2O·s·L−1. The physiological predictors of symptoms during recovery were determined by mixed-effect analysis. Results Nine subjects (31%) had flow-limited breathing on admission despite similar spirometry compared to subjects without flow-limited breathing. Spirometry and resistance measures did not change between enrolment and discharge. EFL index values improved in subjects with flow-limited breathing on admission, with resolution in four patients. In subjects with flow-limited breathing on admission, symptoms were related to inspiratory resistance and EFL index values. In subjects without flow-limited breathing, symptoms related to forced expiratory volume in 1 second/forced vital capacity. In the whole cohort, EFL index values at admission was related to duration of stay (Rs=0.4, P=0.03). Conclusion The presence of flow-limited breathing as well as abnormal respiratory system mechanics contribute independently to symptoms during COPD exacerbations.
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Affiliation(s)
- Kanika Jetmalani
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia ; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Sophie Timmins
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia ; Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, NSW, Australia ; Cooperative Research Centre for Asthma and Airways, George Institute of Global Health, Sydney, NSW, Australia
| | - Nathan J Brown
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia ; Cooperative Research Centre for Asthma and Airways, George Institute of Global Health, Sydney, NSW, Australia
| | - Chantale Diba
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia ; Cooperative Research Centre for Asthma and Airways, George Institute of Global Health, Sydney, NSW, Australia
| | - Norbert Berend
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia ; Cooperative Research Centre for Asthma and Airways, George Institute of Global Health, Sydney, NSW, Australia ; Department of Respiratory Research, George Institute of Global Health, Sydney, NSW, Australia
| | - Cheryl M Salome
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia ; Sydney Medical School, University of Sydney, Sydney, NSW, Australia ; Cooperative Research Centre for Asthma and Airways, George Institute of Global Health, Sydney, NSW, Australia
| | - Fu-Qiang Wen
- Department of Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Peng Chen
- Department of Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Gregory G King
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia ; Sydney Medical School, University of Sydney, Sydney, NSW, Australia ; Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, NSW, Australia ; Cooperative Research Centre for Asthma and Airways, George Institute of Global Health, Sydney, NSW, Australia
| | - Claude S Farah
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia ; Sydney Medical School, University of Sydney, Sydney, NSW, Australia ; Department of Respiratory Medicine, Concord Hospital, Sydney, NSW, Australia
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McNulty W, Usmani OS. Techniques of assessing small airways dysfunction. Eur Clin Respir J 2014; 1:25898. [PMID: 26557240 PMCID: PMC4629724 DOI: 10.3402/ecrj.v1.25898] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 09/11/2014] [Indexed: 11/17/2022] Open
Abstract
The small airways are defined as those less than 2 mm in diameter. They are a major site of pathology in many lung diseases, not least chronic obstructive pulmonary disease (COPD) and asthma. The small airways are frequently involved early in the course of these diseases, with significant pathology demonstrable often before the onset of symptoms or changes in spirometry and imaging. Despite their importance, they have proven relatively difficult to study. This is in part due to their relative inaccessibility to biopsy and their small size which makes their imaging difficult. Traditional lung function tests may only become abnormal once there is a significant burden of disease within them. This has led to the term 'the quiet zone' of the lung. In recent years, more specialised tests have been developed which may detect these changes earlier, perhaps offering the possibility of earlier diagnosis and intervention. These tests are now moving from the realms of clinical research laboratories into routine clinical practice and are increasingly useful in the diagnosis and monitoring of respiratory diseases. This article gives an overview of small airways physiology and some of the routine and more advanced tests of airway function.
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Affiliation(s)
- William McNulty
- National Heart and lung Institute, Imperial College London and Royal Brompton Hospital, London, UK
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Langer D, Ciavaglia CE, Neder JA, Webb KA, O'Donnell DE. Lung hyperinflation in chronic obstructive pulmonary disease: mechanisms, clinical implications and treatment. Expert Rev Respir Med 2014; 8:731-49. [PMID: 25159007 DOI: 10.1586/17476348.2014.949676] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Lung hyperinflation is highly prevalent in patients with chronic obstructive pulmonary disease and occurs across the continuum of the disease. A growing body of evidence suggests that lung hyperinflation contributes to dyspnea and activity limitation in chronic obstructive pulmonary disease and is an important independent risk factor for mortality. In this review, we will summarize the recent literature on pathogenesis and clinical implications of lung hyperinflation. We will outline the contribution of lung hyperinflation to exercise limitation and discuss its impact on symptoms and physical activity. Finally, we will examine the physiological rationale and efficacy of selected pharmacological and non-pharmacological 'lung deflating' interventions aimed at improving symptoms and physical functioning.
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Affiliation(s)
- Daniel Langer
- Respiratory Investigation Unit, Queen's University & Kingston General Hospital, 102 Stuart Street, Kingston, ON K7L 2V6, Canada
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46
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Dose-toxicity relationship of gadoxetate disodium and transient severe respiratory motion artifact. AJR Am J Roentgenol 2014; 203:796-802. [PMID: 25055154 DOI: 10.2214/ajr.13.11587] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The purpose of this article is to determine whether there is a dose-toxicity relationship between gadoxetate disodium and transient severe respiratory motion artifact. MATERIALS AND METHODS Gadoxetate disodium-enhanced MRI studies (559 studies of 559 patients) using a fixed 20-mL (2 mL/s; n = 112) or 10-mL (1-2 mL/s; n = 447) volume at two health systems were included (dose range, 0.05-0.42 mL/kg; mean, 0.15 mL/kg; above-label dosing, 479 [86%]). Each dynamic phase was assigned a respiratory motion score from 1 (none) to 5 (nondiagnostic). Examinations with an unenhanced score of 1-2, arterial score of 4-5, and venous or late-dynamic scores of 1-3 were labeled as transient severe respiratory motion artifact. Stepwise multivariate logistic regression was performed. RESULTS The overall incidence of transient severe respiratory motion artifact was 12% (67/559; site 1, 15% [35/232]; site 2, 9.8% [32/327]). The administered volume of contrast material had a statistically significant effect (20 mL, 20% [22/112] vs 10 mL, 10%, [45/447]; multivariate p = 0.01; odds ratio, 2.1 [20 vs 10 mL]; 95% CI, 1.2-3.7). There was no dose-toxicity relationship for dose-by-weight (p = 0.61 [multivariate]) or above-label dosing (p = 0.88 [univariate]; 13% [10/80] rate for at- or below-label dosing vs 12% [57/479] rate for above-label dosing). Chronic obstructive pulmonary disease was the only non-dose-related predictor in the multivariate model (p < 0.0001; OR, 5.1 [95% CI, 2.5-11.5]; 39% [12/31] vs 10% [55/528]). CONCLUSION Gadoxetate disodium-associated transient severe respiratory motion artifact is significantly more common after 20-mL administration (2 mL/s) and occurs significantly more often in patients with chronic obstructive pulmonary disease. The volume-related effect suggests a nonallergiclike mechanism.
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47
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Dynamics of inflammation resolution and symptom recovery during AECOPD treatment. Sci Rep 2014; 4:5516. [PMID: 24980048 PMCID: PMC4076675 DOI: 10.1038/srep05516] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 06/13/2014] [Indexed: 11/25/2022] Open
Abstract
The association between increases in both systemic and airway inflammation and acute exacerbation of COPD (AECOPD) has been reported by many studies. However, relatively little is known about the dynamics of inflammation resolution and their correlations with the improvement of clinical indices during treatment. In this study, a total of 93 consecutively hospitalized patients with AECOPD were recruited. Sputum and serum inflammatory markers were measured on the day of admission before treatment (day 0), day 4, 7 and 14 during treatment as well as 8 weeks after discharge. Clinical indices (lung function, dyspnea and COPD assessment test (CAT) scores) were also measured at those time points. By day 4, all airway inflammatory measures rapidly decreased and returned to baseline level. Notably, lung function and dyspnea improved to the baseline level by day 4 as well, consistent with the resolution of respiratory inflammation. However, despite the significant decrease by day 4, systemic inflammation did not reach baseline until day 14, concordant with the decrease in CAT score. In summary, we observed a time lag between the resolution of systemic and airway inflammation, which were correlated with the improvements of different clinical indices.
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Abstract
The appropriate management of chronic obstructive pulmonary disease (COPD) involves more than taking prescription medicines. The key components have been set out in detail in many treatment guidelines, both national and international. They include the avoidance of identified risk factors, especially tobacco smoking, and the optimization of daily physical activity. This article reviews the key components of the pharmacologic treatment of COPD, both acute and chronic, with an emphasis on those recent studies, which are likely to change practice in the next few years.
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Affiliation(s)
- Peter Calverley
- Respiratory Research, Clinical Sciences Department, Institute of Ageing & Chronic Diseases, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, UK.
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Laveneziana P, Guenette JA, Webb KA, O’Donnell DE. New physiological insights into dyspnea and exercise intolerance in chronic obstructive pulmonary disease patients. Expert Rev Respir Med 2014; 6:651-62. [DOI: 10.1586/ers.12.70] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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50
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O'Donnell DE, Laveneziana P, Webb K, Neder JA. Chronic obstructive pulmonary disease: clinical integrative physiology. Clin Chest Med 2013; 35:51-69. [PMID: 24507837 DOI: 10.1016/j.ccm.2013.09.008] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Peripheral airway dysfunction, inhomogeneous ventilation distribution, gas trapping, and impaired pulmonary gas exchange are variably present in all stages of chronic obstructive pulmonary disease (COPD). This article provides a cogent physiologic explanation for the relentless progression of activity-related dyspnea and exercise intolerance that all too commonly characterizes COPD. The spectrum of physiologic derangements that exist in smokers with mild airway obstruction and a history compatible with COPD is examined. Also explored are the perceptual and physiologic consequences of progressive erosion of the resting inspiratory capacity. Finally, emerging information on the role of cardiocirculatory impairment in contributing to exercise intolerance in patients with varying degrees of airway obstruction is reviewed.
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Affiliation(s)
- Denis E O'Donnell
- Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, 102 Stuart Street, Kingston, Ontario K7L 2V6, Canada.
| | - Pierantonio Laveneziana
- Service d'Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée Hôpital Universitaire Pitié-Salpêtrière (AP-HP), Laboratoire de Physio-Pathologie Respiratoire, Faculty of Medicine, Pierre et Marie Curie University (Paris VI), 47-83 Boulevard de l'Hôpital,75013 Paris, France
| | - Katherine Webb
- Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, 102 Stuart Street, Kingston, Ontario K7L 2V6, Canada
| | - J Alberto Neder
- Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, 102 Stuart Street, Kingston, Ontario K7L 2V6, Canada
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