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Wyatt ML, Sokolow AG, Brown RF, Kaslow JA, Tolle JJ, Weiner DJ, Rosas-Salazar C. Prevalence, stability, and clinical significance of an isolated low FEV 1 spirometry pattern in children. Pediatr Pulmonol 2024; 59:1747-1756. [PMID: 38558514 DOI: 10.1002/ppul.26987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/01/2024] [Accepted: 03/13/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES In adults, an isolated low FEV1 pattern (an FEV1 below the lower limit of normal with a preserved FVC and FEV1/FVC) has been associated with the risk of developing airway obstruction. Our objective was to examine the prevalence, stability, and clinical significance of an isolated low FEV1 pattern in the pediatric population. METHODS We conducted a retrospective study of spirometries from children ages 6-21 years and categorized tests into spirometry patterns according to published guidelines and recent literature. In a subgroup of tests with an isolated low FEV1 pattern, we evaluated spirometry technique. We also examined the association of having a test with an isolated low FEV1 pattern with clinical markers of disease severity in a subgroup of children with cystic fibrosis (CF). RESULTS The isolated low FEV1 pattern was uncommon across the 29,979 tests included (n = 645 [2%]). In the 263 children with an isolated low FEV1 pattern who had a follow-up test performed, the most frequent spirometry pattern at last test was normal (n = 123 [47%]). A primary diagnosis of CF was associated with increased odds of having at least one test with an isolated low FEV1 pattern (OR = 8.37, 95% CI = 4.70-15.96, p < .001). The spirometry quality in a subgroup of tests with an isolated low FEV1 pattern (n = 50) was satisfactory. In the subgroup of children with CF (n = 102), those who had a test with an isolated low FEV1 pattern had higher odds of using oral antibiotics in the last 12 months than those who had a normal pattern (OR = 3.50, 95% CI = 1.15-10.63, p = .03). CONCLUSIONS The isolated low FEV1 pattern can occur repeatedly over time, usually transitions to a normal pattern, is not due to a poor spirometry technique, and could be clinically relevant in children with chronic lung diseases.
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Affiliation(s)
- MacKenzie L Wyatt
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Andrew G Sokolow
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rebekah F Brown
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jacob A Kaslow
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James J Tolle
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel J Weiner
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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2
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Houdouin V, Dubus JC, Crepon SG, Rialland F, Bruno B, Jubert C, Reix P, Pasquet M, Paillard C, Adjaoud D, Schweitzer C, Le Bourgeois M, Pages J, Yacoubi A, Dalle JH, Bergeron A, Delclaux C. Late-onset pulmonary complications following allogeneic hematopoietic cell transplantation in pediatric patients: a prospective multicenter study. Bone Marrow Transplant 2024; 59:858-866. [PMID: 38454132 DOI: 10.1038/s41409-024-02258-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/24/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
The primary objective of our multicenter prospective study was to describe the incidence of late-onset non-infectious pulmonary complications (LONIPCs) in children undergoing hematopoietic cell transplantation (HCT) using sensitive criteria for pulmonary function test (PFT) abnormalities including the non-specific pattern of airflow obstruction. Secondary objectives were to assess the factors associated with LONIPC occurrence and the sensitivity of the 2014 NIH-Consensus Criteria of bronchiolitis obliterans syndrome (BOS). PFT and clinical assessment were performed prior to HCT and at 6, 12, 24, and 36 months post-HCT. LONIPC diagnosis was validated by an Adjudication Committee. The study comprised 292 children from 12 centers. Thirty-two individuals (11%, 95% CI: 8-15%) experienced 35 LONIPCs: 25 BOS, 4 interstitial lung diseases, 4 organizing pneumonia and 2 pulmonary veno-occlusive diseases. PFT abnormalities were obstructive defects (FEV1/FVC z-score < -1.645; n = 12), restrictive defects (TLC < 80% predicted, FEV1 and FVC z-scores < -1.645; n = 7) and non-specific pattern (FEV1 and FVC z-score< -1.645, FEV1/FVC z-score > -1.645, and TLC > 80% predicted; n = 8). HCT for malignant disease was the only factor associated with LONIPC (P = 0.04). The 2014 NIH-Consensus Criteria would only diagnose 8/25 participants (32%) as having BOS. In conclusion, 11% of children experienced a LONIPC in a prospective design. Clinical Trials.gov identifier (NCT number): NCT02032381.
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Affiliation(s)
- Véronique Houdouin
- Université de Paris Cité, AP-HP, Hôpital Robert Debré, Service de Pneumopédiatrie, RESPIRARE, INSERM U976, Paris, France.
| | - Jean Christophe Dubus
- Université Aix-Marseille, AP-HM, Hôpital universitaire Timone-Enfants, Service de Pneumopédiatrie, MEPHI, Méditerranée-Infection, Marseille, France
| | - Sophie Guilmin Crepon
- AP-HP, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, Inserm, CIC-EC 1426, Paris, France
| | - Fanny Rialland
- Hôpital de la mère et l'enfant, Service d'hématologie pédiatrique, Nantes, France
| | - Bénedicte Bruno
- Hôpital Jeanne de Flandre, Service d'hématologie pédiatrique, Lille, France
| | - Charlotte Jubert
- Centre hospitalo-universitaire de Bordeaux, Service d'hématologie pédiatrique, Bordeaux, France
| | - Philippe Reix
- Université Lyon 1, Hôpital Femme Mère Enfant, Service de pneumologie, allergologie, mucoviscidose, CNRS, Laboratoire de Biométrie et biologie Evolutive UMR, 5558, Villeurbanne, France
| | - Marlène Pasquet
- Centre hospitalo-universitaire de Toulouse Purpan, Hôpital des enfants, Service d'immuno-hémato-oncologie pédiatrique, INSERM U1037, Toulouse, France
| | - Catherine Paillard
- Centre hospitalo-universitaire de Strasbourg, Service d'hématologie pédiatrique, Strasbourg, France
| | - Dalila Adjaoud
- Centre hospitalo-universitaire de Grenoble, Service d'hématologie pédiatrique, Grenoble, France
| | - Cyril Schweitzer
- Centre hospitalo-universitaire de Nancy, Service de Physiologie respiratoire Pédiatrique, Nancy, France
| | - Muriel Le Bourgeois
- AP-HP, Hôpital Necker Enfants Malades, Service de pneumologie pédiatrique, Paris, France
| | - Justine Pages
- AP-HP, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, Inserm, CIC-EC 1426, Paris, France
| | - Adyla Yacoubi
- AP-HP, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, Inserm, CIC-EC 1426, Paris, France
| | - Jean Hugues Dalle
- Université de Paris Cité, AP-HP, Hôpital Robert Debré, Service d'hématologie pédiatrique, Paris, France
| | - Anne Bergeron
- Université de Genève, Hôpitaux Universitaires de Genève, Genève, Suisse
| | - Christophe Delclaux
- Université de Paris Cité, AP-HP, Hôpital Robert Debré, Service de Physiologie Pédiatrique -Centre du Sommeil, INSERM NeuroDiderot, Paris, France
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3
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Beverin L, Topalovic M, Halilovic A, Desbordes P, Janssens W, De Vos M. Predicting total lung capacity from spirometry: a machine learning approach. Front Med (Lausanne) 2023; 10:1174631. [PMID: 37275373 PMCID: PMC10238228 DOI: 10.3389/fmed.2023.1174631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 04/13/2023] [Indexed: 06/07/2023] Open
Abstract
Background and objective Spirometry patterns can suggest that a patient has a restrictive ventilatory impairment; however, lung volume measurements such as total lung capacity (TLC) are required to confirm the diagnosis. The aim of the study was to train a supervised machine learning model that can accurately estimate TLC values from spirometry and subsequently identify which patients would most benefit from undergoing a complete pulmonary function test. Methods We trained three tree-based machine learning models on 51,761 spirometry data points with corresponding TLC measurements. We then compared model performance using an independent test set consisting of 1,402 patients. The best-performing model was used to retrospectively identify restrictive ventilatory impairment in the same test set. The algorithm was compared against different spirometry patterns commonly used to predict restriction. Results The prevalence of restrictive ventilatory impairment in the test set is 16.7% (234/1402). CatBoost was the best-performing machine learning model. It predicted TLC with a mean squared error (MSE) of 560.1 mL. The sensitivity, specificity, and F1-score of the optimal algorithm for predicting restrictive ventilatory impairment was 83, 92, and 75%, respectively. Conclusion A machine learning model trained on spirometry data can estimate TLC to a high degree of accuracy. This approach could be used to develop future smart home-based spirometry solutions, which could aid decision making and self-monitoring in patients with restrictive lung diseases.
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Affiliation(s)
- Luka Beverin
- Statistics Research Centre, KU Leuven, Leuven, Belgium
| | | | | | | | - Wim Janssens
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases Metabolism and Ageing, Ku Leuven, Leuven, Belgium
| | - Maarten De Vos
- ArtiQ NV, Leuven, Belgium
- Stadius, Department of Electrical Engineering, KU Leuven, Leuven, Belgium
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4
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Hardie W, Powell AW, Jenkins TM, Foster K, Tretter JT, Fleck RJ, Garcia VF, Brown RL. Ventilatory limitations are not associated with dyspnea on exertion or reduced aerobic fitness in pectus excavatum. Pediatr Pulmonol 2021; 56:2911-2917. [PMID: 34143574 DOI: 10.1002/ppul.25540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/22/2021] [Accepted: 06/13/2021] [Indexed: 11/12/2022]
Abstract
Exercise intolerance and chest pain are common symptoms in patients with pectus excavatum. To assess if the anatomic extent of pectus deformities determined by the correction index (CI) is associated with a pulmonary impairment at rest and during exercise we performed a retrospective review on pectus patients in our center who completed a symptom questionnaire, cardiopulmonary exercise test (CPET), pulmonary function tests (PFT), and chest magnetic resonance imaging. Of 259 patients studied, dyspnea on exertion and chest pain was reported in 64% and 41%, respectively. Peak oxygen uptake (VO2 ) was reduced in 30% and classified as mild in two-thirds. A pulmonary limitation during exercise was identified in less than 3%. Ventilatory limitations on PFT was found in 26% and classified as mild in 85%. Obstruction was the most common abnormal pattern (11%). There were no differences between patients with normal or abnormal PFT patterns for the CI, VO2, or percentage reporting dyspnea or chest pain. Scatter plots demonstrated significant but weak inverse relationships between the CI and lung volumes at rest and during exercise. Multivariable linear regression modeling evaluating predictors of VO2 demonstrated positive associations with the forced expiratory volume at one second and a negative association with the CI. We conclude that resting PFT patterns have poor correlation with the anatomic extent of the pectus defect, symptomatology or aerobic fitness. Pulmonary limitations on CPET are uncommon and lung volumes during exercise are only minimally associated with the CI.
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Affiliation(s)
- William Hardie
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Adam W Powell
- Division of Cardiology, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Todd M Jenkins
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Karla Foster
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Justin T Tretter
- Division of Cardiology, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Robert J Fleck
- Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Victor F Garcia
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Rebeccah L Brown
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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5
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Pérez-Padilla R, Gochicoa-Rangel L, Thirión-Romero I. Measuring Lung Volumes in an Office With a New Device Body-Box Free. Chest 2021; 159:2143-2144. [PMID: 34099122 DOI: 10.1016/j.chest.2021.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 10/21/2022] Open
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6
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Dufetelle E, Mulier G, Taytard J, Boizeau P, Le Roux E, Beydon N. Peripheral obstruction without airflow limitation is rare and not specific to asthma in children. Pediatr Pulmonol 2021; 56:858-865. [PMID: 33369239 DOI: 10.1002/ppul.25222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/01/2020] [Accepted: 12/05/2020] [Indexed: 11/10/2022]
Abstract
Peripheral (or small) airway obstruction (PAO) is considered a marker of childhood asthma but the techniques able to directly measure it are rarely used in routine. Usual spirometry and plethysmography can detect a certain degree of PAO when reduced forced vital capacity (FVC) is associated to normal forced expiratory volume in 1 s (FEV1 ) to FVC ratio, and normal total lung capacity (TLC). The frequency of this functional pattern has never been studied in different pediatric respiratory conditions. To assess the prevalence and outcome of PAO in children with different diseases or symptoms, we retrospectively extracted from our database all files of Caucasian subjects encompassing spirometry and plethysmography measurements. Spirometry patterns (normal, airflow limitation [AFL; low FEV1 /FVC], low FVC [with normal FEV1 /FVC]) and final functional patterns (normal, AFL, PAO, restrictive [low TLC], or mixed) were described. We included 4394 files recorded in 1794 children (median [IQR] age: 10.7 [9.2-12.9] years). At inclusion, 125 (7%) children had low FVC of which 56 (44.8%, and 3.1% [95% CI 2.3-3.9] of the whole population) had PAO. PAO prevalence increased with age (OR (95% CI) per 2-year-increase: 2.26 (1.59-3.23); p < .001), and was more frequent in chronic bronchial diseases other than asthma (1.6% vs. 8.0%). On repeated tests, PAO frequently normalized (26.1%) or persisted (43.5%), but it less often progressed into AFL (13%) or restrictive (13%) patterns. PAO is an infrequent nonspecific and persistent functional pattern. Its prevalence increases with age and in diagnosis of chronic respiratory diseases other than asthma.
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Affiliation(s)
- Edouard Dufetelle
- Unité d'Exploration Fonctionnelle Respiratoire, Service de Physiologie, APHP, Hôpital Armand-Trousseau, Paris, France
| | - Guillaume Mulier
- Unité d'épidémiologie Clinique, AP-HP. Hôpital Universitaire Robert Debré, Paris, France.,Inserm CIC 1426, F-75019, Nord Université de Paris, Paris, France
| | - Jessica Taytard
- Service de Pneumologie pédiatrique, Centre National de Référence des Maladies Respiratoires Rares, AP-HP, Hôpital Trousseau, Paris, France.,INSERM, UMR-S 1158, Sorbonne Université, Paris, France
| | - Priscilla Boizeau
- Unité d'épidémiologie Clinique, AP-HP. Hôpital Universitaire Robert Debré, Paris, France.,Inserm CIC 1426, F-75019, Nord Université de Paris, Paris, France
| | - Enora Le Roux
- Unité d'épidémiologie Clinique, AP-HP. Hôpital Universitaire Robert Debré, Paris, France.,Inserm CIC 1426, F-75019, Nord Université de Paris, Paris, France
| | - Nicole Beydon
- Unité d'Exploration Fonctionnelle Respiratoire, Service de Physiologie, APHP, Hôpital Armand-Trousseau, Paris, France.,INSERM U 938, Centre de Recherche Saint Antoine, Sorbonne Université, Paris, France
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7
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Skloot GS, O'Connor-Chapman KL, Schechter CB, Markley DJ, Bates JHT. Forced expiratory time: a composite of airway narrowing and airway closure. J Appl Physiol (1985) 2020; 130:80-86. [PMID: 33090909 DOI: 10.1152/japplphysiol.00556.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Forced expiratory time (FET) is a spirometrically derived variable thought to reflect lung function, but its physiological basis remains poorly understood. We developed a mathematical theory of FET assuming a linear forced expiratory flow-volume profile that terminates when expiratory flow falls below a defined detection threshold. FET is predicted to correlate negatively with both FEV1 and FVC if variations in the rate of lung emptying (relative to normal) among individuals in a population exceed variations in the amount of lung emptying. We retrospectively determined FET pre- and postmethacholine challenge in 1,241 patients (818 had normal lung function, 137 were obstructed, and 229 were restricted) and examined its relationships to spirometric and demographic variables in both hyperresponsive and normoresponsive individuals. Mean FET was 9.6 ± 2.2 s in the normal group, 12.3 ± 3.0 s in those with obstruction, and 8.8 ± 1.9 s in those with restriction. FET was inversely related to FEV1/FVC in all groups, negatively related to FEV1 in the obstructed patients, and positively related to FVC in both the normal and restricted patients. There was no relationship with methacholine responsiveness. Overall, our theory of the relationship between FET to the spirometric indices is supported by these findings and potentially explains how FET is affected by sex, age, smoking status, and possibly body mass index.NEW & NOTEWORTHY Forced expiratory time (FET) has long been felt to reflect important physiological information about lung function but exactly how has never been clear. Here, we use a model analysis to assess the contributions of airway narrowing versus airway closure to FET in a population of individuals and find support for the theory that FET correlates positively with FEV1 if the amounts of lung emptying over a forced expiration vary from predicted values more than variations in the rates of lung emptying, whereas the correlation is negative in the opposite case.
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Affiliation(s)
- Gwen S Skloot
- The Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kieley L O'Connor-Chapman
- The Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Clyde B Schechter
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Daniel J Markley
- The Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jason H T Bates
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont
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8
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Weber J, Reeves AP, Doucette JT, Jeon Y, Sood A, San José Estépar R, Celedón JC, de la Hoz RE. Quantitative CT Evidence of Airway Inflammation in WTC Workers and Volunteers with Low FVC Spirometric Pattern. Lung 2020; 198:555-563. [PMID: 32239319 DOI: 10.1007/s00408-020-00350-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/23/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The most common abnormal spirometric pattern reported in WTC worker and volunteer cohorts has consistently been that of a nonobstructive reduced forced vital capacity (low FVC). Low FVC is associated with obesity, which is highly prevalent in these cohorts. We used quantitative CT (QCT) to investigate proximal and distal airway inflammation and emphysema in participants with stable low FVC pattern. METHODS We selected study participants with at least two available longitudinal surveillance spirometries, and a chest CT with QCT measurements of proximal airway inflammation (wall area percent, WAP), end-expiratory air trapping, suggestive of distal airway obstruction (expiratory to inspiratory mean lung attenuation ratio, MLAEI), and emphysema (percentage of lung volume with attenuation below - 950 HU, LAV%). The comparison groups in multinomial logistic regression models were participants with consistently normal spirometries, and participants with stable fixed obstruction (COPD). RESULTS Compared to normal spirometry participants, and after adjusting for age, sex, race/ethnicity, BMI, smoking, and early arrival at the WTC disaster site, low FVC participants had higher WAP (ORadj 1.24, 95% CI 1.06, 1.45, per 5% unit), suggestive of proximal airway inflammation, but did not differ in MLAEI, or LAV%. COPD participants did not differ in WAP with the low FVC ones and were more likely to have higher MLAEI or LAV% than the other two subgroups. DISCUSSION WTC workers with spirometric low FVC have higher QCT-measured WAP compared to those with normal spirometries, but did not differ in distal airway and emphysema measurements, independently of obesity, smoking, and other covariates.
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Affiliation(s)
- Jonathan Weber
- Department of Research and Education, Saint Francis Hospital, Roslyn, NY, USA
| | - Anthony P Reeves
- School of Electrical and Computer Engineering, Cornell University, Ithaca, NY, USA
| | - John T Doucette
- Department of Environmental Medicine and Public Health, Icahn School of Medicine At Mount Sinai, New York, NY, USA
| | - Yunho Jeon
- Department of Environmental Medicine and Public Health, Icahn School of Medicine At Mount Sinai, New York, NY, USA
| | - Akshay Sood
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | | | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rafael E de la Hoz
- Department of Environmental Medicine and Public Health, Icahn School of Medicine At Mount Sinai, New York, NY, USA. .,Department of Medicine, Icahn School of Medicine At Mount Sinai, New York, NY, USA. .,Division of Occupational Medicine, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, WTC HP CCE Box 1059, New York, NY, 10029, USA.
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9
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Delclaux C. No need for pulmonologists to interpret pulmonary function tests. Eur Respir J 2019; 54:54/1/1900829. [DOI: 10.1183/13993003.00829-2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 05/29/2019] [Indexed: 11/05/2022]
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10
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Delclaux C, Laveneziana P, Garcia G, Ninot G, Roche N, Morelot-Panzini C. [Pulmonary function testing of dyspnea complaint by the pulmonologist]. Rev Mal Respir 2019; 36:484-494. [PMID: 31010751 DOI: 10.1016/j.rmr.2019.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 06/11/2018] [Indexed: 12/01/2022]
Abstract
Dyspnea results from an imbalance between ventilatory demand (linked to CO2 production, PaCO2 set-point and wasted ventilation-physiological dead space) and ventilatory capacity (linked to passive-compliance, resistance-and active-respiratory muscles-components of the respiratory system). Spirometry and static lung volumes investigate ventilatory capacity only. Ventilatory demand (increased for instance in all pulmonary vascular diseases due to increased physiological dead space) is not evaluated by these routine measurements. DLCO measurement, which evaluates both demand and capacity, depicts the best statistical correlation to dyspnea, for instance in obstructive and interstitial pulmonary diseases. Dyspnea has multiple domains and is inherently complex and weakly explained by resting investigations: explained variance is below 50%. The diagnostic strategy investigating dyspnea has to distinguish complaints related or not to exercise because dyspnea can occur independently from any effort. Cardiopulmonary exercise testing (V'O2, V'CO2, V'E and operating lung volumes measurements) allows the assessment of underlying pathophysiological mechanisms leading to functional impairment and can contribute to unmask potential underlying mechanisms of unexplained dyspnea although its "etiological diagnostic value" for dyspnea remains a challenging issue.
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Affiliation(s)
- C Delclaux
- AP-HP, hôpital Robert-Debré, service de physiologie pédiatrique, Paris, France; Inserm UMR1141, université Paris-Diderot, France.
| | - P Laveneziana
- Sorbonne universités, UPMC Université Paris 06, Inserm, UMRS 1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France; AP-HP, groupe hospitalier Pitié-Salpêtrière Charles-Foix, service des explorations fonctionnelles de la respiration, de l'exercice et de la dyspnée (département «R3S», pôle PRAGUES), Paris, France
| | - G Garcia
- AP-HP, service de Physiologie, explorations fonctionnelles respiratoires, hôpital Bicêtre, France; Université Paris-Saclay, Le Kremlin-Bicêtre, France; Inserm UMR S 999, hôpital Marie-Lannelongue, Le Plessis-Robinson, France
| | - G Ninot
- CEPS Platform, université de Montpellier, France
| | - N Roche
- AP-HP, service de pneumologie et soins intensifs respiratoires, hôpital Cochin, Paris; Université Paris Descartes (EA2511), Paris, France
| | - C Morelot-Panzini
- Sorbonne universités, UPMC Université Paris 06, Inserm, UMRS 1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France; AP-HP, groupe hospitalier Pitié-Salpêtrière Charles-Foix, service de pneumologie et réanimation médicale (département «R3S»), 75013, Paris, France
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11
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Aggarwal AN, Agarwal R, Dhooria S, Prasad KT, Sehgal IS, Muthu V, Singh N, Behera D, Jindal SK, Singh V, Chawla R, Samaria JK, Gaur SN, Agrawal A, Chhabra SK, Chopra V, Christopher DJ, Dhar R, Ghoshal AG, Guleria R, Handa A, Jain NK, Janmeja AK, Kant S, Khilnani GC, Kumar R, Mehta R, Mishra N, Mohan A, Mohapatra PR, Patel D, Ram B, Sharma SK, Singla R, Suri JC, Swarnakar R, Talwar D, Narasimhan RL, Maji S, Bandopadhyay A, Basumatary N, Mukherjee A, Baldi M, Baikunje N, Kalpakam H, Upadhya P, Kodati R. Joint Indian Chest Society-National College of Chest Physicians (India) guidelines for spirometry. Lung India 2019; 36:S1-S35. [PMID: 31006703 PMCID: PMC6489506 DOI: 10.4103/lungindia.lungindia_300_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Although a simple and useful pulmonary function test, spirometry remains underutilized in India. The Indian Chest Society and National College of Chest Physicians (India) jointly supported an expert group to provide recommendations for spirometry in India. Based on a scientific grading of available published evidence, as well as other international recommendations, we propose a consensus statement for planning, performing and interpreting spirometry in a systematic manner across all levels of healthcare in India. We stress the use of standard equipment, and the need for quality control, to optimize testing. Important technical requirements for patient selection, and proper conduct of the vital capacity maneuver, are outlined. A brief algorithm to interpret and report spirometric data using minimal and most important variables is presented. The use of statistically valid lower limits of normality during interpretation is emphasized, and a listing of Indian reference equations is provided for this purpose. Other important issues such as peak expiratory flow, bronchodilator reversibility testing, and technician training are also discussed. We hope that this document will improve use of spirometry in a standardized fashion across diverse settings in India.
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Affiliation(s)
- Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - KT Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Inderpaul S Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Navneet Singh
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - D Behera
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - SK Jindal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Virendra Singh
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Chawla
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - JK Samaria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - SN Gaur
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anurag Agrawal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - SK Chhabra
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Chopra
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - DJ Christopher
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raja Dhar
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aloke G Ghoshal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Randeep Guleria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Handa
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nirmal K Jain
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashok K Janmeja
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surya Kant
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - GC Khilnani
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raj Kumar
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravindra Mehta
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Narayan Mishra
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anant Mohan
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - PR Mohapatra
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dharmesh Patel
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Babu Ram
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - SK Sharma
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupak Singla
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - JC Suri
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Swarnakar
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Talwar
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Lakshmi Narasimhan
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Saurabh Maji
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankan Bandopadhyay
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nita Basumatary
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arindam Mukherjee
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Milind Baldi
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nandkishore Baikunje
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Hariprasad Kalpakam
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pratap Upadhya
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kodati
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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12
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Stringer WW, Porszasz J, Bhatt SP, McCormack MC, Make BJ, Casaburi R. Physiologic Insights from the COPD Genetic Epidemiology Study. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2019; 6:256-266. [PMID: 31342731 DOI: 10.15326/jcopdf.6.3.2019.0128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
COPD Genetic Epidemiology Study (COPDGene®) manuscripts have provided important insights into chronic obstructive pulmonary disease (COPD) pathophysiology and outcomes, including a better understanding of COPD phenotypes relating computed tomography (CT) anatomic data to spirometric and patient-reported outcomes. Spirometry significantly underdiagnoses smoking-induced lung disease, and there is a marked improvement in sensitivity and specificity with CT scanning. This review also highlights the COPDGene® exploration of specific spirometry phenotypes (e.g.,PRISm), contributors to spirometric decline, composite physiologic measures, asthma-COPD overlap (ACO) syndrome, consequences of bronchodilator responsiveness, newer methods to assess small airway dysfunction, and spirometric correlates of comorbid diseases such as obesity and diabetes.
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Affiliation(s)
- William W Stringer
- Los Angeles Biomedical Research Institute, Harbor-University of California, Los Angeles Medical Center, Torrance
| | - Janos Porszasz
- Los Angeles Biomedical Research Institute, Harbor-University of California, Los Angeles Medical Center, Torrance
| | - Surya P Bhatt
- Division of Pulmonary, Allergy, and Critical Care Medicine and Lung Health Center, University of Alabama, Birmingham
| | - Meredith C McCormack
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Barry J Make
- Department of Medicine, National Jewish Health, Denver, Colorado
| | - Richard Casaburi
- Los Angeles Biomedical Research Institute, Harbor-University of California, Los Angeles Medical Center, Torrance
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13
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Dufetelle E, Bokov P, Delclaux C, Beydon N. Should reversibility be assessed in all asthmatic children with normal spirometry? Eur Respir J 2018; 52:13993003.00373-2018. [PMID: 29853493 DOI: 10.1183/13993003.00373-2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/20/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Edouard Dufetelle
- APHP, Unité Fonctionnelle de Physiologie-Explorations Fonctionnelles Respiratoires Pédiatrique, Hôpital Armand Trousseau, Paris, France
| | - Plamen Bokov
- AP-HP, Hôpital Universitaire Robert Debré, Service de Physiologie Pédiatrique, Paris, France.,INSERM, UMR1141, Hôpital Universitaire Robert Debré, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Christophe Delclaux
- AP-HP, Hôpital Universitaire Robert Debré, Service de Physiologie Pédiatrique, Paris, France.,INSERM, UMR1141, Hôpital Universitaire Robert Debré, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Nicole Beydon
- APHP, Unité Fonctionnelle de Physiologie-Explorations Fonctionnelles Respiratoires Pédiatrique, Hôpital Armand Trousseau, Paris, France.,INSERM U938, Centre de Recherche Saint Antoine, Paris, France
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14
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Subclinical pulmonary dysfunction contributes to high altitude pulmonary edema susceptibility in healthy non-mountaineers. Sci Rep 2017; 7:14892. [PMID: 29097771 PMCID: PMC5668232 DOI: 10.1038/s41598-017-14947-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 10/18/2017] [Indexed: 12/11/2022] Open
Abstract
HAPE susceptible (HAPE-S, had HAPE episode in past) subjects may have subclinical cardio-pulmonary dysfunction. We compared the results of pulmonary function tests in 25 healthy HAPE-S non-mountaineers and 19 matched HAPE resistant (HAPE-R, no HAPE episode in past). Acute normobaric hypoxia (FIo2 0.12) was administered at sea level to confirm hypoxia intolerance in HAPE-S. Unlike HAPE-R, HAPE-S subjects had elevated baseline and post-hypoxia systolic pulmonary arterial pressures (20.9 ± 3 vs 27.3 ± 5 mm Hg during normoxia and 26.2 ± 6 vs 45.44 ± 10 mm Hg during hypoxia, HAPE-R vs HAPE-S). Forced vital capacity (FVC) and single breath alveolar volume (SBVA) were significantly lower in HAPE-S compared to HAPE-R (FVC: 4.33 ± 0.5 vs 4.6 ± 0.4; SBVA: 5.17 ± 1 vs 5.6 ± 1 Lt; HAPE-S vs HAPE-R). Two subgroups with abnormal pulmonary function could be identified within HAPE-S; HAPE-S1 (n = 4) showed DLCO>140% of predicted, suggestive of asthma and HAPE-S2 (n = 12) showed restrictive pattern. Each of these patterns have previously been linked to early small airway disease and may additionally represent a lower cross-sectional area of the pulmonary vascular bed, related to lower lung volumes. HAPE susceptibility in healthy non-mountaineers may be related to sub-clinical pulmonary pathology that limits compensatory rise in ventilation and pulmonary circulation during hypoxic stress.
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15
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Bokov P, Martin C, Graba S, Gillet-Juvin K, Essalhi M, Delclaux C. Bronchodilator Response Assessment of the Small Airways Obstructive Pattern. Open Respir Med J 2017; 11:47-53. [PMID: 28839497 PMCID: PMC5543622 DOI: 10.2174/1874306401711010047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 05/25/2017] [Accepted: 07/06/2017] [Indexed: 11/22/2022] Open
Abstract
Background: A concomitant decrease in FEV1 and FVC with normal FEV1/FVC ratio and TLC defines small airways obstructive pattern (SAOP) and constitutes a classic pitfall of pulmonary-function-tests interpretation. Objective: To evaluate the prevalence of flow- (FEV1 increase≥12% and 200 mL), volume- (FVC or inspiratory capacity [IC] increase≥12% and 200 mL), flow and volume-, and non-response to bronchodilation in patients with SAOP. An additional objective was to assess whether impulse oscillometry (IOS) parameters allow the diagnosis of SAOP and its reversibility. Methods: Fifty consecutive adult patients with SAOP (FEV1 and FVC < lower limit of normal, FEV1/FVC and TLC > lower limit of normal) diagnosed on spirometry and plethysmography underwent the assessment of reversibility (400 µg salbutamol) on FEV1, FVC, IC and IOS parameters. Results: The diseases most frequently associated with SAOP were COPD and asthma (26 and 15 patients, respectively). Six patients were flow-responders, 20 were volume-responders, 9 were flow and volume-responders and 15 patients were non-responders. Overall, 26 patients had a significant improvement of IC, and 35 / 50 (70%, 95%CI: 57-83) exhibited a significant bronchodilator response. The difference between Rrs5Hz and Rrs20Hz was increased in 28/50 patients (56%, 95%CI: 42-70 with value higher than upper limit of normal) and its decrease after bronchodilator significantly correlated to FEV1 increase only, suggesting proximal airway assessment. Conclusion: A significant reversibility, mainly assessed on IC increase, is frequent in Small Airways Obstructive Pattern. Impulse oscillometry is of limited value in this context because of its low sensitivity.
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Affiliation(s)
- Plamen Bokov
- AP-HP ; Hôpital Européen Georges Pompidou ; Service de Physiologie, Paris. France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris. France
| | - Clémence Martin
- AP-HP ; Hôpital Européen Georges Pompidou ; Service de Physiologie, Paris. France
| | - Sémia Graba
- AP-HP ; Hôpital Européen Georges Pompidou ; Service de Physiologie, Paris. France
| | - Karine Gillet-Juvin
- AP-HP ; Hôpital Européen Georges Pompidou ; Service de Physiologie, Paris. France
| | - Mohamed Essalhi
- AP-HP ; Hôpital Européen Georges Pompidou ; Service de Physiologie, Paris. France
| | - Christophe Delclaux
- AP-HP ; Hôpital Européen Georges Pompidou ; Service de Physiologie, Paris. France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris. France
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16
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De la Rosa D, Martínez-Garcia MA, Giron RM, Vendrell M, Olveira C, Borderias L, Maiz L, Torres A, Martinez-Moragon E, Rajas O, Casas F, Cordovilla R, de Gracia J. Clinical impact of chronic obstructive pulmonary disease on non-cystic fibrosis bronchiectasis. A study on 1,790 patients from the Spanish Bronchiectasis Historical Registry. PLoS One 2017; 12:e0177931. [PMID: 28542286 PMCID: PMC5436841 DOI: 10.1371/journal.pone.0177931] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 05/05/2017] [Indexed: 11/24/2022] Open
Abstract
Background Few studies have evaluated the coexistence of bronchiectasis (BE) and chronic obstructive pulmonary disease (COPD) in series of patients diagnosed primarily with BE. The aim of this study was to analyse the characteristics of patients with BE associated with COPD included in the Spanish Bronchiectasis Historical Registry and compare them to the remaining patients with non-cystic fibrosis BE. Methods We conducted a multicentre observational study of historical cohorts, analysing the characteristics of 1,790 patients who had been included in the registry between 2002 and 2011. Of these, 158 (8.8%) were registered as BE related to COPD and were compared to the remaining patients with BE of other aetiologies. Results Patients with COPD were mostly male, older, had a poorer respiratory function and more frequent exacerbations. There were no differences in the proportion of patients with chronic bronchial colonisation or in the isolated microorganisms. A significantly larger proportion of patients with COPD received treatment with bronchodilators, inhaled steroids and intravenous antibiotics, but there was no difference in the use of long term oral or inhaled antibiotherapy. During a follow-up period of 3.36 years, the overall proportion of deaths was 13.8%. When compared to the remaining aetiologies, patients with BE associated with COPD presented the highest mortality rate. The multivariate analysis showed that the diagnosis of COPD in a patient with BE as a primary diagnosis increased the risk of death by 1.77. Conclusion Patients with BE related to COPD have the same microbiological characteristics as patients with BE due to other aetiologies. They receive treatment with long term oral and inhaled antibiotics aimed at controlling chronic bronchial colonisation, even though the current COPD treatment guidelines do not envisage this type of therapy. These patients’ mortality is notably higher than that of remaining patients with non-cystic fibrosis BE.
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Affiliation(s)
- David De la Rosa
- Department of Pneumology, Hospital Plató, Barcelona, Spain
- * E-mail:
| | | | - Rosa Maria Giron
- Departament of Pneumology, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, Spain
| | - Montserrat Vendrell
- Department of Pneumology, Hospital Josep Trueta Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Casilda Olveira
- Department of Pneumology, Hospital Regional Universitario de Málaga, Instituto de Biomedicina de Málaga (IBIMA), Facultad de Medicina de Málaga, Spain
| | - Luis Borderias
- Department of Pneumology, Hospital General San Jorge, Huesca, Spain
| | - Luis Maiz
- Department of Pneumology, Hospital Ramón y Cajal, Madrid, Spain
| | - Antoni Torres
- Respiratory Institute, Hospital Clinic i Provincial, Barcelona, Spain
| | | | - Olga Rajas
- Departament of Pneumology, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, Spain
| | - Francisco Casas
- Department of Pneumology, Hospital Universitario San Cecilio, Granada, Spain
| | - Rosa Cordovilla
- Department of Pneumology, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Javier de Gracia
- Department of Pneumology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
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17
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Bokov P, Delclaux C. Evidence of pneumoconstriction in asthmatics. J Asthma 2017; 55:220-222. [PMID: 28471693 DOI: 10.1080/02770903.2017.1316393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION In asthma, bronchial smooth muscle contraction is responsible for the obstructive ventilatory defect that may be relieved by the administration of bronchodilators. It has been observed that deep inspiration causes dilation of the airways in both asthmatic and nonasthmatic subjects. Pneumoconstriction is a rare manifestation of the contractile cells present in the perialveolar space leading to a restrictive defect in asthmatics. CASE STUDY We present the lung function tests of two asthmatic patients (a boy and a woman) depicting a restrictive defect (pneumoconstriction) that disappeared after salbutamol administration while no improvement was noted in the spirometric data. RESULTS We observed a particular static lung volume distribution that could be explained by a concept of cellular mechanoresponsiveness called "glassy dynamics" applied to smooth muscle cells. CONCLUSION We concluded that the presence of contractile interstitial cells in the perialveolar space could be responsible for the observed anomalies reflecting pneumoconstriction. We explained the observed distribution of static lung volumes by the glassy dynamics of cytoskeleton, a concept that had no clinical validation.
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Affiliation(s)
- Plamen Bokov
- a Service de Physiologie - Explorations Fonctionnelles , Hôpital Robert Debré , Paris , France.,b Department of Physiology , Université Paris - Diderot , Paris , France
| | - Christophe Delclaux
- a Service de Physiologie - Explorations Fonctionnelles , Hôpital Robert Debré , Paris , France.,b Department of Physiology , Université Paris - Diderot , Paris , France
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18
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Lutfi MF. The physiological basis and clinical significance of lung volume measurements. Multidiscip Respir Med 2017; 12:3. [PMID: 28194273 PMCID: PMC5299792 DOI: 10.1186/s40248-017-0084-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 01/02/2017] [Indexed: 11/10/2022] Open
Abstract
From a physiological standpoint, the lung volumes are either dynamic or static. Both subclasses are measured at different degrees of inspiration or expiration; however, dynamic lung volumes are characteristically dependent on the rate of air flow. The static lung volumes/capacities are further subdivided into four standard volumes (tidal, inspiratory reserve, expiratory reserve, and residual volumes) and four standard capacities (inspiratory, functional residual, vital and total lung capacities). The dynamic lung volumes are mostly derived from vital capacity. While dynamic lung volumes are essential for diagnosis and follow up of obstructive lung diseases, static lung volumes are equally important for evaluation of obstructive as well as restrictive ventilatory defects. This review intends to update the reader with the physiological basis, clinical significance and interpretative approaches of the standard static lung volumes and capacities.
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Affiliation(s)
- Mohamed Faisal Lutfi
- Department of Physiology, Faculty of Medicine and Health Sciences, Al-Neelain University, Khartoum, Sudan
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19
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Bokov P, Delclaux C. [Interpretation and use of routine pulmonary function tests: Spirometry, static lung volumes, lung diffusion, arterial blood gas, methacholine challenge test and 6-minute walk test]. Rev Med Interne 2015; 37:100-10. [PMID: 26657268 DOI: 10.1016/j.revmed.2015.10.356] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 10/24/2015] [Indexed: 10/22/2022]
Abstract
Resting pulmonary function tests (PFT) include the assessment of ventilatory capacity: spirometry (forced expiratory flows and mobilisable volumes) and static volume assessment, notably using body plethysmography. Spirometry allows the potential definition of obstructive defect, while static volume assessment allows the potential definition of restrictive defect (decrease in total lung capacity) and thoracic hyperinflation (increase in static volumes). It must be kept in mind that this evaluation is incomplete and that an assessment of ventilatory demand is often warranted, especially when facing dyspnoea: evaluation of arterial blood gas (searching for respiratory insufficiency) and measurement of the transfer coefficient of the lung, allowing with the measurement of alveolar volume to calculate the diffusing capacity of the lung for CO (DLCO: assessment of alveolar-capillary wall and capillary blood volume). All these pulmonary function tests have been the subject of an Americano-European Task force (standardisation of lung function testing) published in 2005, and translated in French in 2007. Interpretative strategies for lung function tests have been recommended, which define abnormal lung function tests using the 5th and 95th percentiles of predicted values (lower and upper limits of normal values). Thus, these recommendations need to be implemented in all pulmonary function test units. A methacholine challenge test will only be performed in the presence of an intermediate pre-test probability for asthma (diagnostic uncertainty), which is an infrequent setting. The most convenient exertional test is the 6-minute walk test that allows the assessment of walking performance, the search for arterial desaturation and the quantification of dyspnoea complaint.
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Affiliation(s)
- P Bokov
- Service de physiologie, clinique de la dyspnée, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France; Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France
| | - C Delclaux
- Service de physiologie, clinique de la dyspnée, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France; Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France.
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20
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Pastre J, Plantier L, Planes C, Borie R, Nunes H, Delclaux C, Israël-Biet D. Different KCO and VA combinations exist for the same DLCO value in patients with diffuse parenchymal lung diseases. BMC Pulm Med 2015; 15:100. [PMID: 26334728 PMCID: PMC4557311 DOI: 10.1186/s12890-015-0084-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 07/29/2015] [Indexed: 11/23/2022] Open
Abstract
Background DLCO is the product of the CO transfer coefficient (KCO) by the “accessible” alveolar volume (VA). In theory, the same DLCO may result from various combinations of KCO and VA values, each of which reflect different injury sites and mechanisms. We sought to determine in this study the potential variability of both VA and KCO for fixed values of DLCO in diffuse parenchymal lung diseases (DPLD). Methods To this end, we designed a retrospective, cross-sectional study of three distinct types of DPLD and analysed pulmonary function test (PFT) datasets. Results We show here that for the same value of DLCO (50 % predicted), KCO varied from 60 to 95 % predicted and VA from 55 to 85 % predicted in various types of DPLD idiopathic pulmonary fibrosis, sarcoidosis and connective tissue disease-associated DPLD, indicating distinct pathogenic mechanisms in these diseases. In addition, a comparison of VA with total lung capacity may help to evidence the distal airway obstruction sometimes associated with certain DPLD particularly sarcoidosis. Conclusion Clinicians should take into account not only DLCO but also VA and KCO values when managing patients with DPLD.
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Affiliation(s)
- Jean Pastre
- Université Paris Descartes, Sorbonne Paris Cité and AP-HP, Service de Pneumologie, Hôpital Européen Georges Pompidou, Paris, France.
| | - Laurent Plantier
- Université Paris Diderot, Sorbonne Paris Cité and AP-HP, Service de Physiologie, Hôpital Bichat-Claude Bernard, Paris, France.
| | - Carole Planes
- Université Paris 13, Sorbonne Paris Cité and AP-HP, Service de Physiologie, Hôpital Avicenne, Bobigny, France.
| | - Raphaël Borie
- Université Paris Descartes, Sorbonne Paris Cité and AP-HP, Service de Pneumologie, Hôpital Bichat-Claude Bernard, Paris, France.
| | - Hilario Nunes
- Université Paris 13, Sorbonne Paris Cité and AP-HP, Service de Pneumologie, Hôpital Avicenne, Bobigny, France.
| | - Christophe Delclaux
- Université Paris Descartes, Sorbonne Paris Cité and AP-HP, Service de Physiologie, Hôpital Européen Georges Pompidou, Paris, France.
| | - Dominique Israël-Biet
- Université Paris Descartes, Sorbonne Paris Cité and AP-HP, Service de Pneumologie, Hôpital Européen Georges Pompidou, Paris, France.
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