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Quintero Santofimio V, Knox-Brown B, Potts J, Bartlett-Pestell S, Feary J, Amaral AFS. Small Airways Obstruction and Mortality: Findings From the UK Biobank. Chest 2024:S0012-3692(24)00651-2. [PMID: 38797279 DOI: 10.1016/j.chest.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/10/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Small airways obstruction (SAO) is common in general populations. It has been associated with respiratory symptoms, cardiometabolic diseases, and progression to COPD over time. Whether SAO predicts mortality is largely unknown. RESEARCH QUESTION Is spirometry-defined SAO associated with increased mortality? METHODS Data were analyzed from 252,877 adult participants, aged 40 to 69 years at baseline, in the UK Biobank who had provided good-quality spirometry measurements. SAO was defined as the ratio of the forced expiratory volume in 3 s to the forced expiratory volume in 6 s less than the lower limit of normal. SAO was considered to be isolated if present when the FEV1/forced expiratory volume in 6 s ratio was normal (ie, greater than the lower limit of normal). A multivariable Cox regression model was used to assess the association of SAO, and isolated SAO, with all-cause and disease-specific mortality. Sex differences were investigated in these associations, and the primary analysis was repeated, excluding those who ever smoked. All models were adjusted for potential confounders such as sex, BMI, smoking status, smoking pack-years, assessment center, Townsend deprivation index, and ethnicity. RESULTS A total of 59,744 participants with SAO were identified, of whom 24,004 had isolated SAO. A total of 5,009 deaths were reported over a median of 12.8 years of follow-up. Participants with SAO had increased all-cause (hazard ratio [HR], 1.31; 95% CI, 1.26-1.36), cardiovascular (HR, 1.39; 95% CI, 1.29-1.51), respiratory (HR, 2.20; 95% CI, 1.92-2.51), and neoplasm (HR, 1.23; 95% CI, 1.17-1.29) mortality risk. These associations were not modified by sex. However, in those who never smoked, only respiratory and cardiovascular mortality risk was associated with SAO. Isolated SAO was also associated with an increased mortality risk (HR, 1.14; 95% CI, 1.07-1.20). INTERPRETATION Individuals with SAO have an increased risk of all-cause and disease-specific mortality. Further studies are needed to determine whether SAO causes mortality or is a marker of underlying disease.
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Affiliation(s)
| | - Ben Knox-Brown
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - James Potts
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Samuel Bartlett-Pestell
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; NIHR Imperial Biomedical Research Centre, London, United Kingdom
| | - Johanna Feary
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; NIHR Imperial Biomedical Research Centre, London, United Kingdom
| | - Andre F S Amaral
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; NIHR Imperial Biomedical Research Centre, London, United Kingdom
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Carpagnano GE, Portacci A, Dragonieri S, Montagnolo F, Iorillo I, Lulaj E, Maselli L, Buonamico E, Quaranta VN. Managing Small Airway Disease in Patients with Severe Asthma: Transitioning from the "Silent Zone" to Achieving "Quiet Asthma". J Clin Med 2024; 13:2320. [PMID: 38673593 PMCID: PMC11051485 DOI: 10.3390/jcm13082320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/11/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
Background/Objectives: Several studies have demonstrated the positive clinical and functional impact of adding Long-Acting Muscarinic Antagonist (LAMA) to Inhaled Corticosteroids (ICS) and Long-Acting Beta-Agonists (LABA) therapy in the treatment of severe asthma. Aim and objectives: To demonstrate that treating Small Airways Disease (SAD) in severe asthma patients who are candidates for biologics can improve respiratory symptoms, lung function, and airways inflammation, potentially avoiding or delaying the use of biological therapy. Methods: Thirty-two severe asthma patients with SAD were transitioned from separate inhalers for ICS/LABA and LAMA to extrafine single-inhaler beclomethasone, formoterol, and glycopyrronium. None of these patients underwent biological therapy before the study. Follow-up evaluations were conducted at baseline (T0) and three months after initiation (T3). Assessments included clinical evaluations, spirometry, oscillometry, and inflammation markers. Results: Transitioning to single-inhaler triple therapy from T0 to T3 resulted in significant improvements in Asthma Control Test (ACT) and SAD parameters, including increased Forced Expiratory Volume in the mid-range of lung capacity and improved airway resistance and reactance measurements using impulse oscillometry. A significant reduction in airway inflammation was evidenced by lower levels of Fractional Exhaled Nitric Oxide 350 (FeNO 350) (p < 0.001 for all). Conclusions: Adopting a single-inhaler triple therapy notably enhanced clinical control and small airway function in patients with severe asthma and SAD, supporting the positive impact of target-therapy for the achievement of a stable state termed "Quiet Asthma".
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Affiliation(s)
| | | | - Silvano Dragonieri
- Respiratory Diseases, University of Bari, 70121 Bari, Italy; (G.E.C.); (A.P.); (F.M.); (I.I.); (E.L.); (L.M.); (E.B.); (V.N.Q.)
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Moradi F, Kjellberg S, Li Y, Daka B, Olin AC. Respiratory function after 30+ years following sulfur mustard exposure in survivors in Sweden. Front Med (Lausanne) 2024; 11:1251500. [PMID: 38500955 PMCID: PMC10945011 DOI: 10.3389/fmed.2024.1251500] [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: 07/01/2023] [Accepted: 02/14/2024] [Indexed: 03/20/2024] Open
Abstract
Background Sulfur mustard (SM) exposure causes acute and chronic respiratory diseases. The extent of small airway dysfunction (SAD) in individuals exposed to SM is unclear. This study evaluated and compared SAD in SM-exposed and SM-unexposed participants using noninvasive lung function tests assessing small airway function. Methods This retrospective cohort study involved SM-exposed (n = 15, mean age: 53 ± 8 years) and SM-unexposed (n = 15, mean age: 53 ± 7 years) Kurdish-Swedish individuals in Sweden. Small airway resistance and reactance were assessed using impulse oscillometry (IOS). Nitrogen (N2) multiple breath washout (MBW) was employed to assess lung ventilation heterogeneity. The gas-exchanging capacity of the lungs was assessed using the diffusing capacity of the lungs for the carbon monoxide (DLCO) test. Lung function outcomes were reported as absolute values and z-scores. Group comparisons were performed using the Mann-Whitney U test. Results No statistically significant differences in age, height, or body mass index were observed between the two groups. IOS showed significantly increased small airway resistance, while N2MBW exhibited significantly increased global and acinar ventilation heterogeneity in SM-exposed individuals compared to that in unexposed individuals. SAD was identified in 14 of 15 SM-exposed individuals, defined as at least one abnormal IOS difference between resistance at 5 and 20 Hz (R5-R20) and/or area of reactance (AX) or N2MBW lung's acinar zone (Sacin), and DLCO adjusted to the alveolar volume (DLCO/VA) outcome. Of these 14 individuals, only 5 demonstrated concordant findings across the IOS and N2MBW tests. Conclusion Exposure to SM was positively associated with long-term impairment of respiratory tract function in the small airways in the majority of the previously SM-exposed individuals in the present study. Furthermore, both IOS and N2MBW should be employed to detect SAD in SM-exposed survivors as they provide complementary information. Identifying and characterizing the remaining pathology of the small airways in survivors of SM exposure is a first step toward improved treatment and follow-up.
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Affiliation(s)
- Faraidoun Moradi
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- The Centre for Disaster Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Sanna Kjellberg
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ying Li
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bledar Daka
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna-Carin Olin
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Touilloux B, Casutt A, Strippoli MPF, Lenoir A, Janett S, Vollenweider P, Vaucher J, Nicod L, Preisig M, von Garnier C. Associations of Depressive and Anxiety Disorders with Pulmonary Disorders in the Community: The PneumoLaus and PsyCoLaus Studies. Respiration 2024; 103:503-512. [PMID: 38417406 PMCID: PMC11309049 DOI: 10.1159/000537918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/14/2024] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION Mental health disorders figure among the many comorbidities of obstructive respiratory diseases. The multisystemic characteristics of chronic respiratory disease and its impact on quality of life could affect depressive and/or anxiety disorders. We aimed to evaluate the association of spirometric indices, ventilatory disorders, and self-reported respiratory diseases with psychiatric disorders considering potential confounders. METHODS We analysed data from CoLaus|PsyCoLaus, a Swiss population-based cohort study, consisting of 2'774 participants (56% women; mean age: 62.3 (standard deviation = ±9.9) years) who performed spirometry and completed semi-structured psychiatric interviews. We defined ventilatory disorders using GLI-2012 references. Major depressive episode (MDE) and anxiety disorders were defined using the DSM-IV (Diagnostic and Statistical Manual). RESULTS 630 subjects (22.7%) presented a recent MDE. Reversible obstructive ventilatory disorders were associated with recent MDE (OR = 1.94, 95% confidence interval (95% CI) 1.10-3.43) and recent anxiety disorders (2.21 [1.16-4.22]) only in unadjusted model. Self-reported chronic obstructive pulmonary (COPD) and asthma were associated with MDE with ORs of 2.49 (95% CI, 1.19-5.27) and 1.56 (95% CI, 1.04-2.35) after adjustment, respectively. Possible restrictive ventilatory impairment was positively associated with recent anxiety disorders (OR = 2.46, 1.10-5.51). Z-scores of FEV1, FVC, and maximal mid-expiratory flow were not associated with psychiatric disorders. There was no association between ventilatory disorders and MDE in adjusted models. CONCLUSIONS In this cross-sectional population-based study, the association between respiratory disorders and depressive disorders was observed for self-reported COPD and asthma, but not with objective diagnoses based on spirometry. Lung volumes are not associated with psychiatric disorders. Further prospective studies will be necessary to understand the significance of the association.
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Affiliation(s)
- Brice Touilloux
- Division of Pulmonology, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Division of Pulmonology, Department of Medicine and Specialties, Fribourg Hospital and University of Fribourg, Fribourg, Switzerland
| | - Alessio Casutt
- Division of Pulmonology, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Division of Pneumology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Marie-Pierre F. Strippoli
- Psychiatric Epidemiology and Psychopathology Research Center, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Alexandra Lenoir
- Division of Pulmonology, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Internal Medicine V, Ludwig-Maximilians-University (LMU) of Munich, Munich, Germany
| | - Simone Janett
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Peter Vollenweider
- Division of Internal Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Julien Vaucher
- Division of Internal Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Division of Internal Medicine, Department of Medicine and Specialties, Fribourg Hospital and University of Fribourg, Fribourg, Switzerland
| | - Laurent Nicod
- Division of Pulmonology, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Martin Preisig
- Psychiatric Epidemiology and Psychopathology Research Center, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Christophe von Garnier
- Division of Pulmonology, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Knox-Brown B, Potts J, Santofimio VQ, Minelli C, Patel J, Abass NM, Agarwal D, Ahmed R, Mahesh PA, Bs J, Denguezli M, Franssen F, Gislason T, Janson C, Juvekar SK, Koul P, Malinovschi A, Nafees AA, Nielsen R, Paraguas SNM, Buist S, Burney PG, Amaral AFS. Isolated small airways obstruction predicts future chronic airflow obstruction: a multinational longitudinal study. BMJ Open Respir Res 2023; 10:e002056. [PMID: 37989490 PMCID: PMC10660204 DOI: 10.1136/bmjresp-2023-002056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Chronic airflow obstruction is a key characteristic of chronic obstructive pulmonary disease. We investigated whether isolated small airways obstruction is associated with chronic airflow obstruction later in life. METHODS We used longitudinal data from 3957 participants of the multinational Burden of Obstructive Lung Disease study. We defined isolated small airways obstruction using the prebronchodilator mean forced expiratory flow rate between 25% and 75% of the forced vital capacity (FVC) (FEF25-75) if a result was less than the lower limit of normal ( RESULTS Median follow-up time was 8.3 years. Chronic airflow obstruction was more likely to develop in participants with isolated small airways obstruction at baseline (FEF25-75 less than the LLN, OR: 2.95, 95% CI 1.02 to 8.54; FEV3/FVC less than the LLN, OR: 1.94, 95% CI 1.05 to 3.62). FEF25-75 was better than the FEV3/FVC ratio to discriminate future chronic airflow obstruction (AUC: 0.764 vs 0.692). Results were similar among participants of the UK Biobank study. CONCLUSION Measurements of small airways obstruction can be used as early markers of future obstructive lung disease.
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Affiliation(s)
- Ben Knox-Brown
- National Heart and Lung Institute, Imperial College London, London, UK
| | - James Potts
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Cosetta Minelli
- National Heart and Lung Institute, Imperial College London, London, UK
- NIHR Imperial Biomedical Research Centre, London, UK
| | - Jaymini Patel
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Dhiraj Agarwal
- Vadu Rural Health Program, KEM Hospital Pune Research Centre, Pune, India
| | - Rana Ahmed
- The Epidemiological Laboratory, Khartoum, Sudan
| | | | - Jayaraj Bs
- Respiratory Medicine, JSS Medical College, Mysore, Karnataka, India
| | - Meriam Denguezli
- Faculte de Medecine de Sousse, Universite de Sousse, Sousse, Tunisia
| | - Frits Franssen
- Respiratory medicine, Maastricht University Medical Centre+, Maastricht, Netherlands
- Research and Education, CIRO, Horn, Netherlands
| | - Thorarinn Gislason
- Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Christer Janson
- Department of Medical Sciences Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Sanjay K Juvekar
- Vadu Rural Health Program, KEM Hospital Pune Research Centre, Pune, India
| | - Parvaiz Koul
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Andrei Malinovschi
- Department of Medical Sciences Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Asaad Ahmed Nafees
- Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Rune Nielsen
- Department of Thoracic Medicine, University of Bergen, Bergen, Hordaland, Norway
| | - Stefanni Nonna M Paraguas
- Philippine College of Chest Physicians, Quezon City, Philippines
- Philippine Heart Center, Quezon City, Manila, Philippines
| | - Sonia Buist
- Oregon Health & Science University, Portland, Oregon, USA
| | - Peter Gj Burney
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Andre F S Amaral
- National Heart and Lung Institute, Imperial College London, London, UK
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Cottini M, Bondi B, Bagnasco D, Braido F, Passalacqua G, Licini A, Lombardi C, Berti A, Comberiati P, Landi M, Heffler E, Paoletti G. Impulse oscillometry defined small airway dysfunction in asthmatic patients with normal spirometry: Prevalence, clinical associations, and impact on asthma control. Respir Med 2023; 218:107391. [PMID: 37595673 DOI: 10.1016/j.rmed.2023.107391] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND The small-airway dysfunction (SAD), detected with impulse oscillometry (IOS) methods, has been recently better characterized in patients with asthma. However, little is known about SAD in asthmatic patients with normal spirometry (NS). OBJECTIVE In this study, we aimed to investigate, in an unselected sample of 321 patients with physician-diagnosed asthma and NS, prevalence, clinical characterization, and impact on asthma control of IOS-defined SAD. As a secondary objective of the study, we focused on comparing the difference between IOS- and spirometry-defined SAD. METHODS Consecutive patients with a previous diagnosis of asthma but normal spirometry at the moment of the enrollment were stratified by the presence of IOS-defined SAD (difference in resistance at 5 Hz and at 20 Hz [R5-R20] greater than 0.07 kPa x s x L-1). We have also assessed the presence of SAD defined by spirometry, according to FEF 25-75 < 65% of the predicted. Clinical and laboratory features were collected, and univariable and multivariable analyses were used to analyze cross-sectional associations between clinical variables and outcomes (SAD). RESULTS IOS-defined SAD was present in 54.1% of the cohort. In contrast, spirometry-defined SAD was present in only 10% of patients. Subjects with IOS-defined SAD showed less well-controlled asthma and a higher mean inhaled corticosteroid dosage use compared with subjects without SAD (both P < .001). Overweight (odds ratio [OR], 1.14; 95% CI, 1.05-1.23), exacerbation history (OR, 3.06; 95% CI, 1.34-6.97), asthma-related night awakenings (OR, 6.88; 95% CI, 2.13-22.23), exercise-induced asthma symptoms (OR, 33.5; 95% CI, 9.51-117.8), and controlled asthma (OR, 0.22; 95% CI, 0.06-0.84) were independently associated with SAD. CONCLUSIONS Asthmatic patients with IOS-defined SAD showed less well-controlled asthma, more severe exacerbations and higher mean inhaled corticosteroid dosage. We confirmed exercise-induced asthma, asthma-related night awakenings, exacerbation history, and overweight as independently associated with SAD, while showing well-controlled asthma as inversely associated. SAD may be overlooked by standard spirometry.
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Affiliation(s)
| | - Benedetta Bondi
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genova, Italy.
| | - Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genova, Italy
| | - Fulvio Braido
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genova, Italy
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genova, Italy
| | - Anita Licini
- Allergy and Pneumology Outpatient Clinic, Bergamo, Italy
| | - Carlo Lombardi
- Departmental Unit of Allergology, Immunology & Pulmonary Diseases, Fondazione Poliambulanza, Brescia, Italy
| | - Alvise Berti
- Center for Medical Sciences (CISMed) and Department of Cellular, Computational and Integrative Biology (CIBIO), University of Trento, Italy, and Santa Chiara Regional Hospital, APSS, Trento, Italy
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | - Massimo Landi
- Dipartimento di Scienze Mediche, SSDDU Allergologia e Immunologia Clinica, Università degli Studi di Torino, AO Ordine Mauriziano Umberto I, Torino, Italy
| | - Enrico Heffler
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Personalized Medicine, Asthma and Allergy - IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giovanni Paoletti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Personalized Medicine, Asthma and Allergy - IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Almeshari MA, Alobaidi NY, Sapey E, Stockley RA, Stockley JA. Small airways dysfunction: The importance of utilising Z-scores to define MMEF abnormalities in clinical practice. Heliyon 2023; 9:e20744. [PMID: 37867812 PMCID: PMC10585212 DOI: 10.1016/j.heliyon.2023.e20744] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/23/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023] Open
Abstract
Background The small airways comprise the largest cross-sectional area of the lungs, however, assessing and reporting abnormalities for this region of the bronchial tree has been practically and scientifically uncertain. Methods Using routinely collected spirometry data for patients with either asthma or COPD, the accuracy of % predicted values for defining small airways dysfunction was assessed. A z-score of ≤ -1.645 of the maximal-mid expiratory flow (MMEF) was used as the gold standard for defining abnormality in the small airways. Results Records of 3396 patients were included in the analysis. The false positive (FP) rates were 24.6 %, 16.1 %, 11.5 %, or 7.9 % when the % predicted value of 80 %, 70 %, 65 %, or 60 % were used, respectively. Sex, age, and BMI were associated with FP rates. Males were more likely to be categorised as FP with odds ratio (OR) between 1.10 and 1.49 across % predicted groups. Age was associated with FP rates with an OR between 1.01 and 1.08. The BMI was also associated with FP rates with an OR of 1.03 across all % predicted groups. Assessing the association of age groups with FP rate showed that those above 60 years old were more likely to be categorised as FP with an OR between 1.23 and 73.2 compared to those less than 30 years old. Conclusion When assessing the small airways in clinical practice or for scientific purposes, the % predicted values overestimate the actual impairment leading to FP interpretation. Utilising z-score values are recommended to assess the small airways using the spirometric index, MMEF.
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Affiliation(s)
- Mohammed A. Almeshari
- Rehabilitation Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
- Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham, UK
| | - Nowaf Y. Alobaidi
- Respiratory Therapy Department, College of Applied Medical Sciences, King Saud Bin Abdul-Aziz University for Health Sciences, Al Ahsa, Saudi Arabia
| | - Elizabeth Sapey
- Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham, UK
| | - Robert A. Stockley
- Department of Lung Function and Sleep, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2GW, UK
| | - James A. Stockley
- Department of Lung Function and Sleep, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2GW, UK
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Touilloux B, Bongard C, Lechartier B, Truong MK, Marques-Vidal P, Vollenweider P, Vaucher J, Casutt A, von Garnier C. Prevalence of small airway dysfunction in the Swiss PneumoLaus Cohort. ERJ Open Res 2023; 9:00381-2023. [PMID: 37701366 PMCID: PMC10493711 DOI: 10.1183/23120541.00381-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/03/2023] [Indexed: 09/14/2023] Open
Abstract
Background Recent evidence identified exposure to particulate matter of size ≤2.5 µm (PM2.5) as a risk factor for high prevalence of small airway dysfunction (SAD). We assessed the prevalence of SAD in a European region with low air pollution levels. Methods SAD was defined as a maximum mid-expiratory flow (MMEF) <65% of predicted value (PV) or MMEF Results Among 3351 participants (97.6% Caucasian, 55.7% female sex, mean age 62.7 years), we observed MMEF <65% PV in 425 (12.7%) and MMEF 65 years only. In an area where ambient PM2.5 concentration was <15 µg·m-3 during the observation period (2010 and 2020), ≥72% of participants with SAD were ever-smokers. Conclusions The observed low prevalence of SAD of 5.0-12.7% depending on criteria employed may be related to lower PM2.5 exposure. Smoking was the main factor associated with SAD in an area with low PM2.5 exposure. Employing a MMEF threshold <65% PV carries a risk of SAD overdiagnosis in elderly individuals.
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Affiliation(s)
- Brice Touilloux
- Division of Pulmonology, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- Division of Pulmonology, Department of Medicine and Specialties, Fribourg Hospital, Fribourg, Switzerland
| | - Cedric Bongard
- Division of Pulmonology, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Benoit Lechartier
- Division of Pulmonology, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Minh Khoa Truong
- Division of Pulmonology, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Division of Internal Medicine, Department of Medicine, CHUV and UNIL, Lausanne, Switzerland
| | - Peter Vollenweider
- Division of Internal Medicine, Department of Medicine, CHUV and UNIL, Lausanne, Switzerland
| | - Julien Vaucher
- Division of Internal Medicine, Department of Medicine, CHUV and UNIL, Lausanne, Switzerland
- Division of Internal Medicine, Department of Medicine and Specialties, Fribourg Hospital, Fribourg, Switzerland
- University of Fribourg, Fribourg, Switzerland
| | - Alessio Casutt
- Division of Pulmonology, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- Division of Pneumology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
- These authors contributed equally
| | - Christophe von Garnier
- Division of Pulmonology, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- These authors contributed equally
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Knox-Brown B, Sylvester K, Amaral AF. The association of cardiorespiratory fitness with spirometric small airway obstruction. ERJ Open Res 2023; 9:00275-2023. [PMID: 37650082 PMCID: PMC10463036 DOI: 10.1183/23120541.00275-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/27/2023] [Indexed: 09/01/2023] Open
Abstract
Spirometric small airway obstruction is associated with impaired ventilatory response to exercise independently of FEV1/FVC ratio https://bit.ly/3pre4sk.
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Affiliation(s)
- Ben Knox-Brown
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Karl Sylvester
- Respiratory Physiology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
- Respiratory Physiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Andre F.S. Amaral
- National Heart and Lung Institute, Imperial College London, London, UK
- NIHR Imperial Biomedical Research Centre, London, UK
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10
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Knox-Brown B, Patel J, Potts J, Ahmed R, Aquart-Stewart A, Barbara C, Buist AS, Cherkaski HH, Denguezli M, Elbiaze M, Erhabor GE, Franssen FME, Al Ghobain M, Gislason T, Janson C, Kocabaş A, Mannino D, Marks G, Mortimer K, Nafees AA, Obaseki D, Paraguas SNM, Loh LC, Rashid A, Salvi S, Seemungal T, Studnicka M, Tan WC, Wouters EFM, Abozid H, Mueller A, Burney P, Amaral AFS. The association of spirometric small airways obstruction with respiratory symptoms, cardiometabolic diseases, and quality of life: results from the Burden of Obstructive Lung Disease (BOLD) study. Respir Res 2023; 24:137. [PMID: 37221593 DOI: 10.1186/s12931-023-02450-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/13/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Spirometric small airways obstruction (SAO) is common in the general population. Whether spirometric SAO is associated with respiratory symptoms, cardiometabolic diseases, and quality of life (QoL) is unknown. METHODS Using data from the Burden of Obstructive Lung Disease study (N = 21,594), we defined spirometric SAO as the mean forced expiratory flow rate between 25 and 75% of the FVC (FEF25-75) less than the lower limit of normal (LLN) or the forced expiratory volume in 3 s to FVC ratio (FEV3/FVC) less than the LLN. We analysed data on respiratory symptoms, cardiometabolic diseases, and QoL collected using standardised questionnaires. We assessed the associations with spirometric SAO using multivariable regression models, and pooled site estimates using random effects meta-analysis. We conducted identical analyses for isolated spirometric SAO (i.e. with FEV1/FVC ≥ LLN). RESULTS Almost a fifth of the participants had spirometric SAO (19% for FEF25-75; 17% for FEV3/FVC). Using FEF25-75, spirometric SAO was associated with dyspnoea (OR = 2.16, 95% CI 1.77-2.70), chronic cough (OR = 2.56, 95% CI 2.08-3.15), chronic phlegm (OR = 2.29, 95% CI 1.77-4.05), wheeze (OR = 2.87, 95% CI 2.50-3.40) and cardiovascular disease (OR = 1.30, 95% CI 1.11-1.52), but not hypertension or diabetes. Spirometric SAO was associated with worse physical and mental QoL. These associations were similar for FEV3/FVC. Isolated spirometric SAO (10% for FEF25-75; 6% for FEV3/FVC), was also associated with respiratory symptoms and cardiovascular disease. CONCLUSION Spirometric SAO is associated with respiratory symptoms, cardiovascular disease, and QoL. Consideration should be given to the measurement of FEF25-75 and FEV3/FVC, in addition to traditional spirometry parameters.
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Affiliation(s)
- Ben Knox-Brown
- National Heart and Lung Institute, Imperial College London, 1B Manresa Road, London, SW3 6LR, UK.
| | - Jaymini Patel
- National Heart and Lung Institute, Imperial College London, 1B Manresa Road, London, SW3 6LR, UK
| | - James Potts
- National Heart and Lung Institute, Imperial College London, 1B Manresa Road, London, SW3 6LR, UK
| | - Rana Ahmed
- The Epidemiological Laboratory (Epilab), Khartoum, Sudan
| | | | - Cristina Barbara
- Faculdade de Medicina, Instituto de Saúde Ambiental, Universidade de Lisboa, Lisbon, Portugal
- Serviço de Pneumologia, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - A Sonia Buist
- Oregon Health & Science University, Portland, OR, USA
| | - Hamid Hacene Cherkaski
- Dept of Pneumology, Faculty of Medicine Annaba, University Badji Mokhtar of Annaba, Annaba, Algeria
| | - Meriam Denguezli
- Faculté de Médecine Dentaire de Monastir, Université de Monastir, Avenue Avicenne, Monastir, Tunisia
| | - Mohammed Elbiaze
- Department of Respiratory Medicine, Faculty of Medicine, Mohammed Ben Abdellah University, University Hospital, Fes, Morocco
| | | | - Frits M E Franssen
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Research and Education, CIRO, Horn, the Netherlands
| | - Mohammed Al Ghobain
- King Abdullah International Medical Research Centre, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Thorarinn Gislason
- Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Ali Kocabaş
- Department of Chest Diseases, Cukurova University School of Medicine, Adana, Turkey
| | - David Mannino
- University of Kentucky, Lexington, KY, USA
- COPD Foundation, Miami, FL, USA
| | - Guy Marks
- Woolcock Institute of Medical Research, Sydney, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | - Kevin Mortimer
- University of Cambridge, Cambridge, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Asaad Ahmed Nafees
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | | | - Stefanni Nonna M Paraguas
- Philippine College of Chest Physicians, Quezon City, Philippines
- Philippine Heart Centre, Quezon City, Philippines
| | - Li Cher Loh
- RCSI & UCD Malaysia Campus, Penang, Malaysia
| | | | - Sundeep Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, India
- Symbiosis International (Deemed University), Pune, India
| | - Terence Seemungal
- Faculty of Medical Sciences, University of the West Indies, St Augustine, Trinidad and Tobago
| | - Michael Studnicka
- University Clinic for Pneumology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Wan C Tan
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Emiel F M Wouters
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Hazim Abozid
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | | | - Peter Burney
- National Heart and Lung Institute, Imperial College London, 1B Manresa Road, London, SW3 6LR, UK
| | - Andre F S Amaral
- National Heart and Lung Institute, Imperial College London, 1B Manresa Road, London, SW3 6LR, UK
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11
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Liwsrisakun C, Chaiwong W, Pothirat C. Comparative assessment of small airway dysfunction by impulse oscillometry and spirometry in chronic obstructive pulmonary disease and asthma with and without fixed airflow obstruction. Front Med (Lausanne) 2023; 10:1181188. [PMID: 37265488 PMCID: PMC10229856 DOI: 10.3389/fmed.2023.1181188] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/19/2023] [Indexed: 06/03/2023] Open
Abstract
Background Small airways play a major role in the pathogenesis and prognosis of chronic obstructive pulmonary disease (COPD) and asthma. More data on small airway dysfunction (SAD) using spirometry and impulse oscillometry (IOS) in these populations are required. The objective of this study was to compare the two methods, spirometry and IOS, for SAD detection and its prevalence defined by spirometry and IOS in subjects with COPD and asthma with and without fixed airflow obstruction (FAO). Design This is a cross-sectional study. Methods Spirometric and IOS parameters were compared across four groups (COPD, asthma with FAO, asthma without FAO, and healthy subjects). SAD defined by spirometry and IOS criteria were compared. Results A total of 262 subjects (67 COPD, 55 asthma with FAO, 101 asthma without FAO, and 39 healthy controls) were included. The prevalence of SAD defined by using IOS and spirometry criteria was significantly higher in patients with COPD (62.7 and 95.5%), asthma with FAO (63.6 and 98.2%), and asthma without FAO (38.6 and 19.8%) in comparison with healthy control (7.7 and 2.6%). IOS is more sensitive than spirometry in the detection of SAD in asthma without FAO (38.6% vs. 19.8%, p = 0.003) However, in subjects with FAO (COPD and asthma with FAO), spirometry is more sensitive than IOS to detect SAD (95.5% vs. 62.7%, p < 0.001 and 98.2% vs. 63.6%, p < 0.001, respectively). Conclusion Small airway dysfunction was significantly detected in COPD and asthma with and without FAO. Although IOS shows more sensitivity than spirometry in the detection of SAD in asthma without FAO, spirometry is more sensitive than IOS in patients with FAO including COPD and asthma with FAO.
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12
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Feary J, Quintero-Santofimio V, Potts J, Vermeulen R, Kromhout H, Knox-Brown B, Amaral AF. Occupational exposures and small airway obstruction in the UK Biobank Cohort. ERJ Open Res 2023; 9:00650-2022. [PMID: 37228277 PMCID: PMC10204826 DOI: 10.1183/23120541.00650-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 03/08/2023] [Indexed: 05/27/2023] Open
Abstract
Background Small airways obstruction (SAO) is a key feature of both COPD and asthma, which have been associated with workplace exposures. Whether SAO, which may occur early in the development of obstructive lung disease and without symptoms, also associates with occupational exposures is unknown. Methods Using UK Biobank data, we derived measurements of SAO from the 65 145 participants with high-quality spirometry and lifetime occupational histories. The ALOHA+ Job Exposure Matrix was used to assign lifetime occupational exposures to each participant. The association between SAO and lifetime occupational exposures was evaluated using a logistic regression model adjusted for potential confounders. A second logistic regression model was also run to account for potential co-exposures. Results SAO was present in varying proportions of the population depending on definition used: 5.6% (forced expiratory flow between 25 and 75% of the forced vital capacity (FEF25-75) < lower limit of normal (LLN)) and 21.4% (forced expiratory volume in 3 s (FEV3)/forced expiratory volume in 6 s (FEV6) <LLN). After adjustment for confounders and co-exposures, people in the highest category of exposure to pesticides were significantly more likely to have SAO (FEV3/FEV6 <LLN: OR 1.24, 95% CI 1.06-1.44). The association between pesticides and SAO showed an exposure-response pattern. SAO was also less likely among people in the highest exposure categories of aromatic solvents (FEV3/FEV6 <LLN: OR 0.85, 95% CI 0.73-0.99) and metals (FEV3/FEV6 <LLN: OR 0.77, 95% CI 0.62-0.94). Conclusion Our findings suggest that occupational exposure to pesticides play a role in the SAO. However, further work is needed to determine causality, and identify the specific component(s) responsible and the underlying mechanisms involved.
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Affiliation(s)
- Johanna Feary
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - James Potts
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, University of Utrecht, Utrecht, The Netherlands
| | - Hans Kromhout
- Institute for Risk Assessment Sciences, University of Utrecht, Utrecht, The Netherlands
| | - Ben Knox-Brown
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Andre F.S. Amaral
- National Heart and Lung Institute, Imperial College London, London, UK
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13
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Knox-Brown B, Patel J, Potts J, Ahmed R, Aquart-Stewart A, Cherkaski HH, Denguezli M, Elbiaze M, Elsony A, Franssen FME, Ghobain MA, Harrabi I, Janson C, Jõgi R, Juvekar S, Lawin H, Mannino D, Mortimer K, Nafees AA, Nielsen R, Obaseki D, Paraguas SNM, Rashid A, Loh LC, Salvi S, Seemungal T, Studnicka M, Tan WC, Wouters EEFM, Barbara C, Gislason T, Gunasekera K, Burney P, Amaral AFS. Small airways obstruction and its risk factors in the Burden of Obstructive Lung Disease (BOLD) study: a multinational cross-sectional study. Lancet Glob Health 2023; 11:e69-e82. [PMID: 36521955 DOI: 10.1016/s2214-109x(22)00456-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/21/2022] [Accepted: 10/10/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Small airways obstruction is a common feature of obstructive lung diseases. Research is scarce on small airways obstruction, its global prevalence, and risk factors. We aimed to estimate the prevalence of small airways obstruction, examine the associated risk factors, and compare the findings for two different spirometry parameters. METHODS The Burden of Obstructive Lung Disease study is a multinational cross-sectional study of 41 municipalities in 34 countries across all WHO regions. Adults aged 40 years or older who were not living in an institution were eligible to participate. To ensure a representative sample, participants were selected from a random sample of the population according to a predefined site-specific sampling strategy. We included participants' data in this study if they completed the core study questionnaire and had acceptable spirometry according to predefined quality criteria. We excluded participants with a contraindication for lung function testing. We defined small airways obstruction as either mean forced expiratory flow rate between 25% and 75% of the forced vital capacity (FEF25-75) less than the lower limit of normal or forced expiratory volume in 3 s to forced vital capacity ratio (FEV3/FVC ratio) less than the lower limit of normal. We estimated the prevalence of pre-bronchodilator (ie, before administration of 200 μg salbutamol) and post-bronchodilator (ie, after administration of 200 μg salbutamol) small airways obstruction for each site. To identify risk factors for small airways obstruction, we performed multivariable regression analyses within each site and pooled estimates using random-effects meta-analysis. FINDINGS 36 618 participants were recruited between Jan 2, 2003, and Dec 26, 2016. Data were collected from participants at recruitment. Of the recruited participants, 28 604 participants had acceptable spirometry and completed the core study questionnaire. Data were available for 26 443 participants for FEV3/FVC ratio and 25 961 participants for FEF25-75. Of the 26 443 participants included, 12 490 were men and 13 953 were women. Prevalence of pre-bronchodilator small airways obstruction ranged from 5% (34 of 624 participants) in Tartu, Estonia, to 34% (189 of 555 participants) in Mysore, India, for FEF25-75, and for FEV3/FVC ratio it ranged from 5% (31 of 684) in Riyadh, Saudi Arabia, to 31% (287 of 924) in Salzburg, Austria. Prevalence of post-bronchodilator small airways obstruction was universally lower. Risk factors significantly associated with FEV3/FVC ratio less than the lower limit of normal included increasing age, low BMI, active and passive smoking, low level of education, working in a dusty job for more than 10 years, previous tuberculosis, and family history of chronic obstructive pulmonary disease. Results were similar for FEF25-75, except for increasing age, which was associated with reduced odds of small airways obstruction. INTERPRETATION Despite the wide geographical variation, small airways obstruction is common and more prevalent than chronic airflow obstruction worldwide. Small airways obstruction shows the same risk factors as chronic airflow obstruction. However, further research is required to investigate whether small airways obstruction is also associated with respiratory symptoms and lung function decline. FUNDING National Heart and Lung Institute and Wellcome Trust. TRANSLATIONS For the Dutch, Estonian, French, Icelandic, Malay, Marathi, Norwegian, Portuguese, Swedish and Urdu translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Ben Knox-Brown
- National Heart and Lung Institute, Imperial College London, London, UK.
| | - Jaymini Patel
- National Heart and Lung Institute, Imperial College London, London, UK
| | - James Potts
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Rana Ahmed
- Epidemiological Laboratory for Public Health, Research and Development, Khartoum, Sudan
| | | | - Hamid Hacene Cherkaski
- Department of Pneumology, Faculty of Medicine Annaba, University Badji Mokhtar of Annaba, Annaba, Algeria
| | - Meriam Denguezli
- Faculté de Médecine Dentaire de Monastir, Université de Monastir, Monastir, Tunisia
| | - Mohammed Elbiaze
- Department of Respiratory Medicine, Faculty of Medicine, Mohammed Ben Abdellah University, University Hospital, Fes, Morocco
| | - Asma Elsony
- Epidemiological Laboratory for Public Health, Research and Development, Khartoum, Sudan
| | - Frits M E Franssen
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands; Department of Research and Education, CIRO, Horn, Netherlands
| | - Mohammed Al Ghobain
- King Abdullah International Medical Research Centre, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Imed Harrabi
- Ibn El Jazzar Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Rain Jõgi
- Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Sanjay Juvekar
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Herve Lawin
- Unit of Teaching and Research in Occupational and Environmental Health, University of Abomey-Calavi, Cotonou, Benin
| | - David Mannino
- University of Kentucky, Lexington, KY, USA; COPD Foundation, Miami, FL, USA
| | - Kevin Mortimer
- University of Cambridge, Cambridge, UK; Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Asaad Ahmed Nafees
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Rune Nielsen
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Stefanni Nonna M Paraguas
- Philippine College of Chest Physicians, Quezon City, Philippines; Philippine Heart Centre, Quezon City, Philippines
| | | | - Li-Cher Loh
- RCSI and UCD Malaysia Campus, Penang, Malaysia
| | - Sundeep Salvi
- Pulmocare Research and Education Foundation, Pune, India; Symbiosis International (Deemed University), Pune, India
| | - Terence Seemungal
- Faculty of Medical Sciences, University of the West Indies, Trinidad and Tobago
| | - Michael Studnicka
- University Clinic for Pneumology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Wan C Tan
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Emiel E F M Wouters
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands; Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Cristina Barbara
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Serviço de Pneumologia, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Thorarinn Gislason
- Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Kirthi Gunasekera
- Medical Research Institute, Central Chest Clinic, Colombo, Sri Lanka
| | - Peter Burney
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Andre F S Amaral
- National Heart and Lung Institute, Imperial College London, London, UK
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Petrone A, Pelaia C, Quartieri M, Petrone L, Rago GF, Columbro C, Pelaia G. Effectiveness of glycopyrronium bromide in the treatment of small airway dysfunction: A retrospective study. SAGE Open Med 2022; 10:20503121221145605. [PMID: 36582197 PMCID: PMC9793052 DOI: 10.1177/20503121221145605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Glycopyrronium bromide has a quaternary ammonium structure and a low oral bioavailability, which reduces its systemic effects; it acts through a bronchodilating blockade of muscarinic receptors. The aim of this retrospective study was to analyze a possible relationship between the changes in the small airways and the efficacy of a bronchodilation with glycopyrronium bromide; exercise tolerance was also assessed, by performing the six-minute walking test. Methods Forty-one patients were identified (23 females/18 males; mean age 66.82 ± 9.75 years), with a normal forced expiratory volume in 1 s (FEV1)/forced vital capacity ratio of 77.45% ± 4.86%, a reduced forced mid-expiratory flow between 25% and 75% of forced vital capacity (FEF25-75) of 42.9% ± 10.5%, with an increased residual volume/total lung capacity ratio of 132.68% ± 6.41%, FEV1 1.85 ± 0.54 L, forced vital capacity 2.39 ± 0.71 L, airway resistance (sR tot) 168.18% ± 42.5%, total lung capacity 98.28% ± 8.9%, six-minute walking test distance 318.3 ± 36.6 m, modified British Medical Research Council dyspnea scale 1.48 ± 0.77. All patients were initiated with glycopyrronium bromide 50 μg/die and reassessed after 4 months. Results After the treatment with glycopyrronium bromide, a significant improvement was noted regarding forced vital capacity (p = 0.04), FEF25-75 (p < 0.001), sR tot (p < 0.001), residual volume/total lung capacity ratio (p < 0.001) with reduction of dynamic hyperinflation, the significant increase of the distance covered during the six-minute walking test (p < 0.001), and modified British Medical Research Council (p < 0.001) showed enhanced exercise tolerance. FEV1 improved, but the difference was not statistically significant. Conclusions Small airway dysfunction is associated with bronchodilator responsiveness. Glycopyrronium bromide has proven to be capable of inducing favorable effects on lung hyperinflation and its functional and clinical consequences, with a decrease in dyspnea and an increase in exercise capacity. The use of anticholinergic drugs is useful in the management of small airway disease.
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Affiliation(s)
- Albino Petrone
- Department of Respiratory Diseases,
Annunziata Hospital, Cosenza, Italy
| | - Corrado Pelaia
- Department of Health Sciences,
University Magna Graecia of Catanzaro, Catanzaro, Italy,Corrado Pelaia, Department of Health
Sciences, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro 88100,
Italy.
| | - Michela Quartieri
- Department of Respiratory Diseases,
Annunziata Hospital, Cosenza, Italy
| | - Ludovico Petrone
- Department of Health Sciences,
University Magna Graecia of Catanzaro, Catanzaro, Italy
| | | | | | - Girolamo Pelaia
- Department of Health Sciences,
University Magna Graecia of Catanzaro, Catanzaro, Italy
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