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Wharton R, Mathis N, Wang JG, Meislin R, Liu B, Abdurrahman N, Le V, Rurak K, Hanson C, Que LG, Shaz D, Bose S. Feasibility of remote spirometry monitoring of asthma in pregnancy. Respir Med 2024; 233:107782. [PMID: 39187093 DOI: 10.1016/j.rmed.2024.107782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 08/14/2024] [Accepted: 08/23/2024] [Indexed: 08/28/2024]
Affiliation(s)
- Robert Wharton
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Noah Mathis
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jing Gennie Wang
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Rachel Meislin
- Division of Maternal-Fetal Medicine, Departments of Obstetrics and Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bian Liu
- Department of Population Health Science and Policy, Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Najla Abdurrahman
- Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai Hospital, New York, NY, USA
| | - Vi Le
- Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai Hospital, New York, NY, USA
| | - Kevin Rurak
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USA
| | - Corrine Hanson
- Division of Medical Nutrition Education, University of Nebraska Medical Center, Omaha, NE, USA
| | - Loretta G Que
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham, NC, USA
| | - David Shaz
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham, NC, USA
| | - Sonali Bose
- Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai Hospital, New York, NY, USA.
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Gao L, Wang H, Wu Y, Wang T, Xiong S, Qiu R, Zhou H, Liu L, Jia H, Qin J, Xu D, Shen Y, Chen L, Wen FQ. Diagnostic value of impulse oscillometry in chronic obstructive pulmonary disease: a multicentre, retrospective, observational study. BMJ Open 2024; 14:e087687. [PMID: 39384230 DOI: 10.1136/bmjopen-2024-087687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2024] Open
Abstract
OBJECTIVES Diagnosis and assessment of chronic obstructive pulmonary disease (COPD) rely extensively on spirometry, which necessitates patient cooperation. The clinical value of impulse oscillometry (IOS) as a non-volitional method in patients with COPD remains uncertain. DESIGN This retrospective observational study was conducted using patient data from between January 2014 and December 2015. SETTING Five public hospitals in China: West China Hospital, Nuclear Industry 416 Hospital, Suining Central Hospital, Affiliated Hospital, Medical College of Chengdu University and 363 Hospital. PARTICIPANTS The study included 6307 participants aged>40 years, comprising 2109 COPD patients and 4198 general non-COPD individuals, according to the Global Initiative for Obstructive Lung Disease (GOLD) spirometry standard. Participants with lung cancer, pulmonary tuberculosis, pneumonia or those who underwent lung resection were excluded from the study. OUTCOME MEASURES AND ANALYSIS Demographic data, spirometry results and IOS results were collected. Spearman's correlation analysis was used to examine the correlation between the IOS and spirometry parameters. Receiver operating characteristic curve analysis was used to evaluate the IOS performance in COPD diagnosis and severity staging. RESULTS Patients with COPD exhibited significant increases in Z5, R5, R20, R5-R20, Fres and Rp, but a decrease in X5 compared with non-COPD subjects (p<0.0001). IOS parameters, including Z5, R5-R20, Fres, Rp and X5, varied with the GOLD stages, with mild-to-moderate correlations with MMEF25%-75%, forced expiratory volume in one second (FEV1)/forced vital capacity and FEV1%, respectively. However, the combination of these five IOS parameters did not exhibit ideal performance in diagnosing COPD (area under the curve (AUC) 0.78; sensitivity 63.68%; specificity 80.09%), differentiating GOLD stage 1 patients from the general non-COPD population (AUC 0.71; sensitivity 54.71%; specificity 77.49%) or identifying GOLD stages 3 and 4 patients among those with COPD (AUC 0.75; sensitivity 69.51%; specificity 70.32%). CONCLUSION IOS parameters, while showing good correlation with spirometry in patients with COPD, did not perfectly substitute for spirometry in diagnosing COPD, especially in the early and advanced stages of the disease.
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Affiliation(s)
- Lijuan Gao
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Hao Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yanqiu Wu
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Tao Wang
- Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Shuguang Xiong
- Department of Respiratory and Critical Care Medicine, Nuclear Industry 416 Hospital, Chengdu, Sichuan, China
| | - Rong Qiu
- Department of Respiratory and Critical Care Medicine, Suining Central Hospital, Suining, Sichuan, China
| | - Hui Zhou
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital & Medical College of Chengdu University, Chengdu, Sichuan, China
| | - Lin Liu
- Department of Respiratory and Critical Care Medicine, 363 Hospital, Chengdu, Sichuan, China
| | - Huizhuo Jia
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Jiangyue Qin
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Dan Xu
- Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yongchun Shen
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Lei Chen
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Fu-Qiang Wen
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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3
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Lu L, Wu F, Peng J, Wu X, Hou X, Zheng Y, Yang H, Deng Z, Dai C, Zhao N, Zhou K, Wan Q, Tang G, Cui J, Yu S, Luo X, Yang C, Chen S, Ran P, Zhou Y. Clinical characterization and outcomes of impulse oscillometry-defined bronchodilator response: an ECOPD cohort-based study. Respir Res 2024; 25:149. [PMID: 38555433 PMCID: PMC10981824 DOI: 10.1186/s12931-024-02765-7] [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: 12/14/2023] [Accepted: 03/11/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND The clinical significance of the impulse oscillometry-defined small airway bronchodilator response (IOS-BDR) is not well-known. Accordingly, this study investigated the clinical characteristics of IOS-BDR and explored the association between lung function decline, acute respiratory exacerbations, and IOS-BDR. METHODS Participants were recruited from an Early Chronic Obstructive Pulmonary Disease (ECOPD) cohort subset and were followed up for two years with visits at baseline, 12 months, and 24 months. Chronic obstructive pulmonary disease (COPD) was defined as a post-bronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio < 0.70. IOS-BDR was defined as meeting any one of the following criteria: an absolute change in respiratory system resistance at 5 Hz ≤ - 0.137 kPa/L/s, an absolute change in respiratory system reactance at 5 Hz ≥ 0.055 kPa/L/s, or an absolute change in reactance area ≤ - 0.390 kPa/L. The association between IOS-BDR and a decline in lung function was explored with linear mixed-effects model. The association between IOS-BDR and the risk of acute respiratory exacerbations at the two-year follow-up was analyzed with the logistic regression model. RESULTS This study involved 466 participants (92 participants with IOS-BDR and 374 participants without IOS-BDR). Participants with IOS-BDR had higher COPD assessment test and modified Medical Research Council dyspnea scale scores, more severe emphysema, air trapping, and rapid decline in FVC than those without IOS-BDR over 2-year follow-up. IOS-BDR was not associated with the risk of acute respiratory exacerbations at the 2-year follow-up. CONCLUSIONS The participants with IOS-BDR had more respiratory symptoms, radiographic structural changes, and had an increase in decline in lung function than those without IOS-BDR. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR1900024643. Registered on 19 July, 2019.
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Affiliation(s)
- Lifei Lu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Fan Wu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Guangzhou National Laboratory, Guangzhou, China
| | - Jieqi Peng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Guangzhou National Laboratory, Guangzhou, China
| | - Xiaohui Wu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | | | - Huajing Yang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhishan Deng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Cuiqiong Dai
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ningning Zhao
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Kunning Zhou
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qi Wan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Gaoying Tang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiangyu Cui
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shuqing Yu
- Lianping County People's Hospital, Heyuan, China
| | - Xiangwen Luo
- Lianping County People's Hospital, Heyuan, China
| | - Changli Yang
- Wengyuan County People's Hospital, Shaoguan, China
| | | | - Pixin Ran
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
- Guangzhou National Laboratory, Guangzhou, China.
| | - Yumin Zhou
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
- Guangzhou National Laboratory, Guangzhou, China.
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van der Burg NMD, Ekelund C, Bjermer LH, Aronsson D, Ankerst J, Tufvesson E. Bronchodilator Responsiveness Measured by Spirometry and Impulse Oscillometry in Patients with Asthma After Short Acting Antimuscarinic and/or Beta-2-Agonists Inhalation. J Asthma Allergy 2024; 17:21-32. [PMID: 38264293 PMCID: PMC10804873 DOI: 10.2147/jaa.s442217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/02/2023] [Indexed: 01/25/2024] Open
Abstract
Background Bronchodilator responsiveness (BDR) in asthma involves both the central and peripheral airways but is primarily relieved with beta-2-agonists and evaluated by spirometry. To date, antimuscarinics can be added as a reliever medication in more severe asthma. We hypothesize that combining both short-acting beta-2 agonist (SABA) and short-acting muscarinic antagonist (SAMA) could also improve the responsiveness in mild-moderate asthma. Therefore, we aimed to compare the direct effects of inhaling SABA alone, SAMA alone or combining both SABA and SAMA on the central and peripheral airways in asthma. Methods Twenty-three patients with mild-moderate BDR in asthma performed dynamic spirometry and impulse oscillometry before (baseline) and multiple timepoints within an hour after inhalation of SABA (salbutamol), SAMA (ipratropium bromide), or both SABA and SAMA at three different visits. Results The use of SAMA alone did not show any improvement compared to the use of SABA alone. Inhalation of SABA+SAMA, however, averaged either similar or better BDR than SABA alone in FEV1, MMEF, FVC, R5, R20 and R5-R20. Inhaling SABA+SAMA reached a stable BDR in more patients within 0-10 minutes and also reached the FEV1 (Δ%)>12% faster (3.5 minutes) than inhaling SABA alone (5.1 minutes). Inhaling SABA+SAMA was significantly better than SAMA alone in FEV1 (p = 0.015), MMEF (p = 0.0059) and R20 (p = 0.0049). Using these three variables highlighted a subgroup (30%, including more males) of patients that were more responsive to inhaling SABA+SAMA than SABA alone. Conclusion Overall, combining SAMA with SABA was faster and more consistent at increasing the lung function than SABA alone or SAMA alone, and the additive effect was best captured by incorporating peripheral-related variables. Therefore, SAMA should be considered as an add-on reliever for mild-moderate patients with BDR in asthma.
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Affiliation(s)
- Nicole M D van der Burg
- Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
| | - Carl Ekelund
- Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
| | - Leif H Bjermer
- Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
| | - David Aronsson
- Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
| | - Jaro Ankerst
- Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
| | - Ellen Tufvesson
- Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
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5
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Chen KY, Hung MH, Kao KC. Impulse oscillometry and its independent role in the diagnosis of chronic obstructive pulmonary disease. Heliyon 2024; 10:e23627. [PMID: 38187302 PMCID: PMC10767126 DOI: 10.1016/j.heliyon.2023.e23627] [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: 06/04/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024] Open
Abstract
Background Pulmonary function test, particularly in patients with COVID-19, is problematic because it involves forced expiration. Impulse oscillometry (IOS) reduces the potential exposure of health-care staff to infectious droplets. In this study, we investigated the correlation between IOS and spirometry and whether IOS can precisely predict spirometry-based diagnoses of chronic obstructive pulmonary disease (COPD). Methods We retrospectively analyzed the data (January 1 to December 31, 2021) of patients who underwent both spirometry and IOS on the same date. One-way analysis of variance was performed to evaluate the IOS results of patients stratified into two (COPD and non-COPD) groups by spirometry results. IOS results were also analyzed using receiver operator characteristics curves to diagnose advanced COPD, which was indicated by a postbronchodilator (BD) forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio of <0.6. We further evaluated the accuracy of oscillometry as a predictor of spirometry-based COPD diagnosis. Results A total of 115 patients were included in the analysis. The best parameters assessed for spirometry-based COPD diagnosis were area under reactance (AX) and airway resistance (predicted R5% × resonant frequency) in relation to body mass index (BMI). However, when the post-BD FEV1/FVC ratio was <0.6, BMI-adjusted airway resistance had an area under curve (0.782; 95 % confidence interval: 0.620-0.945) value larger than the corresponding AX. A BMI-adjusted airway resistance value of >160 moderately predicted spirometry-based COPD diagnosis. Conclusions BMI-adjusted airway resistance is a potential predictor of spirometry-based COPD diagnosis; the cutoff values of this parameter differ between individuals with and without obesity.
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Affiliation(s)
- Kuang-Yu Chen
- Chest Medicine, Lo-Tung Poh-Ai Hospital, No. 83, Nanchang Street, Luodong Township, Yilan County 265, Taiwan
| | - Ming-Hui Hung
- Chest Medicine, Lo-Tung Poh-Ai Hospital, No. 83, Nanchang Street, Luodong Township, Yilan County 265, Taiwan
| | - Kuo-Chin Kao
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
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Jacquerie P, André B, De Seny D, Henket M, Giltay L, Ernst M, Louis R, Malaise M, Ribbens C, Guiot J. Reproducibility of pulmonary function tests in patients with systemic sclerosis. Sci Rep 2023; 13:18960. [PMID: 37923803 PMCID: PMC10624913 DOI: 10.1038/s41598-023-45881-y] [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: 01/22/2023] [Accepted: 10/25/2023] [Indexed: 11/06/2023] Open
Abstract
Systemic sclerosis (SSc) is a rare autoimmune disease in which interstitial lung disease (ILD) is the leading cause of morbidity and mortality. Clinical management of the lung disease is mainly based on pulmonary function testing (PFT) and their changes over time. Little is known about the reproducibility of PFT testing in SSc patients. The aim of this study was to assess the test-retest reliability and reproducibility of PFTs in SSc patients with or without ILD over 30 days in order determine the potential physiologic variation over the time. We performed prospective observational study of SSc patients. The FVC, FEV1/FVC ratio, DLCO and KCO parameters were assessed in this population at four different timepoints; T0 (time 0) and H3 (T0 + 3 h) defined test-retest reliability, D15 (T0 + 15 days) and D30 (T0 + 30 days) for reproducibility. A mixed linear model was used to test the effect of time (and therefore reproducibility) on patients and we looked for an interaction. We included 25 SSc patients divided in two groups, 14 with ILD and 11 non-ILD. Interactions between time and group were not significant and were not reported. Time and group did not significantly influence the different measures of the PFT: FVC [p values time and group effect respectively (0.33; 0.34)], FEV1/FVC ratio (0.093; 0.056) and DLCO (0.99; 0.13) in the ILD and non ILD group (Table S2). The analyse with interactions between time and group were not significant and are not reported. We also used a Bland Altman test to assess reproducibility for FVC (L) and DLCO (mMKpa/min/L), Figs. 1 and 2 respectively. The measurements were therefore reproducible over time and in each group. PFT parameters are reproducible over time in a clinically stable population of SSc (no significant effect of the time T0, H3, D15 and D30) and there is no significant distinction between patients with ILD and no ILD. These respiratory functional data can further underline their use in clinical practice.
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Affiliation(s)
- P Jacquerie
- Rheumatology Department, CHU LiègeULiège, Domaine Universitaire Sart Tilman, B35, 4020, Liège, Belgium.
| | - B André
- Rheumatology Department, CHU LiègeULiège, Domaine Universitaire Sart Tilman, B35, 4020, Liège, Belgium
| | - D De Seny
- Pneumology Department, CHU Liège, GIGA Research, ULiège, Domaine Universitaire Sart Tilman, Liège, Belgium
| | - M Henket
- Pneumology Department, CHU Liège, GIGA Research, ULiège, Domaine Universitaire Sart Tilman, Liège, Belgium
| | - L Giltay
- Pneumology Department, CHU Liège, GIGA Research, ULiège, Domaine Universitaire Sart Tilman, Liège, Belgium
| | - M Ernst
- Biostatistics and Research Method Center (B-STAT), ULiège, Domaine Universitaire Sart Tilman, Liège, Belgium
| | - R Louis
- Pneumology Department, CHU Liège, GIGA Research, ULiège, Domaine Universitaire Sart Tilman, Liège, Belgium
| | - M Malaise
- Rheumatology Department, CHU LiègeULiège, Domaine Universitaire Sart Tilman, B35, 4020, Liège, Belgium
| | - C Ribbens
- Rheumatology Department, CHU LiègeULiège, Domaine Universitaire Sart Tilman, B35, 4020, Liège, Belgium
| | - J Guiot
- Pneumology Department, CHU Liège, GIGA Research, ULiège, Domaine Universitaire Sart Tilman, Liège, Belgium
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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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Kostorz-Nosal S, Jastrzębski D, Błach A, Skoczyński S. Window of opportunity for respiratory oscillometry: A review of recent research. Respir Physiol Neurobiol 2023; 316:104135. [PMID: 37536553 DOI: 10.1016/j.resp.2023.104135] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/19/2023] [Accepted: 07/30/2023] [Indexed: 08/05/2023]
Abstract
Oscillometry has been around for almost 70 years, but there are still many unknowns. The test is performed during tidal breathing and is therefore free from patient-dependent factors that could influence the results. The Forced Oscillation Technique (FOT), which requires minimal patient cooperation, is gaining ground, particularly with elderly patients and children. In pulmonology, it is a valuable tool for assessing obstructive conditions (with a distinction between central and peripheral obstruction) and restrictive disorders (intrapulmonary and extrapulmonary). Its sensitivity allows the assessment of bronchodilator and bronchoconstrictor responses. Different lung diseases show different patterns of changes in FOT, especially studied in asthma and chronic obstructive pulmonary disease. Because of these differences, many studies have analysed the usefulness of this technique in different areas of medicine. In this paper, the authors would like to present the basics of oscillometry with the areas of its most recent clinical applications.
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Affiliation(s)
- Sabina Kostorz-Nosal
- Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-803 Zabrze, Poland.
| | - Dariusz Jastrzębski
- Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-803 Zabrze, Poland
| | - Anna Błach
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Szymon Skoczyński
- Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-803 Zabrze, Poland
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Zhu RX, Nie XH, Liu XF, Zhang YX, Chen J, Liu XJ, Hui XJ. Short-term effect of particulate matter on lung function and impulse oscillometry system (IOS) parameters of chronic obstructive pulmonary disease (COPD) in Beijing, China. BMC Public Health 2023; 23:1417. [PMID: 37488590 PMCID: PMC10367330 DOI: 10.1186/s12889-023-16308-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 07/13/2023] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the associations between particulate matter (PM), lung function and Impulse Oscillometry System (IOS) parameters in chronic obstructive pulmonary disease (COPD) patients and identity effects between different regions in Beijing, China. METHODS In this retrospective study, we recruited 1348 outpatients who visited hospitals between January 2016 and December 2019. Ambient air pollutant data were obtained from the central monitoring stations nearest the participants' residential addresses. We analyzed the effect of particulate matter with aerodynamic diameter ≤ 2.5 μm (PM2.5) exposure on lung function and IOS parameters using a multiple linear regression model, adjusting for sex, smoking history, education level, age, body mass index (BMI), mean temperature, and relative humidity . RESULTS The results showed a relationship between PM2.5, lung function and IOS parameters. An increase of 10 µg/m3 in PM2.5 was associated with a decline of 2.083% (95% CI: -3.047 to - 1.103) in forced expiratory volume in one second /predict (FEV1%pred), a decline of 193 ml/s (95% CI: -258 to - 43) in peak expiratory flow (PEF), a decline of 0.932% (95% CI: -1.518 to - 0.342) in maximal mid-expiratory flow (MMEF); an increase of 0.732 Hz (95% CI: 0.313 to 1.148) in resonant frequency (Fres), an increase of 36 kpa/(ml/s) (95% CI: 14 to 57) in impedance at 5 Hz (Z5) and an increase of 31 kpa/(ml/s) (95% CI: 2 to 54) in respiratory impedance at 5 Hz (R5). Compared to patients in the central district, those in the southern district had lower FEV1/FVC, FEV1%pred, PEF, FEF75%, MMEF, X5, and higher Fres, Z5 and R5 (p < 0.05). CONCLUSION Short-term exposure to PM2.5 was associated with reductions in lung function indices and an increase in IOS results in patients with COPD. The heavier the PM2.5, the more severe of COPD.
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Affiliation(s)
- Rui-Xia Zhu
- Department of pulmonary and critical care medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiu-Hong Nie
- Department of pulmonary and critical care medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Xiao-Fang Liu
- Department of pulmonary and critical care medicine, Tong Ren Hospital, Capital Medical University, Beijing, China
| | - Yong-Xiang Zhang
- Department of pulmonary and critical care medicine, Daxing District People's Hospital, Beijing, China.
| | - Jin Chen
- Respiratory department, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Xue-Jiao Liu
- Department of pulmonary and critical care medicine, Daxing District People's Hospital, Beijing, China
| | - Xin-Jie Hui
- Department of pulmonary and critical care medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
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Kotsiou OS, Tourlakopoulos K, Kontopoulou L, Mavrovounis G, Pantazopoulos I, Kirgou P, Zarogiannis SG, Daniil Z, Gourgoulianis KI. D-ROMs and PAT Tests Reveal a High Level of Oxidative Stress in Patients with Severe Well-Controlled Asthma, and D-ROMs Are Positively Correlated with R20 Values That Indicate Approximate Central Airway Resistance. J Pers Med 2023; 13:943. [PMID: 37373932 DOI: 10.3390/jpm13060943] [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: 03/15/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The derivatives-reactive oxygen metabolites (d-ROMs) and plasma antioxidant capacity (PAT) tests are oxidative indexes. Severe asthma has been related to oxidative stress. We aimed to investigate d-ROMs and PAT values in severely controlled asthmatics and the correlation of these values with lung function. METHODS Blood samples were collected from severely controlled asthmatics and centrifuged at 3000 rpm for 10 min. The supernatant was collected. The assays were performed within three hours of collection. The fraction of exhaled nitric oxide (FeNO), impulse oscillometry (IOS), and spirometry were determined. Symptom control was recorded using the asthma control test (ACT). RESULTS Approximately 40 patients with severe controlled asthma (75%: women), mean age of 62 ± 12 years, were recruited. Approximately 5% had obstructive spirometry. The IOS revealed airway abnormalities even though the spirometric results were within the normal range, with it being more sensitive than spirometry. The D-ROMs and PAT test values were higher than normal, indicating oxidative stress in severe asthmatics with controlled asthma. D-ROMs were positively correlated with R20 values, indicating central airway resistance. CONCLUSIONS The IOS technique revealed an otherwise hidden airway obstruction with spirometry. The D-ROMs and PAT tests revealed a high level of oxidative stress in severe controlled asthmatics. D-ROMs correlate with R20, indicating central airway resistance.
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Affiliation(s)
- Ourania S Kotsiou
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, 41100 Biopolis, Greece
- Faculty of Nursing, University of Thessaly, 45550 Gaiopolis, Greece
| | | | | | - Georgios Mavrovounis
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, 41100 Biopolis, Greece
| | - Ioannis Pantazopoulos
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, 41100 Biopolis, Greece
| | - Paraskevi Kirgou
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, 41100 Biopolis, Greece
| | | | - Zoe Daniil
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, 41100 Biopolis, Greece
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