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Wang Y, Berger KI, Zhang Y, Shao Y, Goldring RM, Reibman J, Liu M. Novel approach to studying effects of inhalational exposure on lung function in civilians exposed to the World Trade Center disaster. Sci Rep 2023; 13:3218. [PMID: 36828851 PMCID: PMC9958097 DOI: 10.1038/s41598-023-30030-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/14/2023] [Indexed: 02/26/2023] Open
Abstract
It is increasingly important to study the impact of environmental inhalation exposures on human health in natural or man-made disasters in civilian populations. The members of the World Trade Center Environmental Health Center (WTC EHC; WTC Survivors) had complex exposures to environmental disaster from the destruction of WTC towers and can serve to reveal the effects of WTC exposure on the entire spectrum of lung functions. We aimed to investigate the associations between complex WTC exposures and measures of spirometry and oscillometry in WTC Survivors and included 3605 patients enrolled between Oct 1, 2009 and Mar 31, 2018. We performed latent class analysis and identified five latent exposure groups. We applied linear and quantile regressions to estimate the exposure effects on the means and various quantiles of pre-bronchodilator (BD) % predicted forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio, as well as the resistance at an oscillating frequency of 5 Hz (R5), frequency dependence of resistance R5-20, and reactance area (AX). Compared with Group 5, which had low or unknown exposure and was treated as the reference group, Group 1, the local workers with both acute and chronic exposures, had a lower median of % predicted FVC (-3.6; 95% CI: -5.4, -1.7) and higher (more abnormal) measures of AX at 10th quantile (0.77 cmH2O L-1 s; 95% CI: 0.41, 1.13) and 25th quantile (0.80 cmH2O L-1 s; 95% CI: 0.41, 1.20). Results suggested heterogeneous exposures to the WTC disaster had differential effects on the distributions of lung functions in the WTC Survivors. These findings could provide insights for future investigation of environmental disaster exposures.
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Affiliation(s)
- Yuyan Wang
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Kenneth I Berger
- Department of Medicine, New York University Grossman School of Medicine, 550 1st Avenue, New York, NY, 10016, USA
| | - Yian Zhang
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Yongzhao Shao
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
- Department of Environmental Medicine, New York University Grossman School of Medicine, 550 1st Avenue, New York, NY, 10016, USA
| | - Roberta M Goldring
- Department of Medicine, New York University Grossman School of Medicine, 550 1st Avenue, New York, NY, 10016, USA
| | - Joan Reibman
- Department of Medicine, New York University Grossman School of Medicine, 550 1st Avenue, New York, NY, 10016, USA.
- Department of Environmental Medicine, New York University Grossman School of Medicine, 550 1st Avenue, New York, NY, 10016, USA.
| | - Mengling Liu
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA.
- Department of Environmental Medicine, New York University Grossman School of Medicine, 550 1st Avenue, New York, NY, 10016, USA.
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2
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Berger KI, Wohlleber M, Goldring RM, Reibman J, Farfel MR, Friedman SM, Oppenheimer BW, Stellman SD, Cone JE, Shao Y. Respiratory impedance measured using impulse oscillometry in a healthy urban population. ERJ Open Res 2021; 7:00560-2020. [PMID: 33816605 PMCID: PMC8005688 DOI: 10.1183/23120541.00560-2020] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/02/2020] [Indexed: 11/12/2022] Open
Abstract
This study derives normative prediction equations for respiratory impedance in a healthy asymptomatic urban population using an impulse oscillation system (IOS). In addition, this study uses body mass index (BMI) in the equations to describe the effect of obesity on respiratory impedance. Data from an urban population comprising 472 healthy asymptomatic subjects that resided or worked in lower Manhattan, New York City were retrospectively analysed. This population was the control group from a previously completed case–control study of the health effects of exposure to World Trade Center dust. Since all subjects underwent spirometry and oscillometry, these previously collected data allowed a unique opportunity to derive normative prediction equations for oscillometry in an urban, lifetime non-smoking, asymptomatic population without underlying respiratory disease. Normative prediction equations for men and women were successfully developed for a broad range of respiratory oscillometry variables with narrow confidence bands. Models that used BMI as an independent predictor of oscillometry variables (in addition to age and height) demonstrated equivalent or better fit when compared with models that used weight. With increasing BMI, resistance and reactance increased compatible with lung and airway compression from mass loading. This study represents the largest cohort of healthy urban subjects assessed with an IOS device. Normative prediction equations were derived that should facilitate application of IOS in the clinical setting. In addition, the data suggest that modelling of lung function may be best performed using height and BMI as independent variables rather than the traditional approach of using height and weight. Prediction equations for respiratory impedance were derived in an urban cohort incorporating the effects of mass loading from obesity. Urban exposures had minimal effect on impedance allowing application of the equations to a broad range of populations.https://bit.ly/3a3zZvd
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Affiliation(s)
- Kenneth I Berger
- Dept of Medicine, NYU Grossman School of Medicine, New York, NY, USA.,André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA
| | - Margaret Wohlleber
- Dept of Medicine, NYU Grossman School of Medicine, New York, NY, USA.,André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA
| | - Roberta M Goldring
- Dept of Medicine, NYU Grossman School of Medicine, New York, NY, USA.,André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA
| | - Joan Reibman
- Dept of Medicine, NYU Grossman School of Medicine, New York, NY, USA.,Dept of Environmental Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Mark R Farfel
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Stephen M Friedman
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Beno W Oppenheimer
- Dept of Medicine, NYU Grossman School of Medicine, New York, NY, USA.,André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA
| | - Steven D Stellman
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, NY, USA.,Mailman School of Public Health, Columbia University, New York, NY, USA
| | - James E Cone
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Yongzhao Shao
- Dept of Population Health, NYU Grossman School of Medicine, New York, NY, USA
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3
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Porojan-Suppini N, Fira-Mladinescu O, Marc M, Tudorache E, Oancea C. Lung Function Assessment by Impulse Oscillometry in Adults. Ther Clin Risk Manag 2020; 16:1139-1150. [PMID: 33273817 PMCID: PMC7705955 DOI: 10.2147/tcrm.s275920] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/08/2020] [Indexed: 11/23/2022] Open
Abstract
Over the past decades, impulse oscillometry (IOS) has gained ground in the battery of pulmonary function tests. Performing the test requires minimal cooperation of the patient; therefore, it is a useful tool, especially in evaluating lung mechanics in children, elderly patients, and those who cannot perform spirometry. Oscillometry has also been used in both clinical and research departments. Studies were published mainly in asthma regarding detection of bronchodilator response and the therapeutic response to different drugs. Furthermore, it has been shown to be a sensitive technique to evaluate disease control. Other studied diseases were COPD, interstitial lung diseases, small airway disease, impairment of lung function due to exposure to occupational hazards or smoking, central airways obstruction, cystic fibrosis, monitoring lung mechanics during mechanical ventilation and sleep, neuromuscular diseases, lung transplant, and graft function. The aim of this review is to present the utility of oscillometry on the previously mentioned clinical fields.
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Affiliation(s)
- Noemi Porojan-Suppini
- Department of Pulmonology, Center for Research and Innovation in Personalized Medicine of Respiratory Diseases, University of Medicine and Pharmacy "Victor Babeș", Timișoara, Romania
| | - Ovidiu Fira-Mladinescu
- Department of Pulmonology, Center for Research and Innovation in Personalized Medicine of Respiratory Diseases, University of Medicine and Pharmacy "Victor Babeș", Timișoara, Romania
| | - Monica Marc
- Department of Pulmonology, Center for Research and Innovation in Personalized Medicine of Respiratory Diseases, University of Medicine and Pharmacy "Victor Babeș", Timișoara, Romania
| | - Emanuela Tudorache
- Department of Pulmonology, Center for Research and Innovation in Personalized Medicine of Respiratory Diseases, University of Medicine and Pharmacy "Victor Babeș", Timișoara, Romania
| | - Cristian Oancea
- Department of Pulmonology, Center for Research and Innovation in Personalized Medicine of Respiratory Diseases, University of Medicine and Pharmacy "Victor Babeș", Timișoara, Romania
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Randerath W, Dreher M, Gompelmann D, Held M, Koczulla R, Köhnlein T, Rohde G, Wälscher J, Watz H, Steinkamp G. [Technological Innovations in Pulmonology - Examples from Diagnostics and Therapy]. Pneumologie 2020; 74:585-600. [PMID: 32663891 DOI: 10.1055/a-1186-7333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A significant proportion of the current technological developments in pneumology originate from the various areas of information technology. The spectrum ranges from smartphone apps to be used in daily life or in patient care to the use of artificial intelligence in screening and early detection of diseases. The diagnostic accuracy of apps for symptom analysis is currently very limited. Research projects are performed on the integration of symptoms and functional parameters into early detection, but also on mobility measurements as a prognostic marker in COPD. Lung cancer screening using computed tomography represents a major challenge. Here, artificial intelligence can help radiologists to cope with huge amounts of data. However, the quality of the software depends on the sufficient training of the system. Technological developments shape all fields of pneumology. For diagnostic and interventional endoscopy, they offer improved biopsy techniques and microstructural imaging. Advances in lung function measurements allow the differentiated analysis of respiratory mechanical disorders, and they could be transferred to ventilation technology. The translation of basic findings about the lung microbiome into patient care may perspectively help to better understand and treat COPD exacerbations.
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Affiliation(s)
- W Randerath
- Klinik für Pneumologie und Allergologie, Krankenhaus Bethanien, Solingen
| | - M Dreher
- Klinik für Pneumologie und Internistische Intensivmedizin, Medizinische Klinik V, Universitätsklinikum Aachen
| | - D Gompelmann
- Klinische Abteilung für Pulmologie, Universitätsklinik Innere Medizin II, Wien
| | - M Held
- Missioklinik, Klinikum Würzburg Mitte, Zentrum für Thoraxmedizin Würzburg, Medizinische Klinik mit Schwerpunkt Pneumologie und Beatmungsmedizin
| | - R Koczulla
- Fachzentrum für Pneumologie, Schön Klinik Berchtesgadener Land und Universitätsklinikum Marburg
| | - T Köhnlein
- Pneumologisches Facharztzentrum Teuchern
| | - G Rohde
- Pneumologie/Allergologie, Medizinische Klinik 1, Universitätsklinikum Frankfurt
| | - J Wälscher
- Pneumologie, Ruhrlandklinik, Universitätsmedizin Essen
| | - H Watz
- Pneumologisches Forschungsinstitut an der LungenClinic Großhansdorf, Airway Research Center North (ARCN), Deutsches Zentrum für Lungenforschung (DZL)
| | - G Steinkamp
- Medizinisch-wissenschaftliches Publizieren, Schwerin
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5
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Ram J, Pineda-Cely J, Calhoun WJ. Forced Oscillometry: A New Tool for Assessing Airway Function-Is It Ready for Prime Time? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 7:2861-2862. [PMID: 31706498 DOI: 10.1016/j.jaip.2019.07.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 07/31/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Jonathan Ram
- Division of Pulmonary, Critical Care, and Sleep, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Jenny Pineda-Cely
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | - William J Calhoun
- Division of Pulmonary, Critical Care, and Sleep, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas; Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas.
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Cummings KJ, Stanton ML, Kreiss K, Boylstein RJ, Park JH, Cox-Ganser JM, Virji MA, Edwards NT, Segal LN, Blaser MJ, Weissman DN, Nett RJ. Work-related adverse respiratory health outcomes at a machine manufacturing facility with a cluster of bronchiolitis, alveolar ductitis and emphysema (BADE). Occup Environ Med 2020; 77:386-392. [PMID: 32132182 DOI: 10.1136/oemed-2019-106296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 01/27/2020] [Accepted: 02/14/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Four machine manufacturing facility workers had a novel occupational lung disease of uncertain aetiology characterised by lymphocytic bronchiolitis, alveolar ductitis and emphysema (BADE). We aimed to evaluate current workers' respiratory health in relation to job category and relative exposure to endotoxin, which is aerosolised from in-use metalworking fluid. METHODS We offered a questionnaire and spirometry at baseline and 3.5 year follow-up. Endotoxin exposures were quantified for 16 production and non-production job groups. Forced expiratory volume in one second (FEV1) decline ≥10% was considered excessive. We examined SMRs compared with US adults, adjusted prevalence ratios (aPRs) for health outcomes by endotoxin exposure tertiles and predictors of excessive FEV1 decline. RESULTS Among 388 (89%) baseline participants, SMRs were elevated for wheeze (2.5 (95% CI 2.1 to 3.0)), but not obstruction (0.5 (95% CI 0.3 to 1.1)). Mean endotoxin exposures (range: 0.09-28.4 EU/m3) were highest for machine shop jobs. Higher exposure was associated with exertional dyspnea (aPR=2.8 (95% CI 1.4 to 5.7)), but not lung function. Of 250 (64%) follow-up participants, 11 (4%) had excessive FEV1 decline (range: 403-2074 mL); 10 worked in production. Wheeze (aPR=3.6 (95% CI 1.1 to 12.1)) and medium (1.3-7.5 EU/m3) endotoxin exposure (aPR=10.5 (95% CI 1.3 to 83.1)) at baseline were associated with excessive decline. One production worker with excessive decline had BADE on subsequent lung biopsy. CONCLUSIONS Lung function loss and BADE were associated with production work. Relationships with relative endotoxin exposure indicate work-related adverse respiratory health outcomes beyond the sentinel disease cluster, including an incident BADE case. Until causative factors and effective preventive strategies for BADE are determined, exposure minimisation and medical surveillance of affected workforces are recommended.
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Affiliation(s)
- Kristin J Cummings
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Marcia L Stanton
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Kathleen Kreiss
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Randy J Boylstein
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Ju-Hyeong Park
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Jean M Cox-Ganser
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - M Abbas Virji
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Nicole T Edwards
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Leopoldo N Segal
- Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Martin J Blaser
- Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - David N Weissman
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Randall J Nett
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
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7
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Holley AB, Boose WD, Perkins M, Sheikh KL, Solomon NP, Dietsch AM, Vossoughi J, Johnson AT, Collen JF. A Rapid, Handheld Device to Assess Respiratory Resistance: Clinical and Normative Evidence. Mil Med 2019; 183:e370-e377. [PMID: 29425367 DOI: 10.1093/milmed/usx224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/30/2017] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Following reports of respiratory symptoms among service members returning from deployment to South West Asia (SWA), an expert panel recommended pre-deployment spirometry be used to assess disease burden. Unfortunately, testing with spirometry is high cost and time-consuming. The airflow perturbation device (APD) is a handheld monitor that rapidly measures respiratory resistance (APD-Rr) and has promising but limited clinical data. Its speed and portability make it ideally suited for large volume pre-deployment screening. We conducted a pilot study to assess APD performance characteristics and develop normative values. MATERIALS AND METHODS We prospectively enrolled subjects and derived reference equations for the APD from those without respiratory symptoms, pulmonary disease, or tobacco exposure. APD testing was conducted by medical technicians who received a 10-min in-service on its use. A subset of subjects performed spirometry and impulse oscillometry (iOS), administered by trained respiratory therapists. APD measures were compared with spirometry and iOS. RESULTS The total study population included 199 subjects (55.8% males, body mass index 27.7 ± 6.0 kg/m2, age 49.9 ± 18.7 yr). Across the three APD trials, mean inspiratory (APD-Ri), expiratory (APD-Re), and average (APD-Ravg) resistances were 3.30 ± 1.0, 3.69 ± 1.2, and 3.50 ± 1.1 cm H2O/L/s. Reference equations were derived from 142 clinically normal volunteers. Height, weight, and body mass index were independently associated with APD-Ri, APD-Re, and APD-Ravg and were combined with age and gender in linear regression models. APD-Ri, APD-Re, and APD-Ravg were significantly inversely correlated with FEV1 (r = -0.39 to -0.42), FVC (r = -0.37 to -0.40), and FEF25-75 (r = -0.31 to -0.35) and positively correlated with R5 (r = 0.61-0.62), R20 (r = 0.50-0.52), X5 (r = -0.57 to -0.59), and FRES (r = 0.42-0.43). Bland-Altman plots showed that the APD-Rr closely approximates iOS when resistance is normal. CONCLUSION Rapid testing was achieved with minimal training required, and reference equations were constructed. APD-Rr correlated moderately with iOS and weakly with spirometry. More testing is required to determine whether the APD has value for pre- and post-deployment respiratory assessment.
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Affiliation(s)
- Aaron B Holley
- Pulmonary/Sleep and Critical Care Medicine, San Antonio Military Medical Center, 3551 Roger Brooke Dr, San Antonio, TX
| | | | | | - Karen L Sheikh
- Respira Medical, Inc. 09 Pinnacle Drive, Suite R, Linthicum, MD
| | - Nancy P Solomon
- Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD
| | | | - Jafar Vossoughi
- Engineering and Scientific Research Associates, 2330 Jeong H. Kim Engineering Building, College Park, MD
| | - Arthur T Johnson
- Fischell Department of Bioengineering University of Maryland, College Park, 2330 Jeong H. Kim Engineering Building College Park, MD
| | - Jacob F Collen
- Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD
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Butzko RP, Sotolongo AM, Helmer DA, Klein-Adams JC, Osinubi OY, Berman AR, Ortiz-Pacheco R, Falvo MJ. Forced oscillation technique in veterans with preserved spirometry and chronic respiratory symptoms. Respir Physiol Neurobiol 2019; 260:8-16. [DOI: 10.1016/j.resp.2018.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/15/2018] [Accepted: 11/28/2018] [Indexed: 01/01/2023]
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9
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Zaidan MF, Meah S, Duarte A. The Use and Interpretation of Impedance Oscillometry in Pulmonary Disorders. CURRENT PULMONOLOGY REPORTS 2018. [DOI: 10.1007/s13665-018-0218-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Watanabe H, Shirai T, Akamatsu T, Asada K, Hirai K. Forced oscillatory parameters in reversibility testing as predictors for chronic cough responsive to inhaled corticosteroid/long-acting β2 agonist. Ann Allergy Asthma Immunol 2018; 122:345-346.e1. [PMID: 30342091 DOI: 10.1016/j.anai.2018.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/29/2018] [Accepted: 10/04/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Hirofumi Watanabe
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Toshihiro Shirai
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan.
| | - Taisuke Akamatsu
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Kazuhiro Asada
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Keita Hirai
- Department of Clinical Pharmacology and Genetics, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
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11
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Johansson EL, Ternesten-Hasséus E, Gustafsson P, Pullerits T, Arvidsson M, Millqvist E. Small and large airway reactions to osmotic stimuli in asthma and chronic idiopathic cough. Pulm Pharmacol Ther 2018; 49:112-118. [PMID: 29438818 DOI: 10.1016/j.pupt.2018.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/01/2018] [Accepted: 02/04/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Chronic cough is a common symptom and related to several pulmonary, airway and heart diseases. When all likely medical explanations for the coughing are excluded, there remains a large group of patients with chronic coughing, which is mostly a cough reflex easily triggered by environmental irritants and noxious stimuli. The main aim of this study was to improve the diagnostic ability to differentiate chronic idiopathic cough (CIC) from asthma. METHODS Twenty-three patients with CIC, 16 patients with mild asthma and 21 control participants were included. The study consisted of three randomised bronchial provocations with osmotic stimuli: mannitol, eucapnic dry air and hypertonic saline. At each provocation lung function was assessed by spirometry and impulse oscillometry (IOS). RESULTS In a comparison of the groups, while the FEV1 measurements did not differ, the CIC group had increased airway resistance and reactance after provocation with hypertonic saline compared to the control subjects. After mannitol provocation the patients with asthma had significantly increased airway resistance compared to the controls and from eucapnic dry air provocations these patients had a significant reduction in spirometry values and increased airway resistance compared to both the patients with CIC and the controls. CONCLUSION The asthma group reacted in a predictable way with impaired lung function from osmotic provocations, whereas the patients with CIC demonstrated peripheral airway changes from hypertonic saline, also known to be a noxious stimulus. The IOS method uncovers differences between patients with CIC and control participants that contribute to our ability to provide a correct diagnosis.
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Affiliation(s)
- Ewa-Lena Johansson
- Departments of Clinical Neuroscience and Rehabilitation, Physiotherapy, The Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Ewa Ternesten-Hasséus
- Department of Internal Medicine/Respiratory Medicine and Allergology, The Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Per Gustafsson
- Department of Paediatrics, Central Hospital, Skovde, Sweden.
| | - Teet Pullerits
- Department of Internal Medicine/Respiratory Medicine and Allergology, The Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Monica Arvidsson
- Department of Internal Medicine/Respiratory Medicine and Allergology, The Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Eva Millqvist
- Department of Internal Medicine/Respiratory Medicine and Allergology, The Sahlgrenska Academy, University of Gothenburg, Sweden.
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12
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Karayama M, Inui N, Mori K, Kono M, Hozumi H, Suzuki Y, Furuhashi K, Hashimoto D, Enomoto N, Fujisawa T, Nakamura Y, Watanabe H, Suda T. Respiratory impedance is correlated with airway narrowing in asthma using three-dimensional computed tomography. Clin Exp Allergy 2018; 48:278-287. [PMID: 29315896 DOI: 10.1111/cea.13083] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/15/2017] [Accepted: 12/21/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Respiratory impedance comprises the resistance and reactance of the respiratory system and can provide detailed information on respiratory function. However, details of the relationship between impedance and morphological airway changes in asthma are unknown. OBJECTIVE We aimed to evaluate the correlation between imaging-based airway changes and respiratory impedance in patients with asthma. METHODS Respiratory impedance and spirometric data were evaluated in 72 patients with asthma and 29 reference subjects. We measured the intraluminal area (Ai) and wall thickness (WT) of third- to sixth-generation bronchi using three-dimensional computed tomographic analyses, and values were adjusted by body surface area (BSA, Ai/BSA, and WT/the square root (√) of BSA). RESULTS Asthma patients had significantly increased respiratory impedance, decreased Ai/BSA, and increased WT/√BSA, as was the case in those without airflow limitation as assessed by spirometry. Ai/BSA was inversely correlated with respiratory resistance at 5 Hz (R5) and 20 Hz (R20). R20 had a stronger correlation with Ai/BSA than did R5. Ai/BSA was positively correlated with forced expiratory volume in 1 second/forced vital capacity ratio, percentage predicted forced expiratory volume in 1 second, and percentage predicted mid-expiratory flow. WT/√BSA had no significant correlation with spirometry or respiratory impedance. CONCLUSIONS & CLINICAL RELEVANCE Respiratory resistance is associated with airway narrowing.
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Affiliation(s)
- M Karayama
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - N Inui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - K Mori
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - M Kono
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - H Hozumi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Y Suzuki
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - K Furuhashi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - D Hashimoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - N Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - T Fujisawa
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Y Nakamura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - H Watanabe
- Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - T Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Zaidan MF, Reddy AP, Duarte A. Impedance Oscillometry: Emerging Role in the Management of Chronic Respiratory Disease. Curr Allergy Asthma Rep 2018; 18:3. [PMID: 29380068 DOI: 10.1007/s11882-018-0757-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW Chronic respiratory diseases affecting adults and children are widely prevalent, so lung function testing is imperative for diagnosis and management. Spirometry is the traditional standard measure of lung function; however, certain groups of patients are unable to provide accurate and reproducible exhalation maneuvers. Consequently, the impedance oscillometry system (IOS) has been developed as an effort, independent technique to assess airway function in children and the elderly. To better understand this emerging modality, the following review will compare IOS with spirometry, examine the function of the device, provide interpretation strategies, and discuss the evidence supporting its use in adults and children with chronic lung disease. RECENT FINDINGS In a population of symptomatic adults with suspected COPD, impedance oscillometry resistance measurements correlate with FEV1 and lung resistance increases with the severity of airflow limitation. In patients with asthma, IOS is a sensitive measure of airway hyperresponsiveness and bronchodilator response. Impedance oscillometry is evolving as an alternative measure to assess lung function pediatric and adult populations.
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Affiliation(s)
- Mohammed F Zaidan
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Ashwini P Reddy
- Division of Allergy/Immunology, Department of Pediatric Medicine, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alexander Duarte
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA.
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14
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Berger KI, Kalish S, Shao Y, Marmor M, Kazeros A, Oppenheimer BW, Chan Y, Reibman J, Goldring RM. Isolated small airway reactivity during bronchoprovocation as a mechanism for respiratory symptoms in WTC dust-exposed community members. Am J Ind Med 2016; 59:767-76. [PMID: 27582479 DOI: 10.1002/ajim.22639] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Small airway dysfunction occurs following WTC dust exposure, but its role in producing symptoms is unclear. METHODS Methacholine challenge (MCT) was used to assess the relationship between onset of respiratory symptoms and small airway abnormalities in 166 symptomatic WTC dust-exposed patients. Forced oscillation testing (FOT) and respiratory symptoms were assessed during MCT. FOT parameters included resistance at 5 and 20 Hz (R5 and R20 ) and the R5 minus R20 (R5-20 ). RESULTS Baseline spirometry was normal in all (mean FEV1 100 + 13% predicted, mean FEV1 /FVC 80 + 4%). MCT revealed bronchial hyperreactivity by spirometry in 67 patients. An additional 24 patients became symptomatic despite minimal FEV1 change (<5%); symptom onset coincided with increased R5 and R5-20 (P > 0.001 vs. baseline). The dose-response of FOT (reactivity) was greater compared with subjects that remained asymptomatic (P < 0.05). CONCLUSIONS FOT during MCT uncovered reactivity in small airways as a mechanism for respiratory symptoms in subjects with inhalational lung injury. Am. J. Ind. Med. 59:767-776, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Kenneth I. Berger
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine; NYU School of Medicine; New York New York
- Andre Cournand Pulmonary Physiology Laboratory; Bellevue Hospital; New York New York
| | - Samantha Kalish
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine; NYU School of Medicine; New York New York
| | - Yongzhao Shao
- Department of Population Health; NYU School of Medicine; New York New York
| | - Michael Marmor
- Department of Population Health; NYU School of Medicine; New York New York
| | - Angeliki Kazeros
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine; NYU School of Medicine; New York New York
| | - Beno W. Oppenheimer
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine; NYU School of Medicine; New York New York
- Andre Cournand Pulmonary Physiology Laboratory; Bellevue Hospital; New York New York
| | - Yinny Chan
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine; NYU School of Medicine; New York New York
- Andre Cournand Pulmonary Physiology Laboratory; Bellevue Hospital; New York New York
| | - Joan Reibman
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine; NYU School of Medicine; New York New York
| | - Roberta M. Goldring
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine; NYU School of Medicine; New York New York
- Andre Cournand Pulmonary Physiology Laboratory; Bellevue Hospital; New York New York
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15
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Berger KI, Goldring RM, Oppenheimer BW. Rebuttal From Dr Berger et al. Chest 2016; 148:1137-1138. [PMID: 26020419 DOI: 10.1378/chest.15-1037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Kenneth I Berger
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine; André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY.
| | - Roberta M Goldring
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine; André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY
| | - Beno W Oppenheimer
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine; André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY
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16
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Enright PL. Rebuttal From Dr Enright. Chest 2015; 148:1138-1139. [DOI: 10.1378/chest.15-1039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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