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Zachariades A, Bachar N, Danino N, Shafran I, Shtrichman R, Shuster G, Voigt W. A new tidal breathing measurement device detects bronchial obstruction during methacholine challenge test. Adv Med Sci 2024; 69:1-7. [PMID: 38096771 DOI: 10.1016/j.advms.2023.11.001] [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: 06/27/2023] [Revised: 10/25/2023] [Accepted: 11/29/2023] [Indexed: 05/04/2024]
Abstract
PURPOSE Bronchial hyperresponsiveness (BHR), a hallmark of bronchial asthma, is typically diagnosed through a methacholine inhalation test followed by spirometry, known as the methacholine challenge test (MCT). While spirometry relies on proper patients' cooperation and precise execution of forced breathing maneuvers, we conducted a comparative analysis with the portable nanomaterial-based sensing device, SenseGuard™, to non-intrusively assess tidal breathing parameters. MATERIALS AND METHODS In this prospective study, 37 adult participants with suspected asthma underwent sequential spirometry and SenseGuard™ measurements after inhaling increasing methacholine doses. RESULTS Among the 37 participants, 18 were MCT responders, 17 were non-responders and 2 were excluded due to uninterpretable data. The MCT responders exhibited a significant lung function difference when comparing the change from baseline to maximum response. This was evident through a notable decrease in forced expiratory volume in 1 s (FEV1) levels in spirometry, as well as in prominent changes in tidal breathing parameters as assessed by SenseGuard™, including the expiratory pause time (Trest) to total breath time (Ttot) ratio, and the expiratory time (Tex) to Ttot ratio. Notably, the ratios Trest/Ttot (∗p = 0.02), Tex/Ttot (∗p = 0.002), and inspiratory time (Tin) to Tex (∗p = 0.04) identified MCT responders distinctly, corresponding to spirometry (∗p < 0.0001). CONCLUSIONS This study demonstrates that tidal breathing assessment using SenseGuard™ device reliably detects clinically relevant changes of respiratory parameter during the MCT. It effectively distinguishes between responders and non-responders, with strong agreement to conventional spirometry-measured FEV1. This technology holds promise for monitoring clinical respiratory changes in bronchial asthma patients pending further studies.
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Affiliation(s)
| | | | | | | | | | | | - Wieland Voigt
- NanoVation-GS LTD., Haifa, Israel; Medical Innovation and Management, Steinbeis University Berlin, Berlin, Germany
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2
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Kang N, Lee K, Byun S, Lee JY, Choi DC, Lee BJ. Novel Artificial Intelligence-Based Technology to Diagnose Asthma Using Methacholine Challenge Tests. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2024; 16:42-54. [PMID: 38262390 PMCID: PMC10823143 DOI: 10.4168/aair.2024.16.1.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/11/2023] [Accepted: 10/06/2023] [Indexed: 01/25/2024]
Abstract
PURPOSE The methacholine challenge test (MCT) has high sensitivity but relatively low specificity for asthma diagnosis. This study aimed to develop and validate machine learning (ML) models to improve the diagnostic performance of MCT for asthma. METHODS Data from 1,501 patients with asthma symptoms who underwent MCT between 2015 and 2020 were analyzed. The patients were grouped as either the training (80%, n = 1,265) and test sets (20%, n = 236) depending on the time of referral. The conventional model (provocative concentration that causes a 20% decrease in forced expiratory volume in one second [FEV1]; PC20 ≤ 16 mg/mL) was compared with the prediction models derived from five ML methods: logistic regression, support vector machine, random forest, extreme gradient boosting, and artificial neural network. The area under the receiver operator characteristic curves (AUROC) and area under the precision-recall curves (AUPRC) of each model were compared. The prediction models were further analyzed using different input combinations of FEV1, forced vital capacity (FVC), and forced expiratory flow at 25%-75% of forced vital capacity (FEF25%-75%) values obtained during MCT. RESULTS In total, 545 patients (36.3%) were diagnosed with asthma. The AUROC of the conventional model was 0.856 (95% confidence interval [CI], 0.852-0.861), and the AUPRC was 0.759 (95% CI, 0.751-0.766). All the five ML prediction models had higher AUROC and AUPRC values than those of the conventional model, and random forest showed both highest AUROC (0.950; 95% CI, 0.948-0.952) and AUROC (0.909; 95% CI, 0.905-0.914) when FEV1, FVC, and FEF25%-75% were included as inputs. CONCLUSIONS Artificial intelligence-based models showed excellent performance in asthma prediction compared to using PC20 ≤ 16 mg/mL. The novel technology could be used to enhance the clinical diagnosis of asthma.
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Affiliation(s)
- Noeul Kang
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - KyungHyun Lee
- Department of Electronics Engineering, Incheon National University, Incheon, Korea
| | - Sangwon Byun
- Department of Electronics Engineering, Incheon National University, Incheon, Korea
| | - Jin-Young Lee
- Health Promotion Center, Samsung Medical Center, Seoul, Korea
| | - Dong-Chull Choi
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Jae Lee
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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3
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Bhattacharyya P. Obstructive airway disease: Pragmatism in diagnoses in real world. Lung India 2024; 41:1-2. [PMID: 38160451 PMCID: PMC10883447 DOI: 10.4103/lungindia.lungindia_367_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/16/2023] [Indexed: 01/03/2024] Open
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4
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Gauvreau GM, Hohlfeld JM, FitzGerald JM, Boulet LP, Cockcroft DW, Davis BE, Korn S, Kornmann O, Leigh R, Mayers I, Watz H, Grant SS, Jain M, Cabanski M, Pertel PE, Jones I, Lecot JR, Cao H, O'Byrne PM. Inhaled anti-TSLP antibody fragment, ecleralimab, blocks responses to allergen in mild asthma. Eur Respir J 2023; 61:13993003.01193-2022. [PMID: 36822634 PMCID: PMC9996823 DOI: 10.1183/13993003.01193-2022] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/24/2022] [Indexed: 02/25/2023]
Abstract
BACKGROUND Thymic stromal lymphopoietin (TSLP) is a key upstream regulator driving allergic inflammatory responses. We evaluated the efficacy and safety of ecleralimab, a potent inhaled neutralising antibody fragment against human TSLP, using allergen inhalation challenge (AIC) in subjects with mild atopic asthma. METHODS This was a 12-week, randomised, double-blind, placebo-controlled, parallel-design, multicentre allergen bronchoprovocation study conducted at 10 centres across Canada and Germany. Subjects aged 18-60 years with stable mild atopic asthma were randomised (1:1) to receive 4 mg once-daily inhaled ecleralimab or placebo. Primary end-points were the allergen-induced change in forced expiratory volume in 1 s (FEV1) during the late asthmatic response (LAR) measured by area under the curve (AUC3-7h) and maximum percentage decrease (LAR%) on day 84, and the safety of ecleralimab. Allergen-induced early asthmatic response (EAR), sputum eosinophils and fractional exhaled nitric oxide (F ENO) were secondary and exploratory end-points. RESULTS 28 subjects were randomised to ecleralimab (n=15) or placebo (n=13). On day 84, ecleralimab significantly attenuated LAR AUC3-7h by 64% (p=0.008), LAR% by 48% (p=0.029), and allergen-induced sputum eosinophils by 64% at 7 h (p=0.011) and by 52% at 24 h (p=0.047) post-challenge. Ecleralimab also numerically reduced EAR AUC0-2h (p=0.097) and EAR% (p=0.105). F ENO levels were significantly reduced from baseline throughout the study (p<0.05), except at 24 h post-allergen (day 43 and day 85). Overall, ecleralimab was safe and well tolerated. CONCLUSION Ecleralimab significantly attenuated allergen-induced bronchoconstriction and airway inflammation, and was safe in subjects with mild atopic asthma.
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Affiliation(s)
- Gail M Gauvreau
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- These authors contributed equally to this work
| | - Jens M Hohlfeld
- Fraunhofer Institute for Toxicology and Experimental Medicine and Hannover Medical School, Hannover, Germany
- These authors contributed equally to this work
| | - J Mark FitzGerald
- Centre for Lung Health, University of British Columbia, Vancouver, BC, Canada
- These authors contributed equally to this work
| | | | - Donald W Cockcroft
- Division of Respirology, Critical Care and Sleep Medicine, Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Beth E Davis
- Division of Respirology, Critical Care and Sleep Medicine, Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Stephanie Korn
- IKF Pneumologie Mainz and Thoraxklinik, Heidelberg, Germany
| | - Oliver Kornmann
- IKF Pneumologie Frankfurt, Clinical Research Centre Respiratory Diseases, Frankfurt, Germany
| | - Richard Leigh
- Department of Medicine, Cumming School of Medicine, Calgary, AB, Canada
| | - Irvin Mayers
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Henrik Watz
- Pulmonary Research Institute at Lungen Clinic Grosshansdorf, Airway Research Centre North (ARCN), German Centre for Lung Research (DZL), Grosshansdorf, Germany
| | - Sarah S Grant
- Novartis Institutes of Biomedical Research, Cambridge, MA, USA
| | - Monish Jain
- Novartis Institutes of Biomedical Research, Cambridge, MA, USA
| | - Maciej Cabanski
- Novartis Institutes of Biomedical Research, Cambridge, MA, USA
| | - Peter E Pertel
- Novartis Institutes of Biomedical Research, Cambridge, MA, USA
| | | | | | - Hui Cao
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Paul M O'Byrne
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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5
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Effect of daily dosing with tiotropium against methacholine induced bronchoconstriction in asthmatics. Pulm Pharmacol Ther 2022; 77:102174. [DOI: 10.1016/j.pupt.2022.102174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/20/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
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6
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Georgakopoulou VE, Tarantinos K, Papalexis P, Spandidos DA, Damaskos C, Gkoufa A, Chlapoutakis S, Sklapani P, Trakas N, Mermigkis D. Role of pulmonary function testing in inflammatory bowel diseases (Review). MEDICINE INTERNATIONAL 2022; 2:25. [PMID: 36699508 PMCID: PMC9829212 DOI: 10.3892/mi.2022.50] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/01/2022] [Indexed: 01/28/2023]
Abstract
Inflammatory bowel disease (IBD) is a term used to describe chronic inflammatory entities of the gastrointestinal system with an unclear etiology. Extra-intestinal manifestations beyond the involvement of the gastrointestinal tract can also occur. Several studies have investigated the alterations of pulmonary function tests (PFTs) in patients with IBD. To the best of our knowledge, the present review article is the first to summarize all the types of PFTs that have been performed in patients with IBD. Contradictory data exist regarding the association of PFT alterations with disease activity. PFT abnormalities can develop in individuals with IBD who have no clear clinical signs or radiological evidence, suggesting that PFTs may be useful in detecting latent respiratory involvement. The most prevalent finding in the PFTs of adults and children with IBD is an impairment in the diffusing capacity for carbon monoxide, although evidence on the other tests, particularly spirometric values, and their connection with disease activity is inconsistent.
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Affiliation(s)
| | | | - Petros Papalexis
- Unit of Endocrinology, First Department of Internal Medicine, Laiko General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece,Department of Biomedical Sciences, University of West Attica, 12243 Athens, Greece,Correspondence to: Dr Petros Papalexis, Department of Biomedical Sciences, University of West Attica, 28 Agiou Spyridonos Street, 12243 Athens, Greece
| | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Christos Damaskos
- Renal Transplantation Unit, Laiko General Hospital, 11527 Athens, Greece,N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Aikaterini Gkoufa
- First Department of Internal Medicine, Laiko General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | | - Pagona Sklapani
- Department of Cytology, Mitera Hospital, 15123 Athens, Greece
| | - Nikolaos Trakas
- Department of Biochemistry, Sismanogleio Hospital, 15126 Athens, Greece
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Dean J, Jackson N, Keidel-Morgan B, Hamer D, Singh D. Methacholine challenges: comparison of different tidal breathing challenge methods. ERJ Open Res 2021; 7:00282-2021. [PMID: 34761001 PMCID: PMC8573237 DOI: 10.1183/23120541.00282-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/04/2021] [Indexed: 11/16/2022] Open
Abstract
Tidal-breathing methacholine challenges are now recommended by guidelines, to avoid the bronchoprotective effects of deep inhalation. This study compared different tidal breathing methacholine challenge methods; assessed the agreement between tidal dosimetric and continuous output challenges; and assessed challenge repeatability with different methods. 15 asthma patients performed dosimetric challenges and a continuous-output breath-actuated challenge, all ≥3 days apart. All subjects had a pre-bronchodilator forced expiratory volume in 1 s (FEV1) ≥65% predicted, and a cumulative dose causing a 20% reduction in FEV1 (PD20) <1.2 mg. Of the dosimetric challenges, one method increased methacholine concentration (standard dosimetric challenge), and one adjusted nebuliser output time to increase dose (adjusted dosimetric challenge). The adjusted dosimetric and continuous output challenges were performed twice on separate days to assess for repeatability. All challenges were matched for dose at each dose step. The mean PD20 ratio of the standard dosimetric challenge to the adjusted dosimetric challenge was 0.90 (95% CI 0.66–1.23, p=0.49) and intraclass correlation coefficient (ICC) was 0.82. Repeated adjusted dosimetric challenges had an ICC 0.62 for PD20. Repeated continuous output challenges had an ICC 0.74 for PD20. The adjusted dosimetric and continuous output challenges correlated (r=0.69, p=0.0043; ICC 0.65), but PD20 was higher for the adjusted dosimetric challenge (mean PD20 ratio 2.31, 95% CI 1.57–3.40; p=0.0004). Tidal dosimetric methacholine challenge using adjustment of nebuliser output produces results with good repeatability. The results of this adjusted dosimetric method differed from the continuous output method, underscoring that the results of different methacholine challenge methodologies may not be directly comparable. Tidal breathing challenges are now the preferred method to administer a methacholine challenge. This study reports a tidal dosimetric methacholine challenge method that adjusts nebuliser output, which can be used to obtain results with good repeatability.https://bit.ly/3fX0F3f
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Affiliation(s)
- James Dean
- Medicines Evaluation Unit, Manchester, UK
| | | | | | | | - Dave Singh
- Medicines Evaluation Unit, Manchester, UK.,Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK
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8
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Sylvester KP, Clayton N, Cliff I, Hepple M, Kendrick A, Kirkby J, Miller M, Moore A, Rafferty GF, O'Reilly L, Shakespeare J, Smith L, Watts T, Bucknall M, Butterfield K. ARTP statement on pulmonary function testing 2020. BMJ Open Respir Res 2021; 7:7/1/e000575. [PMID: 32631927 PMCID: PMC7337892 DOI: 10.1136/bmjresp-2020-000575] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/11/2020] [Accepted: 02/14/2020] [Indexed: 01/01/2023] Open
Abstract
The Association for Respiratory Technology & Physiology (ARTP) last produced a statement on the performance of lung function testing in 1994. At that time the focus was on a practical statement for people working in lung function laboratories. Since that time there have been many technological advances and alterations to best practice in the measurement and interpretation of lung function assessments. In light of these advances an update was warranted. ARTP, therefore, have provided within this document, where available, the most up-to-date and evidence-based recommendations for the most common lung function assessments performed in laboratories across the UK. These recommendations set out the requirements and considerations that need to be made in terms of environmental and patient factors that may influence both the performance and interpretation of lung function tests. They also incorporate procedures to ensure quality assured diagnostic investigations that include those associated with equipment, the healthcare professional conducting the assessments and the results achieved by the subject. Each section aims to outline the common parameters provided for each investigation, a brief principle behind the measurements (where applicable), and suggested acceptability and reproducibility criteria.
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Affiliation(s)
- Karl Peter Sylvester
- Respiratory Physiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK .,Lung Function Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Nigel Clayton
- The North West Lung Function Laboratory, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Ian Cliff
- Respiratory Physiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, UK
| | - Michael Hepple
- Respiratory Physiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, UK
| | - Adrian Kendrick
- Lung Function Unit, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Jane Kirkby
- Respiratory Function Lab, Sheffield Children's NHS Foundation Trust, Sheffield, Sheffield, UK
| | - Martin Miller
- Applied Health Research, University of Birmingham, Birmingham, Birmingham, UK
| | - Alan Moore
- Respiratory Physiology Department, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, Birmingham, UK
| | | | - Liam O'Reilly
- Department of Respiratory Physiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, Coventry, UK
| | - Joanna Shakespeare
- Department of Respiratory Physiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, Coventry, UK
| | - Laurie Smith
- Respiratory Function Lab, Sheffield Children's NHS Foundation Trust, Sheffield, Sheffield, UK.,POLARIS, Academic Radiology, The University of Sheffield, Sheffield, Sheffield, Sheffield, UK
| | - Trefor Watts
- West Midlands Strategic Health Authority, Birmingham, Birmingham, UK
| | | | - Keith Butterfield
- Department of Respiratory Medicine, Dorset County Hospital NHS Foundation Trust, Dorchester, Dorset, UK
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9
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Oliveira MA, Lino-Alvarado AE, Moriya HT, Vitorasso RL. Drug class effects on respiratory mechanics in animal models: access and applications. Exp Biol Med (Maywood) 2021; 246:1094-1103. [PMID: 33601911 DOI: 10.1177/1535370221993095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Assessment of respiratory mechanics extends from basic research and animal modeling to clinical applications in humans. However, to employ the applications in human models, it is desirable and sometimes mandatory to study non-human animals first. To acquire further precise and controlled signals and parameters, the animals studied must be further distant from their spontaneous ventilation. The majority of respiratory mechanics studies use positive pressure ventilation to model the respiratory system. In this scenario, a few drug categories become relevant: anesthetics, muscle blockers, bronchoconstrictors, and bronchodilators. Hence, the main objective of this study is to briefly review and discuss each drug category, and the impact of a drug on the assessment of respiratory mechanics. Before and during the positive pressure ventilation, the experimental animal must be appropriately sedated and anesthetized. The sedation will lower the pain and distress of the studied animal and the plane of anesthesia will prevent the pain. With those drugs, a more controlled procedure is carried out; further, because many anesthetics depress the respiratory system activity, a minimum interference of the animal's respiration efforts are achieved. The latter phenomenon is related to muscle blockers, which aim to minimize respiratory artifacts that may interfere with forced oscillation techniques. Generally, the respiratory mechanics are studied under appropriate anesthesia and muscle blockage. The application of bronchoconstrictors is prevalent in respiratory mechanics studies. To verify the differences among studied groups, it is often necessary to challenge the respiratory system, for example, by pharmacologically inducing bronchoconstriction. However, the selected bronchoconstrictor, doses, and administration can affect the evaluation of respiratory mechanics. Although not prevalent, studies have applied bronchodilators to return (airway resistance) to the basal state after bronchoconstriction. The drug categories can influence the mathematical modeling of the respiratory system, systemic conditions, and respiratory mechanics outcomes.
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Affiliation(s)
- Maria A Oliveira
- Department of Pharmacology, Institute of Biomedical Science, University of Sao Paulo (USP) Sao Paulo, SP 05508-000, Brazil
| | - Alembert E Lino-Alvarado
- Biomedical Engineering Laboratory - University of Sao Paulo (USP) Sao Paulo, SP 05508-010, Brazil
| | - Henrique T Moriya
- Biomedical Engineering Laboratory - University of Sao Paulo (USP) Sao Paulo, SP 05508-010, Brazil
| | - Renato L Vitorasso
- Biomedical Engineering Laboratory - University of Sao Paulo (USP) Sao Paulo, SP 05508-010, Brazil
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Fuentes N, McCullough M, Panettieri RA, Druey KM. RGS proteins, GRKs, and beta-arrestins modulate G protein-mediated signaling pathways in asthma. Pharmacol Ther 2021; 223:107818. [PMID: 33600853 DOI: 10.1016/j.pharmthera.2021.107818] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2021] [Indexed: 12/17/2022]
Abstract
Asthma is a highly prevalent disorder characterized by chronic lung inflammation and reversible airways obstruction. Pathophysiological features of asthma include episodic and reversible airway narrowing due to increased bronchial smooth muscle shortening in response to external and host-derived mediators, excessive mucus secretion into the airway lumen, and airway remodeling. The aberrant airway smooth muscle (ASM) phenotype observed in asthma manifests as increased sensitivity to contractile mediators (EC50) and an increase in the magnitude of contraction (Emax); collectively these attributes have been termed "airways hyper-responsiveness" (AHR). This defining feature of asthma can be promoted by environmental factors including airborne allergens, viruses, and air pollution and other irritants. AHR reduces airway caliber and obstructs airflow, evoking clinical symptoms such as cough, wheezing and shortness of breath. G-protein-coupled receptors (GPCRs) have a central function in asthma through their impact on ASM and airway inflammation. Many but not all treatments for asthma target GPCRs mediating ASM contraction or relaxation. Here we discuss the roles of specific GPCRs, G proteins, and their associated signaling pathways, in asthma, with an emphasis on endogenous mechanisms of GPCR regulation of ASM tone and lung inflammation including regulators of G-protein signaling (RGS) proteins, G-protein coupled receptor kinases (GRKs), and β-arrestin.
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Affiliation(s)
- Nathalie Fuentes
- Lung and Vascular Inflammation Section, Laboratory of Allergic Diseases, NIAID/NIH, Bethesda, MD, United States of America
| | - Morgan McCullough
- Lung and Vascular Inflammation Section, Laboratory of Allergic Diseases, NIAID/NIH, Bethesda, MD, United States of America
| | - Reynold A Panettieri
- Rutgers Institute for Translational Medicine and Science, Child Health Institute of New Jersey, Rutgers University School of Medicine, New Brunswick, NJ, United States of America
| | - Kirk M Druey
- Lung and Vascular Inflammation Section, Laboratory of Allergic Diseases, NIAID/NIH, Bethesda, MD, United States of America.
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11
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Graham BL, Steenbruggen I, Miller MR, Barjaktarevic IZ, Cooper BG, Hall GL, Hallstrand TS, Kaminsky DA, McCarthy K, McCormack MC, Oropez CE, Rosenfeld M, Stanojevic S, Swanney MP, Thompson BR. Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement. Am J Respir Crit Care Med 2020; 200:e70-e88. [PMID: 31613151 PMCID: PMC6794117 DOI: 10.1164/rccm.201908-1590st] [Citation(s) in RCA: 1835] [Impact Index Per Article: 458.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: Spirometry is the most common pulmonary function test. It is widely used in the assessment of lung function to provide objective information used in the diagnosis of lung diseases and monitoring lung health. In 2005, the American Thoracic Society and the European Respiratory Society jointly adopted technical standards for conducting spirometry. Improvements in instrumentation and computational capabilities, together with new research studies and enhanced quality assurance approaches, have led to the need to update the 2005 technical standards for spirometry to take full advantage of current technical capabilities.Methods: This spirometry technical standards document was developed by an international joint task force, appointed by the American Thoracic Society and the European Respiratory Society, with expertise in conducting and analyzing pulmonary function tests, laboratory quality assurance, and developing international standards. A comprehensive review of published evidence was performed. A patient survey was developed to capture patients' experiences.Results: Revisions to the 2005 technical standards for spirometry were made, including the addition of factors that were not previously considered. Evidence to support the revisions was cited when applicable. The experience and expertise of task force members were used to develop recommended best practices.Conclusions: Standards and consensus recommendations are presented for manufacturers, clinicians, operators, and researchers with the aims of increasing the accuracy, precision, and quality of spirometric measurements and improving the patient experience. A comprehensive guide to aid in the implementation of these standards was developed as an online supplement.
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Abstract
Asthma affects approximately 300 million people worldwide and approximately 7.5% of adults in the United States. Asthma is characterized by inflammation of the airways, variable airflow obstruction, and bronchial hyperresponsiveness. The diagnosis of asthma is a clinical one with the history and physical examination being significant, but objective measures, such as pulmonary function testing, can be used to aid in the diagnosis. There are multiple associated comorbidities with asthma, including rhinitis, sinusitis, gastroesophageal reflux disease, obstructive sleep apnea, and depression. There is often an allergic component of asthma, and patient education is vital.
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Affiliation(s)
- Anil Nanda
- Asthma and Allergy Center, 724 West Main Street, Suite 160, Lewisville, TX 75067, USA; Asthma and Allergy Center, 4900 Long Prairie Road, Suite 100, Flower Mound, TX, USA; Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Anita N Wasan
- Allergy and Asthma Center, 6824 Elm Street, Suite 120, McLean, VA 22101, USA
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13
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Singh D, Khan N, Dean J, Fowler A, Gupta A, Endriss V, Iacono P, Disse B. FEV 1 recovery following methacholine challenge in asthma: Variability and comparison of methods. Pulm Pharmacol Ther 2019; 60:101876. [PMID: 31843704 DOI: 10.1016/j.pupt.2019.101876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 12/12/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Methacholine challenges have been used in clinical trials to assess therapeutic effects and potential adverse reactions of interventions on pulmonary function in a sensitive population, such as in subjects with asthma. Here, we evaluate the variability of the methacholine challenge recovery model, and compare the results obtained for both incremental and bolus challenge methods. METHODS The extent, time course and variability of change in forced expiratory volume in 1 s (FEV1) following repeated methacholine challenges in subjects with mild asthma were investigated in an open-label, four-period, fixed-sequence, two-method, replicate crossover study. At Visits 1 and 2, subjects underwent an incremental challenge using doubling doses of methacholine until a ≥20% decrease in FEV1 was observed; at Visits 3 and 4, subjects underwent a bolus challenge, inhaling a single dose of methacholine calculated from the cumulative dose established during Visit 1. RESULTS A total of 19 subjects were included in the study. Both the mean FEV1 area under the curve (FEV1 AUC0-tz) and mean maximum reductions in FEV1 (absolute and relative) 120 min post-challenge values were higher for the incremental challenges than the bolus challenges, with no reported difference between repetitions of the same methodology. FEV1 AUC0-tz decrease 120 min post challenge demonstrated an intra-subject coefficient of variation (CV) of 47.2% (incremental) and 78.3% (bolus), suggesting considerable between-visit variability. The mean absolute, and similarly relative, maximum reductions in FEV1 compared with post-diluent baseline values demonstrated lower intra-subject variability (incremental 21.16%, bolus 40.67%) than the FEV1 AUC0-tz-based endpoint. There was a trend towards faster recovery following the bolus challenge than with the incremental challenge. The provocative dose of methacholine inducing a ≥20% decrease in FEV1 resulted in a between-group mean difference of 27.20% in the incremental challenge periods, with a high intra-subject CV of 80.64%, demonstrating considerable variability. CONCLUSION Maximum reduction in FEV1 had the lowest variability. There was little difference between repetitions of the same methodology, as indicated by overlapping confidence intervals. There was a trend towards faster recovery following bolus challenge than with the incremental challenge. The results of this trial could be of value when designing future clinical trials using the methacholine challenge methodology.
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Affiliation(s)
- Dave Singh
- Medicines Evaluation Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom.
| | - Naimat Khan
- Medicines Evaluation Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom.
| | - James Dean
- Medicines Evaluation Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom.
| | - Andrew Fowler
- Respiratory Clinical Research, Boehringer Ingelheim Ltd, Bracknell, United Kingdom(1).
| | - Abhya Gupta
- Respiratory Clinical Research, Boehringer Ingelheim International GmbH, Biberach, Germany.
| | - Verena Endriss
- Biostatistics and Data Sciences, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany.
| | - Philippe Iacono
- Respiratory Clinical Research, Boehringer Ingelheim France, Paris, France.
| | - Bernd Disse
- Consultant to Boehringer Ingelheim, Mainz, Germany.
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Okonkwo CS, Davis BE, Blais CM, Cockcroft DW. Short-term effect of once-daily fluticasone furoate on methacholine-induced bronchoconstriction in mild asthmatics. Respir Med 2019; 156:53-57. [PMID: 31434037 DOI: 10.1016/j.rmed.2019.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/10/2019] [Accepted: 08/13/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Inhaled corticosteroids (ICS) decrease airway inflammation and airway hyperresponsiveness (AHR). Previous studies have generally investigated the effect of ICS on methacholine-induced AHR following weeks or months of medium to high dose treatment. PURPOSE The short-term effects of once-daily fluticasone furoate (FF) 100 mcg on methacholine-induced AHR and airway inflammation were examined over the course of one week. METHODS Eleven mild asthmatics completed this randomized, double-blind crossover study. Once-daily FF (100 mcg) and identical appearing placebo Ellipta® inhalers were given for 7 days with a 2-week washout. Methacholine challenges were performed before and 24 h after the first, third and seventh doses. Fractional exhaled nitric oxide (FeNO) was measured initially and at 7 days. RESULTS FF significantly (p = 0.0009-0.0078) increased methacholine PD20 (provocative dose causing 20% fall in forced expiratory volume in 1 s) at all times. Doubling dose shifts (95% CI) were 1.23 (0.60-1.86), 1.17 (0.68-1.67) and 1.44 (0.93-1.94) after the first, third and seventh dose respectively. FeNO (geometric mean, 95% CI) decreased significantly (p = 0.0049) following FF treatment from 37.9 ppb (23.7-60.5) initially to 22.9 ppb (14.8-35.5) at 7 days. Placebo did not affect methacholine PD20 or FeNO. CONCLUSION Single-dose FF 100 mcg decreased methacholine AHR at 24 h without significant further improvement with continued daily use over 7 days. The inhibition in AHR after one week of daily dosing coincided with a significant decrease in FeNO at 7 days. Contrary to past assumptions, the ICS FF appears to rapidly reduce AHR to methacholine.
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Affiliation(s)
- Chiamaka S Okonkwo
- University of Saskatchewan, College of Medicine, Department of Anatomy, Physiology and Pharmacology, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Beth E Davis
- University of Saskatchewan, College of Medicine, Department of Anatomy, Physiology and Pharmacology, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada; University of Saskatchewan, Department of Medicine, Division of Respirology, Critical Care and Sleep Medicine, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Christianne M Blais
- University of Saskatchewan, Department of Medicine, Division of Respirology, Critical Care and Sleep Medicine, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Donald W Cockcroft
- University of Saskatchewan, College of Medicine, Department of Anatomy, Physiology and Pharmacology, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada; University of Saskatchewan, Department of Medicine, Division of Respirology, Critical Care and Sleep Medicine, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada.
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15
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Ultra-LABAs for the treatment of asthma. Respir Med 2019; 156:47-52. [PMID: 31425937 DOI: 10.1016/j.rmed.2019.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/08/2019] [Accepted: 08/12/2019] [Indexed: 11/22/2022]
Abstract
The term ultra-LABA indicates once-daily β2-AR agonists (abediterol, indacaterol, olodaterol and vilanterol) that are single enantiomers of the (R)-configuration. All have a near full-agonist profile at human β2-AR. They can be prescribed in asthmatics only when associated with an with ICS, although further confirmations need to clarify what really these agents add if used in association to ICS and in what asthmatic patients this association may have more value. They are also under development in triple inhalers that include an ultra-LABA, a LAMA and an ICS. The once-daily posology might increase adherence in long-term treatment of asthma but superiority to twice-daily LABAs has not yet been fully demonstrated. In any case, still no ultra-LABA can be recommended as preferred.
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Allan R, Haughie S, Ahrens R, Singh S, Ward J. A Dose-Response Study Examining the Use of Methacholine Challenge to Demonstrate Local Therapeutic Equivalence of the Salmeterol Component of Generic Inhaled Fluticasone Propionate/Salmeterol Combination Products. J Aerosol Med Pulm Drug Deliv 2019; 32:352-363. [PMID: 31259673 DOI: 10.1089/jamp.2018.1519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Asthma is widely treated using inhaled corticosteroid/long-acting beta agonist (LABA) combinations, for example, fluticasone propionate/salmeterol (FPS) dry powder inhaler, marketed as Advair® Diskus®. Some regulators require generics to demonstrate local (lung) therapeutic equivalence (LTE) for each component of the FPS reference, ideally with a dose-response within the approved FPS dose range. We sought to develop a methacholine challenge (MeCh) LTE methodology for assessing the LABA (salmeterol) component of FPS. Methods: Forty-six patients with asthma received single doses of albuterol (active control; 90 or 180 μg), FPS (100/50 or 200/100 μg), and placebo on 5 separate study days. Spirometry and MeCh were performed 1, 6, and 10 hours after study drug inhalation. Primary endpoint was provocative concentration of methacholine producing a 20% fall in forced expiratory volume in 1 second (PC20). Study entry required screening PC20 ≤8 mg/mL, with a greater than fourfold increase (and PC20 ≤128 mg/mL) after 180 μg albuterol. Results: Both albuterol (90 and 180 μg) and FPS (100/50 and 200/100 μg) significantly increased PC20 compared with placebo (sustained 6 and 10 hours postdose with FPS but not albuterol). The dose-response slopes (95% confidence interval) estimated 1 hour after treatment were 0.374 (-0.068 to 0.815) and 0.310 (-0.135 to 0.754) between low and high doses of albuterol and FPS, respectively, both nonsignificant. Slopes were shallower than those available in the literature for albuterol and formoterol, but similar to those for salmeterol. Conclusions: These data confirm that the bronchoprotective effect of FPS lasts longer than that of albuterol. The shallow dose-response slope we observed for albuterol is contrary to previous reports, probably due to the measurement of PC20 beginning at 1 hour postdose. The results suggest that use of MeCh to assess LTE for salmeterol formulations may be more difficult to accomplish than it is for albuterol and formoterol products.
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Affiliation(s)
| | | | - Richard Ahrens
- Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Sachinkumar Singh
- Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Jon Ward
- Mylan Pharma UK Limited, Sandwich, United Kingdom
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