1
|
Affiliation(s)
- Sabine C Zimmermann
- Medizinische Klinik und Poliklinik V, LMU Klinikum Campus Großhadern, Marchioninistraße 15, 81377, München, Deutschland.
| | - Jürgen Behr
- Medizinische Klinik und Poliklinik V, Klinikum Großhadern der LMU München, Marchioninistraße 15, 81377, München, Deutschland
| |
Collapse
|
2
|
Rutting S, Chapman DG, Badal T, Sanai F, Zimmermann SC, Thamrin C, King GG, Tonga KO. Higher body mass index is associated with increased lung stiffness and less airway obstruction in individuals with asthma and fixed airflow obstruction. ERJ Open Res 2021; 7:00336-2020. [PMID: 33532464 PMCID: PMC7836555 DOI: 10.1183/23120541.00336-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022] Open
Abstract
Persistent or fixed airflow obstruction (FAO) is prevalent in up to 60% of patients with severe asthma [1] and is associated with older age, more rapid decline in lung function and increased symptoms [1–3]. The underlying mechanisms of FAO in asthma are unknown, but growing evidence suggests that parenchymal changes resulting in loss of elastic recoil and decreased lung stiffness (i.e. increased lung compliance) contribute to FAO [2, 4]. In a recent study of older asthma patients with FAO, decreased lung stiffness was the sole predictor of more severe airflow obstruction, as measured by reduced forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio [2]. Higher body mass index (BMI) is associated with less severe airway obstruction in older asthma patients with fixed airflow obstruction. This is potentially mediated through BMI-related mechanisms that increase lung stiffness (i.e. reduce lung compliance).https://bit.ly/3jBwCNy
Collapse
Affiliation(s)
- Sandra Rutting
- Airway Physiology & Imaging Group and Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW, Australia.,The Dept of Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - David G Chapman
- Airway Physiology & Imaging Group and Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW, Australia.,Translational Airways Group, School of Life Sciences, University of Technology, Sydney, NSW, Australia
| | - Tanya Badal
- Airway Physiology & Imaging Group and Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW, Australia.,Dept of Respiratory Medicine, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Farid Sanai
- Airway Physiology & Imaging Group and Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW, Australia.,The Dept of Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Sabine C Zimmermann
- Airway Physiology & Imaging Group and Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW, Australia.,The Dept of Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Cindy Thamrin
- Airway Physiology & Imaging Group and Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Gregory G King
- Airway Physiology & Imaging Group and Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW, Australia.,The Dept of Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Katrina O Tonga
- Airway Physiology & Imaging Group and Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW, Australia.,The Dept of Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,The Dept of Thoracic and Transplant Medicine, St Vincent's Hospital, Darlinghurst, NSW, Australia.,St Vincent's Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
3
|
Zimmermann SC, Huvanandana J, Nguyen CD, Bertolin A, Watts JC, Gobbi A, Farah CS, Peters MJ, Dellacà RL, King GG, Thamrin C. Day-to-day variability of forced oscillatory mechanics for early detection of acute exacerbations in COPD. Eur Respir J 2020; 56:13993003.01739-2019. [PMID: 32430416 DOI: 10.1183/13993003.01739-2019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 04/17/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Telemonitoring trials for early detection of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have provided mixed results. Day-to-day variations in lung function measured by the forced oscillation technique (FOT) may yield greater insight. We evaluated the clinical utility of home telemonitoring of variability in FOT measures in terms of 1) the relationship with symptoms and quality of life (QoL); and 2) the timing of variability of FOT measures and symptom changes prior to AECOPD. METHODS Daily FOT parameters at 5 Hz (resistance (R) and reactance (X); Resmon Pro Diary, Restech Srl, Milan, Italy), daily symptoms (COPD Assessment Test (CAT)) and 4-weekly QoL data (St George's Respiratory Questionnaire (SGRQ)) were recorded over 8-9 months from chronic obstructive pulmonary disease (COPD) patients. Variability of R and X was calculated as the standard deviation (sd) over 7-day running windows and we also examined the effect of varying window size. The relationship of FOT versus CAT and SGRQ was assessed using linear mixed modelling, daily changes in FOT variability and CAT prior to AECOPD using one-way repeated measures ANOVA. RESULTS Fifteen participants with a mean±sd age of 69±10 years and a % predicted forced expiratory volume in 1 s (FEV1) of 39±10% had a median (interquartile range (IQR)) adherence of 95.4% (79.0-98.8%). Variability of the inspiratory component of X (indicated by the standard deviation of inspiratory reactance (SDXinsp)) related to CAT and weakly to SGRQ (fixed effect estimates 1.57, 95% CI 0.65-2.49 (p=0.001) and 4.41, 95% CI -0.06 to 8.89 (p=0.05), respectively). SDXinsp changed significantly on the same day as CAT (1 day before AECOPD, both p=0.02) and earlier when using shorter running windows (3 days before AECOPD, p=0.01; accuracy=0.72 for 5-day windows). CONCLUSIONS SDXinsp from FOT telemonitoring reflects COPD symptoms and may be a sensitive biomarker for early detection of AECOPD.
Collapse
Affiliation(s)
- Sabine C Zimmermann
- Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, The University of Sydney, Glebe, Australia.,Dept of Respiratory Medicine, Royal North Shore Hospital, St Leonards, Australia.,Sydney Medical School Northern, The University of Sydney, St Leonards, Australia.,Dept of Respiratory Medicine, Concord Repatriation General Hospital, Concord, Australia.,Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Glebe, Australia
| | - Jacqueline Huvanandana
- Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, The University of Sydney, Glebe, Australia.,Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Glebe, Australia
| | - Chinh D Nguyen
- Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, The University of Sydney, Glebe, Australia.,Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Glebe, Australia
| | - Amy Bertolin
- Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, The University of Sydney, Glebe, Australia.,Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Glebe, Australia
| | - Joanna C Watts
- Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, The University of Sydney, Glebe, Australia.,Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Glebe, Australia
| | - Alessandro Gobbi
- Restech Srl, Milan, Italy.,Dept of Electronics, Informatics and Biomedical Engineering, Politecnico di Milano, Milan, Italy
| | - Claude S Farah
- Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, The University of Sydney, Glebe, Australia.,Dept of Respiratory Medicine, Concord Repatriation General Hospital, Concord, Australia.,Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Glebe, Australia
| | - Matthew J Peters
- Dept of Respiratory Medicine, Concord Repatriation General Hospital, Concord, Australia
| | - Raffaele L Dellacà
- Dept of Electronics, Informatics and Biomedical Engineering, Politecnico di Milano, Milan, Italy
| | - Gregory G King
- Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, The University of Sydney, Glebe, Australia.,Dept of Respiratory Medicine, Royal North Shore Hospital, St Leonards, Australia.,Sydney Medical School Northern, The University of Sydney, St Leonards, Australia.,Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Glebe, Australia
| | - Cindy Thamrin
- Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, The University of Sydney, Glebe, Australia.,Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Glebe, Australia
| |
Collapse
|
4
|
Zimmermann SC, Thamrin C, Chan AS, Bertolin A, Chapman DG, King GG. Relationships Between Forced Oscillatory Impedance and 6-minute Walk Distance After Pulmonary Rehabilitation in COPD. Int J Chron Obstruct Pulmon Dis 2020; 15:157-166. [PMID: 32021155 PMCID: PMC6982450 DOI: 10.2147/copd.s225543] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/19/2019] [Indexed: 12/16/2022] Open
Abstract
Rationale Pulmonary rehabilitation for chronic obstructive pulmonary disease (COPD) reduces dyspnoea and improves exercise capacity and quality of life. The improvement in exercise capacity is variable and unpredictable, however. Respiratory system impedance obtained by forced oscillation technique (FOT) as a measure of ventilatory impairment in COPD may relate to improvement in exercise capacity with pulmonary rehabilitation. We aimed to determine if baseline FOT parameters relate to changes in exercise capacity following pulmonary rehabilitation. Methods At the start of rehabilitation, 15 COPD subjects (mean(SD) 75.2(6.1) years, FEV1 z-score −2.61(0.84)) had measurements by FOT, spirometry, plethysmographic lung volumes and 6-minute walk distance (6MWD). Respiratory system resistance (Rrs) and reactance (Xrs) parameters as the mean over all breaths (Rmean, Xmean), during inspiration only (Rinsp, Xinsp), and expiratory flow limitation (DeltaXrs = Xinsp−Xexp), were calculated. FOT and 6MWD measurements were repeated at completion of rehabilitation and 3 months after completion. Results At baseline, Xrs measures were unrelated to 6MWD. Xinsp improved significantly with rehabilitation (from mean(SD) −2.35(1.02) to −2.04(0.85) cmH2O.s.L−1, p=0.008), while other FOT parameters did not. No FOT parameters related to the change in 6MWD at program completion. Baseline Xmean, DeltaXrs, and FVC z-score correlated with the change in 6MWD between completion and 3 months after completion of rehabilitation (rs=0.62, p=0.03; rs=−0.65, p=0.02; and rs=0.62, p=0.03, respectively); with worse ventilatory impairment predicting loss of 6MWD. There were no relationships between Rrs parameters, FEV1 or FEV1/FVC z-scores and changes in 6MWD. Conclusion Baseline reactance parameters may be helpful in predicting those patients with COPD at most risk of loss of exercise capacity following completion of pulmonary rehabilitation.
Collapse
Affiliation(s)
- Sabine C Zimmermann
- The Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW 2037, Australia.,The Northern Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney, Camperdown, NSW 2006, Australia.,Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Cindy Thamrin
- The Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW 2037, Australia
| | - Andrew Sl Chan
- The Northern Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney, Camperdown, NSW 2006, Australia.,Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Amy Bertolin
- The Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW 2037, Australia
| | - David G Chapman
- The Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW 2037, Australia.,School of Life Sciences, Faculty of Science, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Gregory G King
- The Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW 2037, Australia.,The Northern Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney, Camperdown, NSW 2006, Australia.,Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| |
Collapse
|
5
|
Milne S, Huvanandana J, Nguyen C, Duncan JM, Chapman DG, Tonga KO, Zimmermann SC, Slattery A, King GG, Thamrin C. Time-based pulmonary features from electrical impedance tomography demonstrate ventilation heterogeneity in chronic obstructive pulmonary disease. J Appl Physiol (1985) 2019; 127:1441-1452. [PMID: 31556831 DOI: 10.1152/japplphysiol.00304.2019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pulmonary electrical impedance tomography (EIT) is a functional imaging technique that allows real-time monitoring of ventilation distribution. Ventilation heterogeneity (VH) is a characteristic feature of chronic obstructive pulmonary disease (COPD) and has previously been quantified using features derived from tidal variations in the amplitude of the EIT signal. However, VH may be better described by time-based metrics, the measurement of which is made possible by the high temporal resolution of EIT. We aimed 1) to quantify VH using novel time-based EIT metrics and 2) to determine the physiological relevance of these metrics by exploring their relationships with complex lung mechanics measured by the forced oscillation technique (FOT). We performed FOT, spirometry, and tidal-breathing EIT measurements in 11 healthy controls and 9 volunteers with COPD. Through offline signal processing, we derived 3 features from the impedance-time (Z-t) curve for each image pixel: 1) tE, mean expiratory time; 2) PHASE, mean time difference between pixel and global Z-t curves; and 3) AMP, mean amplitude of Z-t curve tidal variation. Distribution was quantified by the coefficient of variation (CV) and the heterogeneity index (HI). Both CV and HI of the tE and PHASE features were significantly increased in COPD compared with controls, and both related to spirometry and FOT resistance and reactance measurements. In contrast, distribution of the AMP feature showed no relationships with lung mechanics. These novel time-based EIT metrics of VH reflect complex lung mechanics in COPD and have the potential to allow real-time visualization of pulmonary physiology in spontaneously breathing subjects.NEW & NOTEWORTHY Pulmonary electrical impedance tomography (EIT) is a real-time imaging technique capable of monitoring ventilation with exquisite temporal resolution. We report novel, time-based EIT measurements that not only demonstrate ventilation heterogeneity in chronic obstructive pulmonary disease (COPD), but also reflect oscillatory lung mechanics. These EIT measurements are noninvasive, radiation-free, easy to obtain, and provide real-time visualization of the complex pathophysiology of COPD.
Collapse
Affiliation(s)
- Stephen Milne
- Airway Physiology and Imaging Group and Woolcock Emphysema Centre, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Respiratory Medicine, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, New South Wales, Australia.,Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacqueline Huvanandana
- Airway Physiology and Imaging Group and Woolcock Emphysema Centre, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Chinh Nguyen
- Airway Physiology and Imaging Group and Woolcock Emphysema Centre, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Joseph M Duncan
- Department of Respiratory Medicine, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, New South Wales, Australia
| | - David G Chapman
- Airway Physiology and Imaging Group and Woolcock Emphysema Centre, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.,Translational Airways Group, School of Life Sciences, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Katrina O Tonga
- Airway Physiology and Imaging Group and Woolcock Emphysema Centre, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine, the University of New South Wales, Kensington, New South Wales, Australia
| | - Sabine C Zimmermann
- Airway Physiology and Imaging Group and Woolcock Emphysema Centre, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Respiratory Medicine, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, New South Wales, Australia
| | - Alexander Slattery
- Department of Respiratory Medicine, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, New South Wales, Australia
| | - Gregory G King
- Airway Physiology and Imaging Group and Woolcock Emphysema Centre, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Respiratory Medicine, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, New South Wales, Australia.,Centre of Excellence in Severe Asthma, New Lambton, New South Wales, Australia
| | - Cindy Thamrin
- Airway Physiology and Imaging Group and Woolcock Emphysema Centre, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
6
|
Tonga KO, Chapman DG, Farah CS, Oliver BG, Zimmermann SC, Milne S, Sanai F, Jetmalani K, Berend N, Thamrin C, King GG. Reduced lung elastic recoil and fixed airflow obstruction in asthma. Respirology 2019; 25:613-619. [PMID: 31482693 DOI: 10.1111/resp.13688] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/01/2019] [Accepted: 08/07/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Fixed airflow obstruction (FAO) in asthma occurs despite optimal inhaled treatment and no smoking history, and remains a significant problem, particularly with increasing age and duration of asthma. Increased lung compliance and loss of lung elastic recoil has been observed in older people with asthma, but their link to FAO has not been established. We determined the relationship between abnormal lung elasticity and airflow obstruction in asthma. METHODS Non-smoking asthmatic subjects aged >40 years, treated with 2 months of high-dose inhaled corticosteroid/long-acting beta-agonist (ICS/LABA), had FAO measured by spirometry, and respiratory system resistance at 5 Hz (Rrs5 ) and respiratory system reactance at 5 Hz (Xrs5 ) measured by forced oscillation technique. Lung compliance (K) and elastic recoil (B/A) were calculated from pressure-volume curves measured by an oesophageal balloon. Linear correlations between K and B/A, and forced expiratory volume in 1 s/forced vital capacity (FEV1 /FVC), Rrs5 and Xrs5 were assessed. RESULTS Eighteen subjects (11 males; mean ± SD age: 64 ± 8 years, asthma duration: 39 ± 22 years) had moderate FAO measured by spirometry ((mean ± SD z-score) post-bronchodilator FEV1 : -2.2 ± 0.5, FVC: -0.7 ± 1.0, FEV1 /FVC: -2.6 ± 0.7) and by increased Rrs5 (median (IQR) z-score) 2.7 (1.9 to 3.2) and decreased Xrs5 : -4.1(-2.4 to -7.3). Lung compliance (K) was increased in 9 of 18 subjects and lung elastic recoil (B/A) reduced in 5 of 18 subjects. FEV1 /FVC correlated negatively with K (rs = -0.60, P = 0.008) and Rrs5 correlated negatively with B/A (rs = -0.52, P = 0.026), independent of age. Xrs5 did not correlate with lung elasticity indices. CONCLUSION Increased lung compliance and loss of elastic recoil relate to airflow obstruction in older non-smoking asthmatic subjects, independent of ageing. Thus, structural lung tissue changes may contribute to persistent, steroid-resistant airflow obstruction. CLINICAL TRIAL REGISTRATION ACTRN126150000985583 at anzctr.org.au (UTN: U1111-1156-2795).
Collapse
Affiliation(s)
- Katrina O Tonga
- The Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, NSW, Australia.,Airway Physiology and Imaging Group and the Woolcock Emphysema Centre, The Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,The Department of Respiratory Medicine, Concord Hospital, Sydney, NSW, Australia.,The Department of Thoracic and Lung Transplant Medicine, St Vincent's Hospital, Sydney, NSW, Australia.,St Vincent's Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - David G Chapman
- Airway Physiology and Imaging Group and the Woolcock Emphysema Centre, The Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Discipline of Medical Sciences, School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - Claude S Farah
- Airway Physiology and Imaging Group and the Woolcock Emphysema Centre, The Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,The Department of Respiratory Medicine, Concord Hospital, Sydney, NSW, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Brian G Oliver
- Airway Physiology and Imaging Group and the Woolcock Emphysema Centre, The Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Discipline of Medical Sciences, School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - Sabine C Zimmermann
- The Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, NSW, Australia.,Airway Physiology and Imaging Group and the Woolcock Emphysema Centre, The Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,The Department of Respiratory Medicine, Concord Hospital, Sydney, NSW, Australia
| | - Stephen Milne
- The Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, NSW, Australia.,Airway Physiology and Imaging Group and the Woolcock Emphysema Centre, The Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,The Department of Respiratory Medicine, Concord Hospital, Sydney, NSW, Australia
| | - Farid Sanai
- Airway Physiology and Imaging Group and the Woolcock Emphysema Centre, The Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Discipline of Medical Sciences, School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - Kanika Jetmalani
- Airway Physiology and Imaging Group and the Woolcock Emphysema Centre, The Woolcock Institute of Medical Research, Sydney, NSW, Australia
| | - Norbert Berend
- Airway Physiology and Imaging Group and the Woolcock Emphysema Centre, The Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,St Vincent's Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia.,Respiratory Research Group, The George Institute for Global Health, Sydney, NSW, Australia
| | - Cindy Thamrin
- Airway Physiology and Imaging Group and the Woolcock Emphysema Centre, The Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Gregory G King
- The Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, NSW, Australia.,Airway Physiology and Imaging Group and the Woolcock Emphysema Centre, The Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,NHMRC Centre of Excellence in Severe Asthma, Newcastle, NSW, Australia
| |
Collapse
|
7
|
Zimmermann SC, Tonga KO, Thamrin C. Dismantling airway disease with the use of new pulmonary function indices. Eur Respir Rev 2019; 28:28/151/180122. [PMID: 30918023 PMCID: PMC9488242 DOI: 10.1183/16000617.0122-2018] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 02/15/2019] [Indexed: 11/27/2022] Open
Abstract
We are currently limited in our abilities to diagnose, monitor disease status and manage chronic airway disease like asthma and chronic obstructive pulmonary disease (COPD). Conventional lung function measures often poorly reflect patient symptoms or are insensitive to changes, particularly in the small airways where disease may originate or manifest. Novel pulmonary function tests are becoming available which help us better characterise and understand chronic airway disease, and their translation and adoption from the research arena would potentially enable individualised patient care. In this article, we aim to describe two emerging lung function tests yielding novel pulmonary function indices, the forced oscillation technique (FOT) and multiple breath nitrogen washout (MBNW). With a particular focus on asthma and COPD, this article demonstrates how chronic airway disease mechanisms have been dismantled with the use of the FOT and MBNW. We describe their ability to assess detailed pulmonary mechanics for diagnostic and management purposes including response to bronchodilation and other treatments, relationship with symptoms, evaluation of acute exacerbations and recovery, and telemonitoring. The current limitations of both tests, as well as open questions/directions for further research, are also discussed. Spirometry is used to diagnose and manage airway disease such as asthma and COPD, but relates poorly to symptoms, lacks sensitivity and is effort dependent. FOT and MBNW are emerging clinical lung function tests that help us dismantle disease mechanisms.http://ow.ly/nM0G30nS6Ct
Collapse
Affiliation(s)
- Sabine C Zimmermann
- Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia.,Dept of Respiratory Medicine, Royal North Shore Hospital, Sydney, Australia.,Sydney Medical School Northern, The University of Sydney, Sydney, Australia.,Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Katrina O Tonga
- Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia.,Dept of Respiratory Medicine, Royal North Shore Hospital, Sydney, Australia.,Sydney Medical School Northern, The University of Sydney, Sydney, Australia.,Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia.,Dept of Thoracic and Transplant Medicine, St Vincent's Hospital, Sydney, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Cindy Thamrin
- Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia .,Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| |
Collapse
|
8
|
Zimmermann SC, Watts JC, Bertolin A, Jetmalani K, King GG, Thamrin C. Discrepancy between in vivo and in vitro comparisons of forced oscillation devices. J Clin Monit Comput 2017; 32:509-512. [PMID: 28761996 DOI: 10.1007/s10877-017-0050-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 07/27/2017] [Indexed: 11/25/2022]
Abstract
The forced oscillation technique (FOT) is an emerging clinical lung function test, with commercial devices becoming increasingly available. However comparability across existing devices has not been established. We evaluated in vivo and in vitro measurements made using three commercial devices against a custom-built device (WIMR): Resmon Pro Diary (Restech srl, Italy), tremoFlo C-100 (Thorasys Medical Systems, Canada), Jaeger Masterscope CT IOS (CareFusion, Hoechberg, Germany). Respiratory system resistance Rrs and reactance Xrs at 5 Hz were examined in twelve healthy subjects (mean age 33 ± 11 years, 7 males), and in two test standards of known resistance and reactance. Subjects performed three measurements during tidal breathing on the four devices in random order. Total, inspiratory and expiratory Rrs and Xrs were calculated and compared using one-way repeated measures ANOVA and Bonferroni post-hoc tests. Rrs did not differ between devices, with <10% deviation from predicted, except for the IOS device. With Xrs, similar values were seen between the WIMR and Resmon devices and between the tremoFlo and IOS devices. No differences were observed using test standards; deviation from theoretical value was <2% for resistance and <5% for reactance. The WIMR, tremoFlo and Resmon Pro but not IOS devices measure similar Rrs, whereas there was more disparity across devices in the estimation of Xrs parameters. The discrepancy between in vivo and in vitro measurements suggest that FOT validation procedures need to take into account the breathing pattern, either using biological controls or a breathing model.
Collapse
Affiliation(s)
- Sabine C Zimmermann
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia.
- Department of Respiratory Medicine, Royal North Shore Hospital, Pacific Highway, St Leonards, NSW, 2065, Australia.
| | - Joanna C Watts
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Amy Bertolin
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Kanika Jetmalani
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Gregory G King
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
- Department of Respiratory Medicine, Royal North Shore Hospital, Pacific Highway, St Leonards, NSW, 2065, Australia
| | - Cindy Thamrin
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| |
Collapse
|
9
|
Rossiwall B, Zimmermann SC. [Experimental research on the peculiarity and esthetic effect of the neck-jaw angle]. Fortschr Kieferorthop 1984; 45:101-10. [PMID: 6590442 DOI: 10.1007/bf02201610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|