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De Weerdt S, Schotte C, Barbé K, Verbanck S, Verbraecken J. The DS-14 questionnaire: psychometric characteristics and utility in patients with obstructive sleep apnea. Sleep Breath 2024; 28:69-78. [PMID: 37418222 DOI: 10.1007/s11325-023-02859-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/02/2023] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 07/08/2023]
Abstract
Little is known about type D personality in patients with obstructive sleep apnea (OSA). The DS-14 questionnaire is the standard tool to assess this personality type, but it has not been properly validated in patients with OSA, nor has it been correlated with clinical features in these patients. PURPOSE To determine the internal consistency and test-retest reliability of the DS-14 questionnaire, as well as the prevalence of type D personality in the overall OSA sample and subgroups. We assessed the influence of type D on perceived symptoms and its congruence with self-reported measures of personality, depression, fatigue, anxiety, quality of life, and quality of sleep. METHODS Patients with OSA completed the DS-14 questionnaire, Big Five Inventory-2 questionnaire, Hospital Anxiety and Depression Scale, SF-36 Health Survey Questionnaire, Epworth Sleepiness Scale and Stanford Sleepiness Scale, Pittsburgh Sleep Quality Index and Insomnia Severity Index, Fatigue Assessment Scale, and Checklist Individual Strength. After 1 month, the DS-14 questionnaire was repeated. RESULTS The overall prevalence of type D personality was 32%. Internal consistency (negative affectivity: α = 0.880, social inhibition: α = 0.851) and diagnostic test-retest reliability (kappa value = 0.664) of the DS-14 questionnaire were high. Significantly more symptoms of anxiety, depression, poor sleep quality, fatigue, and a worse health perception were found in OSA with type D. Neither OSA severity nor REM predominance altered these observations. CONCLUSION The DS-14 questionnaire showed excellent psychometric properties in patients with OSA. The prevalence of type D personality in patients with OSA was higher than in the general population. The presence of type D personality was associated with higher symptom burden.
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Affiliation(s)
- Sonia De Weerdt
- Sleep Laboratory, UZ Brussels, Laarbeeklaan 101, 1090, Jette, Belgium.
| | - Christiaan Schotte
- Faculty of Psychology and al Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Kurt Barbé
- Research Group Biostatistics and Medical Informatics (BISI), Free University of Brussels (VUB), Brussels, Belgium
| | - Sylvia Verbanck
- Respiratory Division, UZ Brussels, Vrije Universiteit Brussel, Brussels, Belgium
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
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2
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Hanon S, Verbanck S, Stylemans D, Meysman M, Vanderhelst E. Peak Inspiratory Flow for Screening of Inspiratory Muscle Weakness in Neuromuscular Disease. Lung 2023:10.1007/s00408-023-00617-7. [PMID: 37055634 DOI: 10.1007/s00408-023-00617-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/08/2023] [Indexed: 04/15/2023]
Affiliation(s)
- Shane Hanon
- Respiratory Division, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Sylvia Verbanck
- Respiratory Division, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Dimitri Stylemans
- Respiratory Division, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Marc Meysman
- Respiratory Division, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Eef Vanderhelst
- Respiratory Division, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090, Brussels, Belgium
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3
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Vincken S, Verbanck S, Braun S, Buyck N, Knoop C, Vanderhelst E. Real-world data on the efficacy and safety of tezacaftor-ivacaftor in adults living with cystic fibrosis homozygous for F508del and heterozygous for F508del and a residual function mutation. Acta Clin Belg 2022:1-5. [DOI: 10.1080/17843286.2022.2145684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Stefanie Vincken
- Department of Pulmonology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Sylvia Verbanck
- Department of Pulmonology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Sue Braun
- Department of Psychology, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101 1090, Brussels, Belgium
| | - Nathalie Buyck
- Department of Pulmonology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Christiane Knoop
- CHU Erasme Université Libre de Bruxelles, Department of Pulmonology, Brussels, Belgium
| | - Eef Vanderhelst
- Department of Pulmonology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
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4
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Hanon S, Vanderhelst E, Buls N, Verbanck S. Getting the Most out of Spirometry: A Tool to Guide Dry Powder Inhaler Use. Respiration 2022; 101:893-900. [DOI: 10.1159/000525715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 06/16/2022] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> Dry powder inhaler (DPI) use requires sufficient peak inspiratory flow over the DPI internal resistance (PIF<sub>R</sub>). <b><i>Objectives:</i></b> We examined whether spirometric peak inspiratory flow (PIF<sub>spiro</sub>) could serve to predict PIF<sub>R</sub> in patients with obstructive lung disease. <b><i>Method:</i></b> Thirty healthy nonsmokers and 140 stable outpatients (70 COPD, 70 asthma) performed spirometry according to the 2019 ERS/ATS spirometry update, yielding PIF<sub>spiro</sub>. Using a PIF<sub>R</sub> measurement device with varying orifices, all subjects’ PIF<sub>R</sub> values were recorded for 5 predefined resistance levels, characterized by 5 orifice cross sections (S<sub>R</sub>). A test group including all healthy subjects, 30 of the asthma, and 30 of the COPD patients was used to establish the relationship between PIF<sub>R</sub> and both PIF<sub>spiro</sub> and S<sub>R</sub> by multiple regression. A validation group including the remaining 40 asthma and 40 COPD patients, served to verify whether their predicted PIF<sub>R</sub> value corresponded to the measured PIF<sub>R</sub> for each resistance level. <b><i>Results:</i></b> The asthma (FEV<sub>1</sub> = 78 ± 17 [SD] %pred) and COPD (FEV<sub>1</sub> = 46 ± 17 [SD] %pred) patients under study had varying airway obstruction. In the test group, PIF<sub>R</sub> could be predicted by ln[PIF<sub>spiro</sub>] (<i>p</i> < 0.0001), S<sub>R</sub> (<i>p</i> < 0.0001), and S<sub>R</sub><sup>2</sup> (<i>p</i> = 0.006), with an adjusted <i>R</i><sup>2</sup> = 0.71. In the validation group, estimated PIF<sub>R</sub> did not significantly differ from measured PIF<sub>R</sub> (<i>p</i> > 0.05 for the 5 resistance levels). <b><i>Conclusions:</i></b> We propose a simple method to predict PIF<sub>R</sub> for a range of common DPI resistances, based on the device characteristics and on the patient’s characteristics reflected in PIF<sub>spiro</sub>. As such, routine spirometry can serve to estimate a patient’s specific PIF<sub>R</sub> without the need for additional testing.
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5
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Vincken S, Knoop C, Verbanck S, Buyck N, Vanderhelst E. P079 Real-life data on the efficacy and safety of tezacaftor/ivacaftor in people living with cystic fibrosis homozygous for F508del and heterozygous for F508del and a residual function mutation. J Cyst Fibros 2022. [PMCID: PMC9184784 DOI: 10.1016/s1569-1993(22)00412-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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6
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Braun S, Eyns H, Verbanck S, Vanderhelst E, Knoop C, De Wachter E, Vincken S. P243 Psychosocial impact of 6 months of treatment with Symkevi® among adult cystic fibrosis patients. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00572-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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7
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Verbanck S, Van Parijs H, Schuermans D, Vinh-Hung V, Storme G, Fontaine C, De Ridder M, Verellen D, Vanderhelst E, Hanon S. Lung Restriction in Breast Cancer Patients after Hypofractionated Tomotherapy and Conventional 3D Conformal Radiotherapy: a 10-year Follow-up. Int J Radiat Oncol Biol Phys 2022; 113:561-569. [DOI: 10.1016/j.ijrobp.2022.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 10/19/2022]
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8
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Vincken S, Verbanck S, Hanon S, Vanderhelst E. Not a wild goose chase: long-lasting MRSA negative status following eradication therapy for chronic MRSA infection in patients with cystic fibrosis. Acta Clin Belg 2021; 77:933-937. [PMID: 34874240 DOI: 10.1080/17843286.2021.2012948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Prevalence of MRSA in patients with CF has risen over the past decades, and chronic infection with MRSA is associated with worse outcome in this patient group. METHODS This retrospective observational study investigated long-term eradication rate in pediatric and adult CF patients with chronic MRSA infection, using a 6-month eradication regimen containing 2 oral antibiotics, combined with topical decolonisation measures. Respiratory tract cultures were performed at least every three months, from the first MRSA-positive culture onwards. RESULTS A total of 24 patients with chronic MRSA infection were identified from our CF patient registry, of which 13 patients underwent an eradication attempt. The regimen consisted of 2 oral antibiotics: a combination of rifampicin, fusidic acid, clindamycin and co-trimoxazol, based on the sensitivity pattern of the MRSA strain. At the end of the study period (median 8.2 years), 12 out of 13 patients (92%) were MRSA negative. None of the patients interrupted treatment due to side-effects. CONCLUSIONS Eradication of chronic MRSA infection is feasible, well-tolerated and highly successful, and can offer a long-lasting MRSA-negative status, obviating the need for patient segregation.
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Affiliation(s)
- Stefanie Vincken
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Respiratory Division, Brussels, Belgium
| | - Sylvia Verbanck
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Respiratory Division, Brussels, Belgium
| | - Shane Hanon
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Respiratory Division, Brussels, Belgium
| | - Eef Vanderhelst
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Respiratory Division, Brussels, Belgium
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9
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Van Rossem I, Hanon S, Verbanck S, Vanderhelst E. Blood Eosinophil Counts in COPD: Adding Within-day Variability to the Equation. Am J Respir Crit Care Med 2021; 205:727-729. [PMID: 34797749 DOI: 10.1164/rccm.202105-1162le] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Inès Van Rossem
- Vrije Universiteit Brussel, 70493, Department of Family Medicine and Chronic Care, Brussel, Belgium;
| | - Shane Hanon
- Vrije Universiteit Brussel, 70493, Universitair Ziekenhuis Brussel, Respiratory Division, Brussel, Belgium
| | - Sylvia Verbanck
- Vrije Universiteit Brussel, 70493, Universitair Ziekenhuis Brussel, Respiratory Division, Brussel, Belgium
| | - Eef Vanderhelst
- Vrije Universiteit Brussel, 70493, Universitair Ziekenhuis Brussel, Respiratory Division, Brussel, Belgium
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10
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Bayat S, Broche L, Dégrugilliers L, Porra L, Paiva M, Verbanck S. Fractal analysis reveals functional unit of ventilation in the lung. J Physiol 2021; 599:5121-5132. [PMID: 34647325 DOI: 10.1113/jp282093] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/06/2021] [Indexed: 12/14/2022] Open
Abstract
Ventilation is inhomogeneous in the lungs across species. It has been hypothesized that ventilation inhomogeneity is largely determined by the design of the airway branching network. Because exchange of gases at the alveolar barrier is more efficient when gas concentrations are evenly distributed at subacinar length scales, it is assumed that a 'functional unit' of ventilation exists within the lung periphery, where gas concentration becomes uniform. On the other hand, because the morphology of pulmonary airways and alveoli, and the distribution of inhaled fluorescent particles show self-similar fractal properties over a wide range of length scales, it has been predicted that fractal dimension of ventilation approaches unity within an internally homogeneous functional unit of ventilation. However, the existence of such a functional unit has never been demonstrated experimentally due to lack of in situ gas concentration measurements of sufficient spatial resolution in the periphery of a complex bifurcating network. Here, using energy-subtractive synchrotron radiation tomography, we measured the distribution of an inert gas (Xe) in the in vivo rabbit lung during Xe wash-in breathing manoeuvres. The effects of convective flow rate, diffusion and cardiac motion were also assessed. Fractal analysis of resulting gas concentration and tissue density maps revealed that fractal dimension was always smaller for Xe than for tissue density, and that only for the gas, a length scale existed where fractal dimension approached unity. The length scale where this occurred was seen to correspond to that of a rabbit acinus, the terminal structure comprising only alveolated airways. KEY POINTS: Gas ventilation is inhomogeneous in the lung of many species. However, it is not known down to what length scales this inhomogeneity persists. It is generally assumed that ventilation becomes homogeneous at subacinar length scales, beyond the spatial resolution of commonly available imaging techniques, hence this has not been demonstrated experimentally. Here we measured the distribution of inhaled Xe gas in the rabbit lung using synchrotron radiation energy-subtractive imaging and used fractal analysis to show that ventilation becomes internally uniform within regions about the size of rabbit lung acini.
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Affiliation(s)
- Sam Bayat
- Department of Pulmonology and Physiology, Grenoble University Hospital, Grenoble, France.,Univ. Grenoble Alpes, STROBE Laboratory Inserm UA07, Grenoble, France
| | - Ludovic Broche
- Biomedical Beamline, European Synchrotron Radiation Facility, Grenoble, France
| | - Loïc Dégrugilliers
- Department of Paediatric Intensive Care, Amiens University Hospital, Amiens, France
| | - Liisa Porra
- Department of Physics, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland
| | - Manuel Paiva
- University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Sylvia Verbanck
- Respiratory Division, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belguim
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11
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Verbanck S, Vanderhelst E, Hanon S. When adopting Global Lung Function Initiative reference values, can we also adapt them to a local context as needed? Eur Respir J 2021; 58:13993003.01601-2021. [PMID: 34531257 DOI: 10.1183/13993003.01601-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 06/22/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Sylvia Verbanck
- Respiratory Division, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Eef Vanderhelst
- Respiratory Division, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Shane Hanon
- Respiratory Division, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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12
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Garner JL, Biddiscombe MF, Meah S, Lewis A, Buttery SC, Hopkinson NS, Kemp SV, Usmani OS, Shah PL, Verbanck S. Endobronchial Valve Lung Volume Reduction and Small Airway Function. Am J Respir Crit Care Med 2021; 203:1576-1579. [PMID: 33596397 DOI: 10.1164/rccm.202010-3939le] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Justin L Garner
- Royal Brompton Hospital London, United Kingdom.,Chelsea & Westminster Hospital London, United Kingdom.,Imperial College London London, United Kingdom
| | - Martyn F Biddiscombe
- Royal Brompton Hospital London, United Kingdom.,Imperial College London London, United Kingdom
| | - Sally Meah
- Royal Brompton Hospital London, United Kingdom
| | - Adam Lewis
- Royal Brompton Hospital London, United Kingdom.,Brunel University London Uxbridge, United Kingdom
| | - Sara C Buttery
- Royal Brompton Hospital London, United Kingdom.,Imperial College London London, United Kingdom
| | - Nicholas S Hopkinson
- Royal Brompton Hospital London, United Kingdom.,Imperial College London London, United Kingdom
| | - Samuel V Kemp
- Royal Brompton Hospital London, United Kingdom.,Imperial College London London, United Kingdom
| | - Omar S Usmani
- Royal Brompton Hospital London, United Kingdom.,Imperial College London London, United Kingdom
| | - Pallav L Shah
- Royal Brompton Hospital London, United Kingdom.,Chelsea & Westminster Hospital London, United Kingdom.,Imperial College London London, United Kingdom
| | - Sylvia Verbanck
- Vrije Universiteit Brussel (VUB) Brussels, Belgium.,Universitair Ziekenhuis Brussel (UZ Brussel) Brussels, Belgium
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13
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Stylemans D, François S, Vincken S, Verbanck S, Vanderhelst E. A case of self-limited drug induced liver injury under treatment with elexacaftor/tezacaftor/ivacaftor: When it is worth taking the risk. J Cyst Fibros 2021; 20:712-714. [PMID: 34134936 DOI: 10.1016/j.jcf.2021.05.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Dimitri Stylemans
- Respiratory Division, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium.
| | - Silke François
- Gastro-enterology Division, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Stefanie Vincken
- Respiratory Division, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Sylvia Verbanck
- Respiratory Division, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Eef Vanderhelst
- Respiratory Division, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
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14
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Stylemans D, Darquenne C, Schuermans D, Verbanck S, Vanderhelst E. Peripheral lung effect of elexacaftor/tezacaftor/ivacaftor in adult cystic fibrosis. J Cyst Fibros 2021; 21:160-163. [PMID: 33832855 DOI: 10.1016/j.jcf.2021.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 11/18/2022]
Abstract
Despite being an important patient group, adult cystic fibrosis patients with an FEV1 below 40%predicted have been excluded from clinical trials with elexacaftor/tezacaftor/ivacaftor. We conducted a real-life 3 months follow-up study in 14 adult CF patients (median FEV1 34%predicted) demonstrating significant treatment effects in terms of FEV1 (an increase of 12%predicted at 4 weeks, remaining stable thereafter). Corresponding decreases in lung clearance index LCI (by 31%predicted, down from baseline 247%predicted) and ventilation heterogeneity in the acinar compartment (Sacin) (by 411%predicted, down from baseline 798%predicted) suggest a distinct peripheral lung effect. One patient had intermittent treatment interruptions because of drug-induced liver injury. Our real-life data confirm that treatment with elexacaftor/tezacaftor/ivacaftor is effective in severely obstructive patients, and this is the first study to show time evolution of ventilation distribution improvement, pointing to the peripheral lung as the main site of treatment effect.
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Affiliation(s)
- Dimitri Stylemans
- Respiratory Division, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium.
| | - Chantal Darquenne
- Department of Medicine, University of California, San Diego, CA 92093-0623, USA
| | - Daniël Schuermans
- Respiratory Division, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Sylvia Verbanck
- Respiratory Division, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Eef Vanderhelst
- Respiratory Division, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
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15
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Verbanck S, Schuermans D, Paiva M, Robinson PD, Vanderhelst E. Reply: Fixed breathing protocols in multiple-breath-washout testing: truly an option in children? Eur Respir J 2021; 57:57/3/2100189. [PMID: 33664102 DOI: 10.1183/13993003.00189-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 01/24/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Sylvia Verbanck
- Respiratory Division, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Daniel Schuermans
- Respiratory Division, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Manuel Paiva
- Respiratory Division, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Paul D Robinson
- Dept of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia.,Contibuted equally
| | - Eef Vanderhelst
- Respiratory Division, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.,Contibuted equally
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16
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Hanon S, Vanderhelst E, Vincken W, Schuermans D, Verbanck S. Peak In- and Expiratory Flow Revisited: Reliability and Reference Values in Adults. Respiration 2021; 100:11-18. [PMID: 33412551 DOI: 10.1159/000511694] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 09/18/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND While peak in- and expiratory flow rates offer valuable information for diagnosis and monitoring in respiratory disease, these indices are usually considered too variable to be routinely used for quantification in clinical practice. OBJECTIVES The aim of the study was to obtain reproducible measurements of maximal inspiratory flow rates and to construct reference equations for peak in- and expiratory flows (PIF and PEF). METHOD With coaching for maximal effort, 187 healthy Caucasian subjects (20-80 years) performed at least 3 combined forced inspiratory and expiratory manoeuvres, until at least 2 peak inspiratory flow measurements were within 10% of each other. The effect on PIF preceded by a slow expiration instead of a forced expiration and PIF repeatability over 3 different days was also investigated in subgroups. Reference values and limits of normal for PIF, mid-inspiratory flow, and PEF were obtained according to the Lambda-Mu-Sigma statistical method. RESULTS A valid PIF could be obtained within 3.3 ± 0.6(SD) attempts, resulting in an overall within-test PIF variability of 4.6 ± 3.2(SD)%. A slow instead of a forced expiration prior to forced inspiration resulted in a significant (p < 0.001) but small PIF increase (2.5% on average). Intraclass correlation coefficient for between-day PIF was 0.981 (95% CI: 0.960-0.992). Over the entire age range, inter-subject PIF variability was smaller than in previous reports, and PIF could be predicted based on its determinants gender, age, and height (r2 = 0.53). CONCLUSIONS When adhering to similar criteria for the measurement of effort-dependent portions of inspiratory and expiratory flow-volume curves, performed according to current ATS/ERS standards, it is possible to obtain reproducible PIF and PEF values for use in routine clinical practice.
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Affiliation(s)
- Shane Hanon
- Respiratory Division, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium,
| | - Eef Vanderhelst
- Respiratory Division, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Walter Vincken
- Respiratory Division, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Daniel Schuermans
- Respiratory Division, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sylvia Verbanck
- Respiratory Division, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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Smet J, Stylemans D, Hanon S, Ilsen B, Verbanck S, Vanderhelst E. Clinical status and lung function 10 weeks after severe SARS-CoV-2 infection. Respir Med 2021; 176:106276. [PMID: 33278758 PMCID: PMC7701883 DOI: 10.1016/j.rmed.2020.106276] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Since studies about clinical status after COVID-19 are scarce, we conducted a cross sectional study with assessment of residual symptoms, lung function and chest CT. MATERIALS AND METHODS During an outpatient follow-up visit, chest CT, pulmonary function and COVID-19 related symptoms were assessed approximately 10 weeks after diagnosis. Demographics, baseline (time of diagnosis) CT score and blood results were collected from patient files. Association between lung function and clinical characteristics (baseline), blood markers (baseline), chest CT (baseline and follow-up) and symptom score (followup) was analysed. Mann-Whitney U tests and Chi squared tests were used for statistical comparison between subgroups with and without restriction. RESULTS AND DISCUSSION Two hundred-twenty subjects were evaluated at a median follow-up of 74±12 (SD) days. Median symptom and median CT score at follow-up were 1(IQR=0- 2) and 2(IQR=0-6) respectively. Forty-six percent of patients had normal lung function, while TLC and TLCO below the lower limit of normal were observed in 38% and 22% of subjects respectively. This restrictive pulmonary impairment was associated with length of hospital stay (8 vs 6 days; p=0.003), admission to the intensive care unit (27% vs 13%;p=0.009), and invasive mechanical ventilation (10% vs 0.7%;p=0.001), but not with symptom score or CT score at baseline and follow-up. CONCLUSIONS Fifty-four percent of COVID-19 survivors had abnormal lung function 10 weeks after diagnosis. Restriction was the most prevalent pulmonary function, with the more critically ill patients being more prone to this condition. Yet, restriction could not be linked with abnormal imaging results or residual symptoms.
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Affiliation(s)
- Jelle Smet
- Corresponding author. Respiratory Division, University Hospital UZ Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | | | | | - Bart Ilsen
- Department of Radiology, University Hospital UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Sylvia Verbanck
- Respiratory Division, University Hospital UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Eef Vanderhelst
- Respiratory Division, University Hospital UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
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18
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Verbanck S, Schuermans D, Paiva M, Robinson PD, Vanderhelst E. Mitigating increased variability of multiple breath washout indices due to tidal breathing. Eur Respir J 2020; 57:13993003.02765-2020. [PMID: 32994196 DOI: 10.1183/13993003.02765-2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/14/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Sylvia Verbanck
- Respiratory Division, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Daniel Schuermans
- Respiratory Division, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Manuel Paiva
- Respiratory Division, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Paul D Robinson
- Dept of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia
| | - Eef Vanderhelst
- Respiratory Division, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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19
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Affiliation(s)
- Sylvia Verbanck
- Respiratory Division University Hospital UZ BrusselBrussels, Belgium
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20
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Verbanck S, Biddiscombe MF, Usmani OS. Inhaled aerosol dose distribution between proximal bronchi and lung periphery. Eur J Pharm Biopharm 2020; 152:18-22. [PMID: 32361031 DOI: 10.1016/j.ejpb.2020.04.019] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/11/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
Modern inhaled drug discovery programs assess dose delivery to proximal and distal airways using rudimentary imaging indices, where relative deposition is estimated by generically defined 'central' and 'peripheral' lung regions. Utilizing recent data linking the proximal airway topology to a characteristic pattern of aerosol lung deposition, we provide a direct measure of dose distribution between the proximal bronchi and the distal lung. We analyzed scintigraphic lung images of twelve asthma patients following inhalation of 1.5-, 3- and 6-µm monodisperse drug particles at breathing flows of 30- and 60-L/min. We explicitly used the central hot-spots associated with each patient's specific bronchial topology to obtain a direct measure of aerosol deposition in the proximal bronchi, rather than applying standard templates of lung boundaries. Maximum deposition in the central bronchi (as % of lung deposition) was 52 ± 10(SD)% (6 µm;60 L/min). Minimum central deposition was 17 ± 2(SD)% (1.5 µm;30 L/min) where the 83% aerosol 'escaping' deposition in the central bronchi reached 75 ± 17(SD)% of the lung area that could be reached by Krypton gas. For all particle sizes, hot-spots appeared in the same patient-specific central airway location, with greatest intensity at 60 L/min. For a range of respirable aerosol sizes and breathing flows, we have quantified deposited dose in the proximal bronchi and their distal lung reach, constituting a platform to support therapeutic inhaled aerosol drug development.
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Affiliation(s)
- Sylvia Verbanck
- Respiratory Division, University Hospital UZBrussel, Brussels, Belgium.
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21
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Foy B, Kay D, Siddiqui S, Brightling C, Paiva M, Verbanck S. Increased ventilation heterogeneity in asthma can be attributed to proximal bronchioles. Eur Respir J 2020; 55:13993003.01345-2019. [PMID: 31806713 DOI: 10.1183/13993003.01345-2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/12/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Brody Foy
- Center for Systems Biology and Dept of Pathology, Massachusetts General Hospital, Boston, MA, USA.,Dept of Systems Biology, Harvard Medical School, Boston, MA, USA
| | - David Kay
- Dept of Computer Science, University of Oxford, Oxford, UK
| | - Salman Siddiqui
- Dept of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Chris Brightling
- Dept of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Manuel Paiva
- Respiratory Division, University Hospital Erasme, Brussels, Belgium
| | - Sylvia Verbanck
- Respiratory Division, University Hospital UZBrussel, Brussels, Belgium
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Stylemans D, Verbanck S, Vincken S, Vincken W, De Wachter E, Vanderhelst E. Pulmonary function patterns and their association with genotype and phenotype in adult cystic fibrosis patients. Acta Clin Belg 2019; 74:386-392. [PMID: 30311545 DOI: 10.1080/17843286.2018.1533716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: While cystic fibrosis (CF) lung disease is generally considered to be an obstructive disorder, other pulmonary function patterns (PFP) may occur. Furthermore, little is known about possible associations between PFP and genotype or phenotypical characteristics. Methods: Cross-sectional study including CF patients aged 16 years or more, identifying different PFP and exploring associations between PFP and genotype or phenotypical characteristics. Results: Obstructive PFP was most prevalent in our population (n = 80), comprising obstructive lung disease (62.5%), small airway (obstructive) disease (11.2%), and mixed obstructive-restrictive disorder (1.3%). However, one in four adult CF patients did not show any obstruction at all: normal (13.7%) or restrictive (8.8%) lung disease and isolated diffusion disorder (2.5%). Obstructive PFP was associated with a greater proportion of CF-related diabetes mellitus (CFRD) (P = 0.04), Pseudomonas aeruginosa colonization (P = 0.02) and frequent exacerbators (P = 0.04). We observed no association between PFP and genotype. Conclusions: Obstructive PFP remains the most common pulmonary function pattern in adult CF and is associated with CFRD, Pseudomonas aeruginosa colonization and frequent exacerbators.
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Affiliation(s)
- Dimitri Stylemans
- Adult Cystic Fibrosis Center, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sylvia Verbanck
- Adult Cystic Fibrosis Center, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Stefanie Vincken
- Adult Cystic Fibrosis Center, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Walter Vincken
- Adult Cystic Fibrosis Center, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Elke De Wachter
- Adult Cystic Fibrosis Center, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Eef Vanderhelst
- Adult Cystic Fibrosis Center, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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Verbanck S, Polfliet M, Schuermans D, Ilsen B, De Mey J, Vanderhelst E, Vandemeulebroucke J. CT imaging-based study of ventilation heterogeneity in smokers :the respective roles of unequal lung expansion and peripheral lung structure. Imaging 2019. [DOI: 10.1183/13993003.congress-2019.pa4808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Verbanck S, King GG, Paiva M, Schuermans D, Vanderhelst E. The Functional Correlate of the Loss of Terminal Bronchioles in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2019; 197:1633-1635. [PMID: 29447463 DOI: 10.1164/rccm.201712-2366le] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
| | | | - Manuel Paiva
- 3 Université Libre de Bruxelles Brussels, Belgium
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25
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Verbanck S, Schuermans D, Thompson B, Vanderhelst E. Aligning Lung Function Equipment and Reference Values in Adults. Respiration 2019; 98:246-252. [DOI: 10.1159/000501283] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 06/03/2019] [Indexed: 11/19/2022] Open
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Vekens K, Verbanck S, Collen C, Storme G, Barbé K, De Ridder M, Vanderhelst E. Pulmonary function changes following helical tomotherapy in patients with inoperable, locally advanced non-small cell lung cancer. Strahlenther Onkol 2019; 196:142-150. [PMID: 31300831 DOI: 10.1007/s00066-019-01489-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 06/22/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate alterations in pulmonary function indices after helical tomotherapy and explore potential associations with biologically corrected dosimetric parameters. PATIENTS AND METHODS In 64 patients with inoperable locally advanced non-small cell lung cancer, pulmonary function tests before and within 6 months after radiotherapy were evaluated retrospectively. In the case of concurrent chemotherapy a total dose of 67.2 Gy was delivered, otherwise 70.5 Gy was provided. In 44 patients, late pulmonary function changes (≥6 months after radiotherapy) could also be assessed. RESULTS In the entire patient group, there were significant declines in forced expiratory volume in 1s (FEV1) (average change -4.1% predicted; P = 0.007), in forced vital capacity (FVC) (-4.9% predicted; P = 0.002), total lung capacity (TLC) (-5.8% predicted; P = 0.0016) and DLCO (diffusing capacity of the lung for carbon monoxide corrected for hemoglobin level) (-8.6% predicted; P < 0.001) during the first 6 months. Corresponding FEV1, FVC, TLC and DLCO declines in the subgroup with late measurements (after 11.3 months on average) were -5.7, -7.4, -7.0, -9.8% predicted. A multivariate analysis including V5 Gy, V10 Gy, V20 Gy, V40 Gy, V60 Gy, mean lung dose (MLD), gross tumor volume (GTV) and planning target volume (PTV) as potential covariates showed that GTV was the most consistent contributor, being significant for ∆FEV1 (P = 0.003), ∆FVC (P = 0.003), ∆TLC (P = 0.001) and ∆DLCO (P = 0.01). V5 Gy or V10 Gy did not contribute to any of the lung function changes. CONCLUSIONS The decline in pulmonary function indices after helical tomotherapy was of similar magnitude to that observed in studies reporting the effect of conformal radiotherapy on lung function. Diffusion capacity was the parameter showing the largest decrease following radiation therapy as compared to baseline and correlated with gross tumor volume. None of the alterations in pulmonary function tests were associated with the lung volume receiving low-dose radiation.
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Affiliation(s)
- K Vekens
- Respiratory Division, University Hospital UZ Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - S Verbanck
- Respiratory Division, University Hospital UZ Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - C Collen
- Department of Radiotherapy, University Hospital UZ Brussel, Brussels, Belgium
| | - G Storme
- Department of Radiotherapy, University Hospital UZ Brussel, Brussels, Belgium
| | - K Barbé
- Department of Biostatistics and Medical Informatics, Vrije Universiteit Brussel, Brussels, Belgium
| | - M De Ridder
- Department of Radiotherapy, University Hospital UZ Brussel, Brussels, Belgium
| | - E Vanderhelst
- Respiratory Division, University Hospital UZ Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
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Verbanck S, Vanderhelst E. The Respective Roles of Lung Clearance Index and Magnetic Resonance Imaging in the Clinical Management of Patients with Cystic Fibrosis. Am J Respir Crit Care Med 2019; 197:409. [PMID: 28800245 DOI: 10.1164/rccm.201706-1137le] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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28
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Vincken S, Verbanck S, De Wachter E, Vanderhelst E. Exhaled nitric oxide in stable adult cystic fibrosis patients, during exacerbation and following CFTR-modifying treatment. Eur Respir J 2019; 53:13993003.02259-2018. [DOI: 10.1183/13993003.02259-2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/20/2019] [Indexed: 11/05/2022]
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29
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Verbanck S, Paiva M. A simulation study of diffusion-convection interaction and its effect on multiple breath washout indices. Respir Physiol Neurobiol 2018; 258:5-11. [DOI: 10.1016/j.resp.2018.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/11/2018] [Accepted: 09/25/2018] [Indexed: 11/17/2022]
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30
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Stylemans D, Verbanck S, Vincken S, Vincken W, Vanderhelst E. P268 Pulmonary function patterns and their association with genotype and phenotype in adult cystic fibrosis patients. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30563-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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31
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Lizal F, Jedelsky J, Morgan K, Bauer K, Llop J, Cossio U, Kassinos S, Verbanck S, Ruiz-Cabello J, Santos A, Koch E, Schnabel C. Experimental methods for flow and aerosol measurements in human airways and their replicas. Eur J Pharm Sci 2018; 113:95-131. [DOI: 10.1016/j.ejps.2017.08.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/14/2017] [Accepted: 08/17/2017] [Indexed: 12/29/2022]
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Lalas A, Nousias S, Kikidis D, Lalos A, Arvanitis G, Sougles C, Moustakas K, Votis K, Verbanck S, Usmani O, Tzovaras D. Substance deposition assessment in obstructed pulmonary system through numerical characterization of airflow and inhaled particles attributes. BMC Med Inform Decis Mak 2017; 17:173. [PMID: 29297393 PMCID: PMC5751792 DOI: 10.1186/s12911-017-0561-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) and asthma are considered as the two most widespread obstructive lung diseases, whereas they affect more than 500 million people worldwide. Unfortunately, the requirement for detailed geometric models of the lungs in combination with the increased computational resources needed for the simulation of the breathing did not allow great progress to be made in the past for the better understanding of inflammatory diseases of the airways through detailed modelling approaches. In this context, computational fluid dynamics (CFD) simulations accompanied by fluid particle tracing (FPT) analysis of the inhaled ambient particles are deemed critical for lung function assessment. Also they enable the understanding of particle depositions on the airways of patients, since these accumulations may affect or lead to inflammations. In this direction, the current study conducts an initial investigation for the better comprehension of particle deposition within the lungs. More specifically, accurate models of the airways obstructions that relate to pulmonary disease are developed and a thorough assessment of the airflow behavior together with identification of the effects of inhaled particle properties, such as size and density, is conducted. Our approach presents a first step towards an effective personalization of pulmonary treatment in regards to the geometric characteristics of the lungs and the in depth understanding of airflows within the airways. METHODS A geometry processing technique involving contraction algorithms is established and used to employ the different respiratory arrangements associated with lung related diseases that exhibit airways obstructions. Apart from the normal lung case, two categories of obstructed cases are examined, i.e. models with obstructions in both lungs and models with narrowings in the right lung only. Precise assumptions regarding airflow and deposition fraction (DF) over various sections of the lungs are drawn by simulating these distinct incidents through the finite volume method (FVM) and particularly the CFD and FPT algorithms. Moreover, a detailed parametric analysis clarifies the effects of the particles size and density in terms of regional deposition upon several parts of the pulmonary system. In this manner, the deposition pattern of various substances can be assessed. RESULTS For the specific case of the unobstructed lung model most particles are detected on the right lung (48.56% of total, when the air flowrate is 12.6 L/min), a fact that is also true when obstructions arise symmetrically in both lungs (51.45% of total, when the air flowrate is 6.06 L/min and obstructions occur after the second generation). In contrast, when narrowings are developed on the right lung only, most particles are pushed on the left section (68.22% of total, when the air flowrate is 11.2 L/min) indicating that inhaled medication is generally deposited away from the areas of inflammation. This observation is useful when designing medical treatment of lung diseases. Furthermore, particles with diameters from 1 μm to 10 μm are shown to be mainly deposited on the lower airways, whereas particles with diameters of 20 μm and 30 μm are mostly accumulated in the upper airways. As a result, the current analysis indicates increased DF levels in the upper airways when the particle diameter is enlarged. Additionally, when the particles density increases from 1000 Kg/m3 to 2000 Kg/m3, the DF is enhanced on every generation and for all cases investigated herein. The results obtained by our simulations provide an accurate and quantitative estimation of all important parameters involved in lung modeling. CONCLUSIONS The treatment of respiratory diseases with inhaled medical substances can be advanced by the clinical use of accurate CFD and FPT simulations and specifically by evaluating the deposition of inhaled particles in a regional oriented perspective in regards to different particle sizes and particle densities. Since a drug with specific characteristics (i.e. particle size and density) exhibits maximum deposition on particular lung areas, the current study provides initial indications to a qualified physician for proper selection of medication.
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Affiliation(s)
- Antonios Lalas
- Information Technologies Institute, Centre for Research and Technology - Hellas (CERTH), Thessaloniki, Greece.
| | - Stavros Nousias
- Department of Electrical and Computer Engineering, University of Patras, Patra, Greece
| | - Dimitrios Kikidis
- Information Technologies Institute, Centre for Research and Technology - Hellas (CERTH), Thessaloniki, Greece
| | - Aris Lalos
- Department of Electrical and Computer Engineering, University of Patras, Patra, Greece
| | - Gerasimos Arvanitis
- Department of Electrical and Computer Engineering, University of Patras, Patra, Greece
| | - Christos Sougles
- Information Technologies Institute, Centre for Research and Technology - Hellas (CERTH), Thessaloniki, Greece
| | | | - Konstantinos Votis
- Information Technologies Institute, Centre for Research and Technology - Hellas (CERTH), Thessaloniki, Greece
| | - Sylvia Verbanck
- Respiratory Division, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Omar Usmani
- National Heart and Lung Institute (NHLI), Imperial College London and Royal Brompton Hospital, London, UK
| | - Dimitrios Tzovaras
- Information Technologies Institute, Centre for Research and Technology - Hellas (CERTH), Thessaloniki, Greece
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Verbanck S, King GG, Zhou W, Miller A, Thamrin C, Schuermans D, Ilsen B, Ernst CW, de Mey J, Vincken W, Vanderhelst E. The quantitative link of lung clearance index to bronchial segments affected by bronchiectasis. Thorax 2017; 73:82-84. [PMID: 28866642 DOI: 10.1136/thoraxjnl-2017-210496] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/14/2017] [Accepted: 08/14/2017] [Indexed: 01/29/2023]
Abstract
In adult patients with cystic fibrosis (CF), the lung clearance index (LCI) derived from the multiple breath washout relates to both acinar and conductive ventilation heterogeneity. The latter component predicts an association between LCI and the number of bronchial segments affected by bronchiectasis. Here, we experimentally demonstrated this association in patients with CF, and also examined an ancillary group of patients with non-CF bronchiectasis. We conclude that lung disease severity in terms of number of bronchial segments results in an associated LCI increase, likely constituting a portion of LCI that cannot be reversed by treatment in patients with CF lung disease.
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Affiliation(s)
- Sylvia Verbanck
- Respiratory Division, University Hospital UZBrussel, Vrije Universiteit Brussel, Brussel, Belgium
| | - Gregory G King
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Wenxiao Zhou
- Department of Radiology and Nuclear Medicine, North Shore Hospital, Sydney, New South Wales, Australia
| | - Anne Miller
- Department of Radiology and Nuclear Medicine, North Shore Hospital, Sydney, New South Wales, Australia
| | - Cindy Thamrin
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Daniel Schuermans
- Respiratory Division, University Hospital UZBrussel, Vrije Universiteit Brussel, Brussel, Belgium
| | - Bart Ilsen
- Department of Radiology, University Hospital UZBrussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Caroline W Ernst
- Department of Radiology, University Hospital UZBrussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Johan de Mey
- Department of Radiology, University Hospital UZBrussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Walter Vincken
- Respiratory Division, University Hospital UZBrussel, Vrije Universiteit Brussel, Brussel, Belgium
| | - Eef Vanderhelst
- Respiratory Division, University Hospital UZBrussel, Vrije Universiteit Brussel, Brussel, Belgium
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Verbanck S, Ghorbaniasl G, Biddiscombe MF, Dragojlovic D, Ricks N, Lacor C, Ilsen B, de Mey J, Schuermans D, Underwood SR, Barnes PJ, Vincken W, Usmani OS. Inhaled Aerosol Distribution in Human Airways: A Scintigraphy-Guided Study in a 3D Printed Model. J Aerosol Med Pulm Drug Deliv 2016; 29:525-533. [DOI: 10.1089/jamp.2016.1291] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sylvia Verbanck
- Respiratory Division, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ghader Ghorbaniasl
- Research Group Fluid Mechanics and Thermodynamics, Department of Mechanical Engineering, Vrije Universiteit Brussel, Brussels, Belgium
| | - Martyn F. Biddiscombe
- Airway Disease Section, National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, United Kingdom
- Nuclear Medicine Department, Royal Brompton Hospital, London, United Kingdom
| | - Dusica Dragojlovic
- Research Group Fluid Mechanics and Thermodynamics, Department of Mechanical Engineering, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nathan Ricks
- Research Group Fluid Mechanics and Thermodynamics, Department of Mechanical Engineering, Vrije Universiteit Brussel, Brussels, Belgium
| | - Chris Lacor
- Research Group Fluid Mechanics and Thermodynamics, Department of Mechanical Engineering, Vrije Universiteit Brussel, Brussels, Belgium
| | - Bart Ilsen
- Radiology Department, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Johan de Mey
- Radiology Department, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Daniel Schuermans
- Respiratory Division, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Peter J. Barnes
- Airway Disease Section, National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, United Kingdom
| | - Walter Vincken
- Respiratory Division, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Omar S. Usmani
- Airway Disease Section, National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, United Kingdom
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Verbanck S, Paiva M. Last Word on Viewpoint: Could lobar flow sequencing account for convection-dependent ventilation heterogeneity in normal man? J Appl Physiol (1985) 2016; 121:593. [PMID: 27543660 DOI: 10.1152/japplphysiol.00513.2016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Sylvia Verbanck
- Respiratory Division, University Hospital UZ Brussel, Brussels, Belgium; and
| | - Manuel Paiva
- Respiratory Division, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Verbanck S, Paiva M. Could lobar flow sequencing account for convection-dependent ventilation heterogeneity in normal humans? J Appl Physiol (1985) 2016; 121:589-91. [DOI: 10.1152/japplphysiol.01049.2015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Sylvia Verbanck
- Respiratory Division, University Hospital UZ Brussel, Brussels, Belgium; and
| | - Manuel Paiva
- Respiratory Division, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Verbanck S, Hanon S, Schuermans D, Van Parijs H, Vinh-Hung V, Miedema G, Verellen D, Storme G, Fontaine C, Lamote J, De Ridder M, Vincken W. Mild Lung Restriction in Breast Cancer Patients After Hypofractionated and Conventional Radiation Therapy: A 3-Year Follow-Up. Int J Radiat Oncol Biol Phys 2016; 95:937-945. [PMID: 27302510 DOI: 10.1016/j.ijrobp.2016.02.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 01/15/2016] [Accepted: 02/01/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE To assess the effect of radiation therapy on lung function over the course of 3 years. METHODS AND MATERIALS Evolution of restrictive and obstructive lung function parameters was investigated in 108 breast cancer participants in a randomized, controlled trial comparing conventional radiation therapy (CR) and hypofractionated tomotherapy (TT) (age at inclusion ranging 32-81 years). Spirometry, plethysmography, and hemoglobin-corrected diffusing capacity were assessed at baseline and after 3 months and 1, 2, and 3 years. Natural aging was accounted for by considering all lung function parameters in terms of percent predicted values using the most recent reference values for women aged up to 80 years. RESULTS In the patients with negligible history of respiratory disease or smoking (n=77), the greatest rate of functional decline was observed during the initial 3 months, this acute decrease being more marked in the CR versus the TT arm. During the remainder of the 3-year follow-up period, values (in terms of percent predicted) were maintained (diffusing capacity) or continued to decline at a slower rate (forced vital capacity). However, the average decline of the restrictive lung function parameters over a 3-year period did not exceed 9% predicted in either the TT or the CR arm. Obstructive lung function parameters remained unaffected throughout. Including also the 31 patients with a history of respiratory disease or more than 10 pack-years showed a very similar restrictive pattern. CONCLUSIONS In women with breast cancer, both conventional radiation therapy and hypofractionated tomotherapy induce small but consistent restrictive lung patterns over the course of a 3-year period, irrespective of baseline respiratory status or smoking history. The fastest rate of lung function decline generally occurred in the first 3 months.
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Affiliation(s)
- Sylvia Verbanck
- Respiratory Division, University Hospital UZ Brussel, Brussels, Belgium.
| | - Shane Hanon
- Respiratory Division, University Hospital UZ Brussel, Brussels, Belgium
| | - Daniel Schuermans
- Respiratory Division, University Hospital UZ Brussel, Brussels, Belgium
| | - Hilde Van Parijs
- Department of Radiotherapy, University Hospital UZ Brussel, Brussels, Belgium
| | - Vincent Vinh-Hung
- Department of Radiotherapy, University Hospital UZ Brussel, Brussels, Belgium
| | - Geertje Miedema
- Department of Radiotherapy, University Hospital UZ Brussel, Brussels, Belgium
| | - Dirk Verellen
- Department of Radiotherapy, University Hospital UZ Brussel, Brussels, Belgium
| | - Guy Storme
- Department of Radiotherapy, University Hospital UZ Brussel, Brussels, Belgium
| | - Christel Fontaine
- Department of Senology and Oncologic Surgery, University Hospital UZ Brussel, Brussels, Belgium
| | - Jan Lamote
- Department of Senology and Oncologic Surgery, University Hospital UZ Brussel, Brussels, Belgium
| | - Mark De Ridder
- Department of Radiotherapy, University Hospital UZ Brussel, Brussels, Belgium
| | - Walter Vincken
- Respiratory Division, University Hospital UZ Brussel, Brussels, Belgium
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Verbanck S, Van Muylem A, Schuermans D, Bautmans I, Thompson B, Vincken W. Transfer factor, lung volumes, resistance and ventilation distribution in healthy adults. Eur Respir J 2015; 47:166-76. [PMID: 26585426 DOI: 10.1183/13993003.00695-2015] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 09/03/2015] [Indexed: 11/05/2022]
Abstract
Monitoring of chronic lung disease requires reference values of lung function indices, including putative markers of small airway function, spanning a wide age range.We measured spirometry, transfer factor of the lung for carbon monoxide (TLCO), static lung volume, resistance and ventilation distribution in a healthy population, studying at least 20 subjects per sex and per decade between the ages of 20 and 80 years.With respect to the Global Lung Function Initiative reference data, our subjects had average z-scores for forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC of -0.12, 0.04 and -0.32, respectively. Reference equations were obtained which could account for a potential dependence of index variability on age and height. This was done for (but not limited to) indices that are pertinent to asthma and chronic obstructive pulmonary disease studies: forced expired volume in 6 s, forced expiratory flow, TLCO, specific airway conductance, residual volume (RV)/total lung capacity (TLC), and ventilation heterogeneity in acinar and conductive lung zones.Deterioration in acinar ventilation heterogeneity and lung clearance index with age were more marked beyond 60 years, and conductive ventilation heterogeneity showed the greatest increase in variability with age. The most clinically relevant deviation from published reference values concerned RV/TLC values, which were considerably smaller than American Thoracic Society/European Respiratory Society-endorsed reference values.
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Affiliation(s)
- Sylvia Verbanck
- Respiratory Division, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Alain Van Muylem
- Respiratory Division, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Daniel Schuermans
- Respiratory Division, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ivan Bautmans
- Geriatrics Dept, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Bruce Thompson
- Allergy, Immunology and Respiratory Medicine, The Alfred Hospital and Monash University, Melbourne, Australia
| | - Walter Vincken
- Respiratory Division, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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Verbanck S, Paiva M. Dual gas techniques for peripheral airway function: diffusing the issues. Eur Respir J 2015; 45:1491-4. [DOI: 10.1183/09031936.00207514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 12/24/2014] [Indexed: 11/05/2022]
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Vanderhelst E, De Meirleir L, Schuermans D, Malfroot A, Vincken W, Verbanck S. The Lung Clearance Index as a probe for the effectiveness of short-term therapies in cystic fibrosis lung disease. J Cyst Fibros 2015; 14:285-6. [DOI: 10.1016/j.jcf.2014.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 08/04/2014] [Accepted: 08/04/2014] [Indexed: 11/17/2022]
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41
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Vanderhelst E, Wachter ED, Willekens J, Schuermans D, Vincken W, Malfroot A, Verbanck S. Increase in ventilated air spaces after eradication of chronic methicillin-resistant Staphylococcus aureus infection in cystic fibrosis patients. Acta Clin Belg 2015; 70:30-3. [PMID: 25253536 DOI: 10.1179/2295333714y.0000000079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Effective microbiogical eradication of methicillin-resistant Staphylococcus aureus (MRSA) in patients with cystic fibrosis (CF) can be obtained, but its effect is not always clear-cut in terms of spirometric indices. The aim of this observational prospective cohort study was to study the potential effect of eradication of chronic MRSA infection on lung function including ventilation distribution. Six CF patients, chronically colonized with MRSA (median age: 21 years (range 14-46); median FEV1: 76 (95%CI 58-98)%pred) were successfully eradicated using oral rifampicin and fusidic acid in combination with topical decolonization measures. Lung function and multiple breath washout test were performed at the start and at the end of the eradication protocol and after an average follow-up period of 7·5±1·5(SD) months. One patient cultured MRSA again 4 months after successful eradication. All patients reported reduced sputum production and viscosity. By the end of the follow-up period, there was an increase in ventilated FRCMBW and no change in plethysmographic FRCPL. This resulted in a significant decrease of trapped air by half a litre (from 579 to 40 ml; P = 0·013). Lung clearance index (LCI) also showed a small but significant decrease (from 7·2 to 6·7; P = 0·014) after eradication of MRSA. We conclude that MRSA eradication can be successful, also in terms of recruitment of previously unventilated air spaces, potentially due to reduced sputum production and/or viscosity.
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Affiliation(s)
- E. Vanderhelst
- Respiratory DivisionUniversity Hospital UZ Brussel, Brussels, Belgium
- Cystic Fibrosis CenterUniversity Hospital UZ Brussel, Brussels, Belgium
| | - E. De Wachter
- Cystic Fibrosis CenterUniversity Hospital UZ Brussel, Brussels, Belgium
| | - J. Willekens
- Cystic Fibrosis CenterUniversity Hospital UZ Brussel, Brussels, Belgium
| | - D. Schuermans
- Respiratory DivisionUniversity Hospital UZ Brussel, Brussels, Belgium
| | - W. Vincken
- Respiratory DivisionUniversity Hospital UZ Brussel, Brussels, Belgium
| | - A. Malfroot
- Cystic Fibrosis CenterUniversity Hospital UZ Brussel, Brussels, Belgium
| | - S. Verbanck
- Respiratory DivisionUniversity Hospital UZ Brussel, Brussels, Belgium
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Vanderhelst E, De Meirleir L, Schuermans D, Malfroot A, Vincken W, Verbanck S. Evidence of an Acinar Response following Treatment for Exacerbation in Adult Patients with Cystic Fibrosis. Respiration 2014; 87:492-8. [DOI: 10.1159/000360772] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 02/17/2014] [Indexed: 11/19/2022] Open
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Affiliation(s)
- Sylvia Verbanck
- Respiratory Division, University Hospital UZ Brussel, Brussels, Belgium; and
| | - Manuel Paiva
- Respiratory Division, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Thompson BR, Hodgson YM, Kotsimbos T, Liakakos P, Ellis MJ, Snell GI, Verbanck S. Bronchiolitis obliterans syndrome leads to a functional deterioration of the acinus post lung transplant. Thorax 2013; 69:487-8. [PMID: 24212890 DOI: 10.1136/thoraxjnl-2013-204671] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Bronchiolitis obliterans syndrome (BOS) limits long-term survival of lung transplant recipients, and airflow obstruction in these patients likely originates in the small airways. 61 double lung transplant recipients performed multiple breath nitrogen washouts to obtain indices of acinar and conductive ventilation heterogeneity (Sacin, Scond). There was a significant association of BOS status with Sacin (Kruskal-Wallis; p<0.001) but not with Scond (p=0.1). These results demonstrate that it is the structural alteration of the terminal bronchioles, generating ventilation heterogeneity at the level of the diffusion front, and not the bronchioles located more proximally, that is driving the airflow obstruction that determines BOS status.
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Affiliation(s)
- Bruce R Thompson
- Allergy, Immunology, and Respiratory Medicine, Alfred Hospital, , Melbourne, Australia
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45
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Gelb AF, Singh DH, Moridzadeh R, Fraser C, Tran D, Verbanck S, George SC. Age-stratified comparison of large and peripheral airway/alveolar nitric oxide levels in children and young adults. J Allergy Clin Immunol 2013; 132:1222-4. [PMID: 23932460 DOI: 10.1016/j.jaci.2013.05.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 05/28/2013] [Accepted: 05/31/2013] [Indexed: 11/18/2022]
Affiliation(s)
- Arthur F Gelb
- Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, Lakewood, Calif, and Geffen School of Medicine at University of California, Los Angeles Medical Center (AFG), Los Angeles, Calif.
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46
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Verbanck S, Paiva M, Paeps E, Schuermans D, Malfroot A, Vincken W, Vanderhelst E. Lung clearance index in adult cystic fibrosis patients: the role of convection-dependent lung units. Eur Respir J 2013; 42:380-8. [DOI: 10.1183/09031936.00125312] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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47
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Vanderhelst E, Schuermans D, Malfroot A, Vincken W, Verbanck S. WS13.6 Evidence of short-term acinar response following intravenous antibiotics therapy in adults with cystic fibrosis. J Cyst Fibros 2013. [DOI: 10.1016/s1569-1993(13)60082-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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48
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Thompson BR, Douglass JA, Ellis MJ, Kelly VJ, O'Hehir RE, King GG, Verbanck S. Peripheral lung function in patients with stable and unstable asthma. J Allergy Clin Immunol 2013; 131:1322-8. [PMID: 23561802 DOI: 10.1016/j.jaci.2013.01.054] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 01/22/2013] [Accepted: 01/24/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Exacerbations of asthma are thought to be caused by airflow obstruction resulting from airway inflammation, bronchospasm, and mucus plugging. Histologic evidence suggests the small airways, including acinar air spaces, are involved; however, this has not been corroborated in vivo by measurements of peripheral small-airway function. OBJECTIVE We sought to determine whether asthma severity is linked to small-airway function, particularly in patients with acute severe asthma. METHODS Eighteen subjects admitted for an asthma exacerbation underwent lung function testing, including measures of acinar ventilation heterogeneity (S(acin)) and conductive ventilation heterogeneity (S(cond)) using the multiple-breath nitrogen washout. Treatment requirement was defined according to Global Initiative for Asthma scores. Data were compared with those obtained in 19 patients with stable asthma. RESULTS For the asthma exacerbation group, the median FEV1 was 59% of predicted value (95% CI, 45% to 75% of predicted value), the median S(cond) value was 185% of predicted value (95% CI, 119% to 245% of predicted value), and the median S(acin) value was 225% of predicted value (95% CI, 143% to 392% of predicted value). FEV1 (percent predicted) was correlated with S(acin) (percent predicted) values (Spearman rho = -0.67, P = .006) but not with S(cond) (percent predicted) values (P > .1). The Global Initiative for Asthma score was significantly related to S(acin) (percent predicted) (Spearman rho = 0.59, P = .016) but not to S(cond) (percent predicted) values (P > .1). The unstable group was characterized by considerably lower forced vital capacity (P < .001) and higher S(cond) (P = .001) values than the unstable group. In a subgroup of 11 unstable patients who could be reviewed after 4 weeks, FEV1, forced vital capacity, S(acin), and S(cond) values showed marked improvements. CONCLUSION Our findings suggest that unstable asthma is characterized by a combined abnormality in the acinar and conductive lung zones, both of which are partly reversible. Functional abnormality in the acinar lung zone in particular showed a direct correlation with airflow obstruction and treatment requirement in patients with acute severe asthma.
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Affiliation(s)
- Bruce R Thompson
- Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital and Monash University, Melbourne, Australia.
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Downie SR, Salome CM, Verbanck S, Thompson BR, Berend N, King GG. Effect of methacholine on peripheral lung mechanics and ventilation heterogeneity in asthma. J Appl Physiol (1985) 2013; 114:770-7. [DOI: 10.1152/japplphysiol.01198.2012] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The forced oscillation technique (FOT) and multiple-breath nitrogen washout (MBNW) are noninvasive tests that are potentially sensitive to peripheral airways, with MBNW indexes being especially sensitive to heterogeneous changes in ventilation. The objective was to study methacholine-induced changes in the lung periphery of asthmatic patients and determine how changes in FOT variables of respiratory system reactance (Xrs) and resistance (Rrs) and frequency dependence of resistance (Rrs5-Rrs19) can be linked to changes in ventilation heterogeneity. The contributions of air trapping and airway closure, as extreme forms of heterogeneity, were also investigated. Xrs5, Rrs5, Rrs19, Rrs5-Rrs19, and inspiratory capacity (IC) were calculated from the FOT. Ventilation heterogeneity in acinar and conducting airways, and trapped gas (percent volume of trapped gas at functional residual capacity/vital capacity), were calculated from the MBNW. Measurements were repeated following methacholine. Methacholine-induced airway closure (percent change in forced vital capacity) and hyperinflation (change in IC) were also recorded. In 40 mild to moderate asthmatic patients, increase in Xrs5 after methacholine was predicted by increases in ventilation heterogeneity in acinar airways and forced vital capacity ( r2 = 0.37, P < 0.001), but had no correlation with ventilation heterogeneity in conducting airway increase or IC decrease. Increases in Rrs5 and Rrs5-Rrs19 after methacholine were not correlated with increases in ventilation heterogeneity, trapped gas, hyperinflation, or airway closure. Increased reactance in asthmatic patients after methacholine was indicative of heterogeneous changes in the lung periphery and airway closure. By contrast, increases in resistance and frequency dependence of resistance were not related to ventilation heterogeneity or airway closure and were more indicative of changes in central airway caliber than of heterogeneity.
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Affiliation(s)
- Sue R. Downie
- Woolcock Institute of Medical Research, Glebe, Sydney, New South Wales, Australia
- Department of Medicine, University of Sydney, New South Wales, Australia
- Cooperative Research Centre for Asthma, Glebe, Sydney, New South Wales, Australia
| | - Cheryl M. Salome
- Woolcock Institute of Medical Research, Glebe, Sydney, New South Wales, Australia
- Department of Medicine, University of Sydney, New South Wales, Australia
- Cooperative Research Centre for Asthma, Glebe, Sydney, New South Wales, Australia
| | - Sylvia Verbanck
- Respiratory Division, Academic Hospital, Vrije Universiteit Brussels, Brussels, Belgium
| | - Bruce R. Thompson
- Cooperative Research Centre for Asthma, Glebe, Sydney, New South Wales, Australia
- Department of Allergy, Immunology, and Respiratory Medicine, The Alfred Hospital and Monash University, Melbourne, Victoria, Australia; and
| | - Norbert Berend
- Woolcock Institute of Medical Research, Glebe, Sydney, New South Wales, Australia
- Department of Medicine, University of Sydney, New South Wales, Australia
- Cooperative Research Centre for Asthma, Glebe, Sydney, New South Wales, Australia
- Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Gregory G. King
- Woolcock Institute of Medical Research, Glebe, Sydney, New South Wales, Australia
- Department of Medicine, University of Sydney, New South Wales, Australia
- Cooperative Research Centre for Asthma, Glebe, Sydney, New South Wales, Australia
- Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
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50
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Robinson PD, Latzin P, Verbanck S, Hall GL, Horsley A, Gappa M, Thamrin C, Arets HGM, Aurora P, Fuchs SI, King GG, Lum S, Macleod K, Paiva M, Pillow JJ, Ranganathan S, Ranganathan S, Ratjen F, Singer F, Sonnappa S, Stocks J, Subbarao P, Thompson BR, Gustafsson PM. Consensus statement for inert gas washout measurement using multiple- and single- breath tests. Eur Respir J 2013; 41:507-22. [PMID: 23397305 DOI: 10.1183/09031936.00069712] [Citation(s) in RCA: 538] [Impact Index Per Article: 48.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Inert gas washout tests, performed using the single- or multiple-breath washout technique, were first described over 60 years ago. As measures of ventilation distribution inhomogeneity, they offer complementary information to standard lung function tests, such as spirometry, as well as improved feasibility across wider age ranges and improved sensitivity in the detection of early lung damage. These benefits have led to a resurgence of interest in these techniques from manufacturers, clinicians and researchers, yet detailed guidelines for washout equipment specifications, test performance and analysis are lacking. This manuscript provides recommendations about these aspects, applicable to both the paediatric and adult testing environment, whilst outlining the important principles that are essential for the reader to understand. These recommendations are evidence based, where possible, but in many places represent expert opinion from a working group with a large collective experience in the techniques discussed. Finally, the important issues that remain unanswered are highlighted. By addressing these important issues and directing future research, the hope is to facilitate the incorporation of these promising tests into routine clinical practice.
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Affiliation(s)
- Paul D Robinson
- Dept of Respiratory Medicine, The Children’s Hospital at Westmead, Westmead, Sydney, Australia.
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