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Siebeneichler AS, Schumann DM, Karakioulaki M, Brachsler N, Darie AM, Grize L, Heck TG, Tamm M, Latzin P, Stolz D. Single and multiple breath nitrogen washout compared with the methacholine test in patients with suspected asthma and normal spirometry. BMJ Open Respir Res 2024; 11:e001919. [PMID: 38697675 PMCID: PMC11086282 DOI: 10.1136/bmjresp-2023-001919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 04/05/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Methods used to assess ventilation heterogeneity through inert gas washout have been standardised and showed high sensitivity in diagnosing many respiratory diseases. We hypothesised that nitrogen single or multiple breath washout tests, respectively nitrogen single breath washout (N2SBW) and nitrogen multiple breath washout (N2MBW), may be pathological in patients with clinical suspicion of asthma but normal spirometry. Our aim was to assess whether N2SBW and N2MBW are associated with methacholine challenge test (MCT) results in this population. We also postulated that an alteration in SIII at N2SBW could be detected before the 20% fall of forced expiratory volume in the first second (FEV1) in MCT. STUDY DESIGN AND METHODS This prospective, observational, single-centre study included patients with suspicion of asthma with normal spirometry. Patients completed questionnaires on symptoms and health-related quality-of-life and underwent the following lung function tests: N2SBW (SIII), N2MBW (Lung clearance index (LCI), Scond, Sacin), MCT (FEV1 and sGeff) as well as N2SBW between each methacholine dose. RESULTS 182 patients were screened and 106 were included in the study, with mean age of 41.8±14 years. The majority were never-smokers (58%) and women (61%). MCT was abnormal in 48% of participants, N2SBW was pathological in 10.6% at baseline and N2MBW abnormality ranged widely (LCI 81%, Scond 18%, Sacin 43%). The dose response rate of the MCT showed weak to moderate correlation with the subsequent N2SBW measurements during the provocation phases (ρ 0.34-0.50) but no correlation with N2MBW. CONCLUSIONS Both MCT and N2 washout tests are frequently pathological in patients with suspicion of asthma with normal spirometry. The weak association and lack of concordance across the tests highlight that they reflect different but not interchangeable pathological pathways of the disease.
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Affiliation(s)
| | | | | | - Nora Brachsler
- Clinic of Pneumology, University Hospital Basel, Basel, Switzerland
| | - Andrei M Darie
- Clinic of Pneumology, University Hospital Basel, Basel, Switzerland
| | - Leticia Grize
- Clinic of Pneumology, University Hospital Basel, Basel, Switzerland
| | | | - Michael Tamm
- Clinic of Pneumology, University Hospital Basel, Basel, Switzerland
| | - Philipp Latzin
- Inselspital, Kinderklinik, University of Bern, Bern, Switzerland
| | - Daiana Stolz
- Clinic of Pneumology, University Hospital Basel, Basel, Switzerland
- Clinic of Pneumology, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Bessa EJC, Ribeiro FDMC, Rodrigues RS, Henrique da Costa C, Rufino R, Pinheiro GDRC, Lopes AJ. Association between clinical, serological, functional and radiological findings and ventilatory distribution heterogeneity in patients with rheumatoid arthritis. PLoS One 2023; 18:e0291659. [PMID: 37862308 PMCID: PMC10588833 DOI: 10.1371/journal.pone.0291659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/02/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND In rheumatoid arthritis (RA), the involvement of the pulmonary interstitium can lead to structural changes in the small airways and alveoli, leading to reduced airflow and maldistribution of ventilation. The single-breath nitrogen washout (SBN2W) test is a measure of the ventilatory distribution heterogeneity and evaluates the small airways. This study aimed to find out which clinical, serological, functional and radiological findings are useful to identify RA patients with pathological values of the phase III slope (SIII) measured by the SBN2W test. METHODS This was a cross-sectional study in which RA patients were assessed using the Health Assessment Questionnaire-Disability Index (HAQ-DI) and the Clinical Disease Activity Index (CDAI) and underwent serological analysis of autoantibodies and inflammatory markers. In addition, they underwent pulmonary function tests (including the SBN2W test) and chest computed tomography (CT). RESULTS Of the 60 RA patients evaluated, 39 (65%) had an SIII >120% of the predicted value. There were significant correlations between SIII and age (r = 0.56, p<0.0001), HAQ-DI (r = 0.34, p = 0.008), forced vital capacity (FVC, r = -0.67, p<0.0001), total lung capacity (r = -0.46, p = 0.0002), residual volume/total lung capacity (TLC) (r = 0.44, p = 0.0004), and diffusing capacity of the lungs for carbon monoxide (r = -0.45, p = 0.0003). On CT scans, the subgroup with moderate/severe disease had a significantly higher SIII than the normal/minimal/mild subgroup (662 (267-970) vs. 152 (88-283)% predicted, p = 0.0004). In the final multiple regression model, FVC, extent of moderate/severe involvement and age were associated with SIII, explaining 59% of its variability. CONCLUSIONS In patients with RA, FVC, extent of lung involvement and age, all of which are easily obtained variables in clinical practice, identify poorly distributed ventilation. In addition, the presence of respiratory symptoms and deteriorated physical function are closely related to the distribution of ventilation in these patients.
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Affiliation(s)
- Elizabeth Jauhar Cardoso Bessa
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Rosana Souza Rodrigues
- D’Or Institute for Research and Education, Rio de Janeiro, Brazil
- Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cláudia Henrique da Costa
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rogério Rufino
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Agnaldo José Lopes
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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Wei T, Chen C, Yang Y, Li L, Wang J, Ye M, Kan H, Yang D, Song Y, Cai J, Hou D. Associations between short-term exposure to ambient air pollution and lung function in adults. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2023:10.1038/s41370-023-00550-0. [PMID: 37179406 DOI: 10.1038/s41370-023-00550-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/06/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Evidence of the acute effects of high-level air pollution on small airway function and systemic inflammation in adults is scarce. OBJECTIVE To examined the associations of short-term (i.e., daily) exposure to multiple air pollutants with lung function and inflammatory markers. METHODS We assessed short-term (daily) effects of air pollutants, including particulate matter with aerodynamic diameter less than 2.5 μm (PM2.5) and 10 μm (PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2) and carbon monoxide (CO), on lung function and peripheral immune cell counts over various lag times using generalized linear regression models. RESULTS A total of 4764 adults were included from the general community-dwelling population in Shanghai, China. Exposure to air pollutants and lung function were negatively correlated. Decline in FEF between 25% and 75% of vital capacity (FEF25-75%) were found associated with PM2.5, SO2, and CO, and decline in forced expiratory volume in 3 s (FEV3) to forced vital capacity (FVC) ratio were associated with all examined pollutants, indicating obstruction in small airways. Obstructed airflow in large and middle airways as indicated by decline in FEV1/FVC were also associated with all pollutants. In subgroup analysis, significant negative associations between the five pollutants and SAD parameters were found only in males but not in females. The difference in the associations of SO2 with FEF75% between males and females achieved statistical significance. Additionally, all examined pollutants were significantly associated with lower peripheral neutrophil count. IMPACT STATEMENT Acute exposure to air pollutants were associated with airflow-limitation. Both small airways and proximal airways were affected. Acute exposure to air pollutants were accompanied with a lower neutrophil count.
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Affiliation(s)
- Tingting Wei
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Cuicui Chen
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yanjie Yang
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Li Li
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jian Wang
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Maosong Ye
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Dong Yang
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yuanlin Song
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- National and Shanghai Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Jing Cai
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China.
- Shanghai Typhoon Institute/CMA, Shanghai Key Laboratory of Meteorology and Health, Shanghai, China.
| | - Dongni Hou
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
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Pistelli F, Sherrill DL, Di Pede F, Baldacci S, Simoni M, Maio S, Carrozzi L, Viegi G. Single breath nitrogen test as predictor of lung function decline and COPD over an 8-year follow-up. Pulmonology 2022:S2531-0437(22)00212-4. [PMID: 36216737 DOI: 10.1016/j.pulmoe.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/07/2022] [Accepted: 09/07/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The single breath nitrogen (SBN2) test was proposed for early detection of "small airways disease" in the seventies. Few longitudinal studies have subsequently evaluated the relationships between SBN2 test measurements and lung function decline or COPD incidence. AIM This study evaluates whether SBN2 test abnormalities may be significant predictors of lung function decline and COPD incidence over an 8-year follow-up. STUDY DESIGN AND METHODS In this longitudinal study, 907 adults (20+ years old; 56% males) from the prospective Po River Delta epidemiological study underwent SBN2 test at baseline and spirometry testing at both baseline and follow-up 8-year apart. Multinomial and multiple regression models were used to assess associations of SBN2 indexes and rates of FEV1 decline or risk of COPD incidence over time, after adjusting for sex, height and baseline age, FEV1 and smoking status. COPD was defined according to either GOLD or ATS-ERS criteria. RESULTS Among SBN2 indexes, only the slope of alveolar plateau (N2-slope) was significantly associated with rates of FEV1 decline (7.93 mL/year for a one-unit change in N2-slope, p<0.0001), and with an increased risk of developing COPD as defined by GOLD (RR 1.81, 95%CI 1.29-2.52, mild; RR 2.78, 95%CI 1.70-4.53, moderate or severe obstruction) and ATS-ERS criteria (RR 1.62, 95%CI 1.14-2.29, mild; RR 3.40, 95%CI 1.72-6.73, moderate or severe obstruction). CONCLUSION In this population-based study, N2-slope from SBN2 test is a significant predictor of lung function decline and COPD incidence over an 8-year follow-up, confirming the role of the "small airways disease" in the natural history of COPD.
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Affiliation(s)
- F Pistelli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa; Via P. Savi, 10 56126 Pisa (Italy); Pulmonary Unit, Cardiothoracic and Vascular Department, Pisa University Hospital; Via Paradisa, 2 56124 Pisa (Italy).
| | - D L Sherrill
- Asthma and Airway Disease Research Center, University of Arizona; 1501 N. Campbell Avenue - 85724 Tucson, AZ (USA)
| | - F Di Pede
- Pulmonary Unit, Cardiothoracic and Vascular Department, Pisa University Hospital; Via Paradisa, 2 56124 Pisa (Italy); Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy, Via Trieste, 41 56126 Pisa (Italy)
| | - S Baldacci
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy, Via Trieste, 41 56126 Pisa (Italy)
| | - M Simoni
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy, Via Trieste, 41 56126 Pisa (Italy)
| | - S Maio
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy, Via Trieste, 41 56126 Pisa (Italy)
| | - L Carrozzi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa; Via P. Savi, 10 56126 Pisa (Italy); Pulmonary Unit, Cardiothoracic and Vascular Department, Pisa University Hospital; Via Paradisa, 2 56124 Pisa (Italy)
| | - G Viegi
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy, Via Trieste, 41 56126 Pisa (Italy)
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Alobaidi NY, Almeshari M, Stockley J, Stockley RA, Sapey E. Small airway function measured using forced expiratory flow between 25% and 75% of vital capacity and its relationship to airflow limitation in symptomatic ever-smokers: a cross-sectional study. BMJ Open Respir Res 2022; 9:9/1/e001385. [PMID: 36202407 PMCID: PMC9540854 DOI: 10.1136/bmjresp-2022-001385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/17/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is diagnosed and its severity graded by traditional spirometric parameters (forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) and FEV1, respectively) but these parameters are considered insensitive for identifying early pathology. Measures of small airway function, including forced expiratory flow between 25% and 75% of vital capacity (FEF25-75), may be more valuable in the earliest phases of COPD. This study aimed to determine the prevalence of low FEF25-75 in ever-smokers with and without airflow limitation (AL) and to determine whether FEF25-75 relates to AL severity. METHOD A retrospective analysis of lung function data of 1458 ever-smokers suspected clinically of having COPD. Low FEF25-75 was defined by z-score<-0.8345 and AL was defined by FEV1/FVC z-scores<-1.645. The severity of AL was evaluated using FEV1 z-scores. Participants were placed into three groups: normal FEF25-75/ no AL (normal FEF25-75/AL-); low FEF25-75/ no AL (low FEF25-75/AL-) and low FEF25-75/ AL (low FEF25-75/AL+). RESULTS Low FEF25-75 was present in 99.9% of patients with AL, and 50% of those without AL. Patients in the low FEF25-75/AL- group had lower spirometric measures (including FEV1 FEF25-75/FVC and FEV3/FVC) than those in the normal FEF25-75/AL- group. FEF25-75 decreased with AL severity. A logistic regression model demonstrated that in the absence of AL, the presence of low FEF25-75 was associated with lower FEV1 and FEV1/FVC even when smoking history was accounted for. CONCLUSIONS Low FEF25-75 is a physiological trait in patients with conventional spirometric AL and likely reflects early evidence of impairment in the small airways when spirometry is within the 'normal range'. FEF25-75 likely identifies a group of patients with early evidence of pathological lung damage who warrant careful monitoring and reinforced early intervention to abrogate further lung injury.
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Affiliation(s)
- Nowaf Y Alobaidi
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Respiratory Therapy Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Alahsa, Saudi Arabia
- King Abdullah International Medical Research Center, Alahsa, Saudi Arabia
| | - Mohammed Almeshari
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Rehabilitation Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - James Stockley
- Lung Function & Sleep Department, Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Robert Andrew Stockley
- Lung Function & Sleep Department, Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Elizabeth Sapey
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
- Acute Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Stolz D, Mkorombindo T, Schumann DM, Agusti A, Ash SY, Bafadhel M, Bai C, Chalmers JD, Criner GJ, Dharmage SC, Franssen FME, Frey U, Han M, Hansel NN, Hawkins NM, Kalhan R, Konigshoff M, Ko FW, Parekh TM, Powell P, Rutten-van Mölken M, Simpson J, Sin DD, Song Y, Suki B, Troosters T, Washko GR, Welte T, Dransfield MT. Towards the elimination of chronic obstructive pulmonary disease: a Lancet Commission. Lancet 2022; 400:921-972. [PMID: 36075255 DOI: 10.1016/s0140-6736(22)01273-9] [Citation(s) in RCA: 160] [Impact Index Per Article: 80.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 05/23/2022] [Accepted: 06/28/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Daiana Stolz
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland; Clinic of Respiratory Medicine and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Takudzwa Mkorombindo
- Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Desiree M Schumann
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
| | - Alvar Agusti
- Respiratory Institute-Hospital Clinic, University of Barcelona IDIBAPS, CIBERES, Barcelona, Spain
| | - Samuel Y Ash
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mona Bafadhel
- School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK; Department of Respiratory Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Chunxue Bai
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - James D Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Dundee, UK
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Shyamali C Dharmage
- Centre for Epidemiology and Biostatistics, School of Population and Global health, University of Melbourne, Melbourne, VIC, Australia
| | - Frits M E Franssen
- Department of Research and Education, CIRO, Horn, Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Urs Frey
- University Children's Hospital Basel, Basel, Switzerland
| | - MeiLan Han
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nadia N Hansel
- Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Nathaniel M Hawkins
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Ravi Kalhan
- Department of Preventive Medicine and Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Melanie Konigshoff
- Division of Pulmonary, Allergy and Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Fanny W Ko
- The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Trisha M Parekh
- Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Maureen Rutten-van Mölken
- Erasmus School of Health Policy & Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Jodie Simpson
- Priority Research Centre for Healthy Lungs, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Don D Sin
- Centre for Heart Lung Innovation and Division of Respiratory Medicine, Department of Medicine, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada
| | - Yuanlin Song
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China; Shanghai Respiratory Research Institute, Shanghai, China; Jinshan Hospital of Fudan University, Shanghai, China
| | - Bela Suki
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Thierry Troosters
- Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Belgium
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease, German Center for Lung Research, Hannover, Germany
| | - Mark T Dransfield
- Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Birmingham VA Medical Center, Birmingham, AL, USA.
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Li Y, Li XY, Yuan LR, Wang HL, Pang M. Evaluation of small airway function and its application in patients with chronic obstructive pulmonary disease (Review). Exp Ther Med 2021; 22:1386. [PMID: 34650634 DOI: 10.3892/etm.2021.10822] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/26/2021] [Indexed: 12/13/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic airway inflammatory disease characterized by incomplete reversible airflow limitation. The diagnosis of COPD is mainly based on pulmonary function examination. In recent years, it has been indicated that small airway dysfunction occurs in patients with all stages of COPD, even in high-risk smoking groups who have not yet met the diagnostic criteria for COPD. Early recognition of small airway dysfunction and early initiation of small airway targeted therapy have become foci of research. In the present review, the methods of evaluating small airway function were summarized and their merits and shortcomings were discussed. Furthermore, the potential of targeted treatment of small airways in patients with COPD was outlined.
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Affiliation(s)
- Yan Li
- Department of Pulmonary and Critical Care Medicine, The First Hospital, Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China
| | - Xin-Yang Li
- Department of Medical Parasitology, School of Basic Medicine, Basic Medical Science Center, Shanxi Medical University, Jinzhong, Shanxi 030600, P.R. China
| | - Li-Rong Yuan
- Department of Pulmonary and Critical Care Medicine, The First Hospital, Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China
| | - Hai-Long Wang
- Department of Medical Parasitology, School of Basic Medicine, Basic Medical Science Center, Shanxi Medical University, Jinzhong, Shanxi 030600, P.R. China
| | - Min Pang
- Department of Pulmonary and Critical Care Medicine, The First Hospital, Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China
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8
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Chen L, Wu L, Lu D, Zi M, Yu H. The Value of Fractional Exhaled Nitric Oxide and Impulse Oscillometric and Spirometric Parameters for Predicting Bronchial Hyperresponsiveness in Adults with Chronic Cough. J Asthma Allergy 2021; 14:1065-1073. [PMID: 34447255 PMCID: PMC8384260 DOI: 10.2147/jaa.s326879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/03/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the contribution of fractional exhaled nitric oxide (FeNO) and impulse oscillometry (IOS) and spirometric parameters in predicting bronchial hyperresponsiveness (BHR) in adults with chronic cough. Patients and Methods In total, 112 patients with chronic cough were enrolled in this prospective diagnostic study. Receiver operating characteristic (ROC) curves were generated to assess the diagnostic efficiency and optimal cut-off values of FeNO and IOS and spirometric parameters in predicting BHR. Optimal combinations of FeNO and IOS and spirometric parameters for BHR prediction were investigated using univariate and multivariate logistic regression models. Bootstrapping was employed for internal validation. Model discrimination and calibration were assessed using indices and calibration plots. Results Rhinitis and values of FeNO, IOS parameters (resonant frequency (Fres), reactance at 5 Hz (X5), and integrated area of low-frequency X (AX)) and spirometric parameters (FEV1, PEF, MEF75, MEF50, MEF25, MMEF) were significantly different between patients with BHR and those without BHR (P < 0.05). After adjusting for rhinitis, logistic analyses showed that FeNO combined with Fres, FeNO combined with MMEF, or the combination of FeNO, Fres and MMEF had high predictive value in diagnosing BHR; the areas under the ROC curves (AUCs) of the corresponding three models were 0.914, 0.919 and 0.927, respectively. In addition, the three models displayed good discrimination, with high C-index values and good calibration. Conclusion FeNO combined with Fres or MMEF or a combination of these three parameters may be conveniently used as indicators in BHR prediction.
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Affiliation(s)
- Lichang Chen
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Lingling Wu
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Dongzhu Lu
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Mei Zi
- Department of Respiratory and Critical Care Medicine, The Third People's Hospital of Shenzhen, Shenzhen, People's Republic of China
| | - Huapeng Yu
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
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Zhang Y, Meng X, Shen Y, Xie J, Yu X, Wang Q, Wang L. The Reliability and Validity of the Brief ICF Core Set in Patients with Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2021; 16:2077-2087. [PMID: 34290501 PMCID: PMC8289296 DOI: 10.2147/copd.s306410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/19/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To analyze the reliability and validity of the Brief international classification of functioning, disability and health (ICF) core set for chronic obstructive pulmonary disease (COPD). Patients and Methods A cross-sectional study was conducted in four tertiary hospitals in Tianjin, China. A total of 100 patients with COPD were selected to evaluate functioning and disability involving body functions, body structures, activities and participation as well as environmental factors of the Brief ICF core set for COPD. Internal consistency was calculated by Cronbach's α. Content validity was examined using the content validity index (CVI), scale-level CVI/universal agreement, and scale-level CVI/average agreement (S-CVI/Ave). In addition, construct validity and convergent validity were also examined. Results The Brief ICF core set for COPD had a high internal consistency, 0.873 for the total scale, with values of 0.750, 0.640, and 0.843 for body functions, body structures, and activity and participation, respectively. The content validity was calculated by the CVI, scale-level CVI/universal agreement, and S-CVI/Ave at values of 0.80-1, 0.929, and 0.986, respectively. Meanwhile, the ICF core set for COPD had good convergent validity, correlating with the mMRC dyspnea score (r=0.690, P<0.01), and there were significant correlations between the ICF core set for COPD and COPD clinical severity grade (r=0.363, P<0.01). A four-factor model of functions and disability in the Brief ICF core set for COPD had the best fit according to confirmatory factor analysis (CFA). Conclusion The Brief ICF core set for COPD is a reliable and valid convenient instrument for assessing comprehensive problems in the functioning of patients with COPD, which can be used to design and to evaluate rehabilitation strategies.
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Affiliation(s)
- Yongmei Zhang
- School of Nursing, Tianjin Medical University, Tianjin, People's Republic of China
| | - Xiaoxuan Meng
- School of Nursing, Tianjin Medical University, Tianjin, People's Republic of China
| | - Yuehao Shen
- Department of Respiratory Care, General Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Jiajia Xie
- Department of Respiratory Care, General Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Xi Yu
- Department of Respiratory Care, Tianjin First Center Hospital, Tianjin, People's Republic of China
| | - Qiaoshuo Wang
- Department of Cardiac Care, Tianjin Chest Hospital, Tianjin, People's Republic of China
| | - Lan Wang
- School of Nursing, Tianjin Medical University, Tianjin, People's Republic of China
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10
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Ferrari da Cruz T, Rufino R, Lopes A, Henrique Costa C. Small airway evaluation in three subjects with alpha-1 antitrypsin deficiency without diagnosed lung disease. BMJ Case Rep 2021; 14:14/3/e239146. [PMID: 33785603 PMCID: PMC8011716 DOI: 10.1136/bcr-2020-239146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We describe three cases of female subjects (aged 16, 44 and 41 years) with no respiratory symptoms, who have alpha-1 antitripsyn mutation (PiSZ, PiZZ and PiZZ) and who performed traditional pulmonary function tests and the single breath nitrogen washout test. They still did not have chronic obstructive pulmonary disease (COPD) or any identifiable change in traditional pulmonary function tests but already have change in nitrogen washout tests. Alpha-1 antitrypsin deficiency is a genetic disorder associated with early-onset COPD. There is evidence that although patients who have well-preserved FEV1 may already have signs of emphysema associated with symptoms. Therefore, the nitrogen washout test is considered to have more sensitive outcomes than other pulmonary function tests for early investigation of small airways disease and could allow the monitoring pulmonary function and evaluating of therapeutic decision.
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Affiliation(s)
| | - Rogério Rufino
- Pneumology, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
| | - Agnaldo Lopes
- Pneumology, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
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11
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Bruce RM, Phan PA, Rigolli M, Tran MC, Pacpaco E, Rahman NM, Farmery AD. Assessment of Ventilatory Heterogeneity in Chronic Obstructive Pulmonary Disease Using the Inspired Sinewave Test. Int J Chron Obstruct Pulmon Dis 2021; 16:401-413. [PMID: 33654391 PMCID: PMC7914067 DOI: 10.2147/copd.s264360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/22/2020] [Indexed: 12/13/2022] Open
Abstract
Background There is marked variability in the symptoms and outcomes of patients with chronic obstructive pulmonary disease (COPD) which are poorly predicted by spirometry/FEV1%pred. Furthermore, as spirometry requires the performance of potentially distressing respiratory manoeuvres which are to some extent user-effort dependent, there is need for non-invasive and simple-to-perform techniques to identify subtypes of COPD which are more closely related to clinically relevant outcomes. Materials and Methods The inspired sinewave test (IST) sinusoidally modulates the inspired concentration of a tracer gas (N2O) over successive tidal breaths. A single-compartment tidal-ventilation lung model processes the amplitude/phase of the expired N2O sinewave and estimates cardiopulmonary variables including: effective lung volume and indices of ventilatory heterogeneity (VH; ELV180/FRCpleth and ELV180/ELVpred). 83 COPD patients and 53 healthy controls performed the IST test, standard pulmonary function tests (Spirometry, body plethysmography and the single breath test of carbon monoxide uptake), and symptom severity questionnaires (COPD assessment test, CAT; mMRC dyspnoea-scale, mMRC-DS; Cough+Mucus score; C+M score). Results ELV180/FRCpleth and ELV180/ELVpred were significantly lower in patients with COPD vs healthy participants (0.34±0.11 vs 0.68±0.14 and 0.7±0.27 vs 0.98±0.15, respectively; P<0.05). Multivariable regression analysis demonstrated that ELV180/FRCpleth was a stronger and independent predictor of CAT, mMRC-DS and C+M score vs FEV1%pred. ELV180/ELVpred was a stronger and independent and better predictor of C+M score vs FEV1%pred. Phenotyping patients, based upon ELV180/ELVpred and FRC%pred, uncovered significant symptomatic differences between groups. Conclusion The IST indices of VH were superior and independent predictors of symptom severity vs FEV1%pred and has potential as a non-invasive and simple-to-perform method to stratify patients into subgroups related to clinically relevant features of COPD.
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Affiliation(s)
- Richard M Bruce
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, King's College London, London, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Phi Anh Phan
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Marzia Rigolli
- University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Minh C Tran
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Edmund Pacpaco
- Oxford University Hospitals NHS Foundation Trust, Oxford Centre for Respiratory Medicine, Oxford, UK
| | - Najib M Rahman
- Oxford University Hospitals NHS Foundation Trust, Oxford Centre for Respiratory Medicine, Oxford, UK
| | - Andrew D Farmery
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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12
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Manco A, Pisi R, Aiello M, Tzani P, Frizzelli A, Fantin A, Alfieri V, Bertorelli G, Chetta A. Small airway dysfunction predicts excess ventilation and dynamic hyperinflation during exercise in patients with COPD. RESPIRATORY MEDICINE: X 2020. [DOI: 10.1016/j.yrmex.2020.100020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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13
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Ferrari da Cruz T, Rufino R, Lopes AJ, Noronha A, Medeiros Anselmo F, Henrique da Costa C. <p>Evaluation of the Small Airways in Patients with Chronic Obstructive Pulmonary Disease and Alpha-1 Antitrypsin Deficiency</p>. Int J Chron Obstruct Pulmon Dis 2020; 15:2267-2274. [PMID: 33061344 PMCID: PMC7522299 DOI: 10.2147/copd.s262418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 07/27/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Small airways are not evaluated with traditional pulmonary function tests. The aim of this study was to evaluate the small airways in patients with chronic obstructive pulmonary disease (COPD) with a nitrogen washout test and to verify whether there is a difference between patients with COPD due to smoking and those with COPD due to alpha-1 antitrypsin mutation. Methods Sixteen patients with mutation in the SERPINA1 gene and 45 patients with no mutation were included in this cross-sectional study. All pulmonary function tests, including the single breath nitrogen washout test, were performed for all patients and alpha-1 antitrypsin dosage was assessed with immunonephelometry. Results A comparison of patients with COPD due to smoking and those with COPD due to smoking and mutation revealed a significant difference in closure volume (%), which was the poorest in the mutation group. In the group with COPD and mutation, there was an inverse correlation between smoking and closure volume (%). We also verified that similar to forced expiratory volume in the first second (FEV1), the phase III slope (%) and ΔN2 750–1250 mL (%) could be used to differentiate the severity of airflow limitation. Conclusion Our results suggest that both variables, phase III slope and the ΔN2 750–1250 mL (%), could be related to COPD severity. Therefore, alterations at the distribution of the location of the emphysema could alter the results of closer volume and that the nitrogen washout test is more sensitive when compared to traditional pulmonary function test in evaluating COPD patients.
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Affiliation(s)
- Thaís Ferrari da Cruz
- Pneumology Department, Pedro Ernesto Hospital of State University of Rio de Janeiro, Rio de Janeiro, PR, Brazil
- Correspondence: Thaís Ferrari da Cruz Av João Gualberto, 253 Ap 241, Cep: 80030-000, Curitiba, PR, BrazilTel +55 41 99911-4487 Email
| | - Rogerio Rufino
- Pneumology Department, Pedro Ernesto Hospital of State University of Rio de Janeiro, Rio de Janeiro, PR, Brazil
| | - Agnaldo José Lopes
- Pneumology Department, Pedro Ernesto Hospital of State University of Rio de Janeiro, Rio de Janeiro, PR, Brazil
| | - Arnaldo Noronha
- Pneumology Department, Pedro Ernesto Hospital of State University of Rio de Janeiro, Rio de Janeiro, PR, Brazil
| | - Fernando Medeiros Anselmo
- Pneumology Department, Pedro Ernesto Hospital of State University of Rio de Janeiro, Rio de Janeiro, PR, Brazil
| | - Cláudia Henrique da Costa
- Pneumology Department, Pedro Ernesto Hospital of State University of Rio de Janeiro, Rio de Janeiro, PR, Brazil
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14
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Alobaidi NY, Stockley JA, Stockley RA, Sapey E. An overview of exacerbations of chronic obstructive pulmonary disease: Can tests of small airways' function guide diagnosis and management? Ann Thorac Med 2020; 15:54-63. [PMID: 32489439 PMCID: PMC7259399 DOI: 10.4103/atm.atm_323_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/20/2019] [Indexed: 12/14/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is common and debilitating. Most patients with COPD experience intermittent, acute deterioration in symptoms which require additional therapy, termed exacerbations. Exacerbations are prevalent in COPD and are associated with poor clinical outcomes including death, a faster decline in lung health, and a reduced quality of life. Current guidelines highlight the need to treat exacerbations promptly and then mitigate future risk. However, exacerbations are self-reported, difficult to diagnose and are treated with pharmacological therapies which have largely been unchanged over 30 years. Recent research has highlighted how exacerbations vary in their underlying cause, with specific bacteria, viruses, and cell types implicated. This variation offers the opportunity for new targeted therapies, but to develop these new therapies requires sensitive tools to reliably identify the cause, the start, and end of an exacerbation and assess the response to treatment. Currently, COPD is diagnosed and monitored using spirometric measures, principally the forced expiratory volume in 1 s and forced vital capacity, but these tests alone cannot reliably diagnose an exacerbation. Measures of small airways' function appear to be an early marker of COPD, and some studies have suggested that these tests might also provide physiological biomarkers for exacerbations. In this review, we will discuss how exacerbations of COPD are currently defined, stratified, monitored, and treated and review the current literature to determine if tests of small airways' function might improve diagnostic accuracy or the assessment of response to treatment.
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Affiliation(s)
- Nowaf Y Alobaidi
- Centre for Translational Inflammation Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Respiratory Therapy Department, College of Applied Medical Sciences, King Saud Bin Abdul-Aziz University for Health Sciences, Al Ahsa, Saudi Arabia
| | - James A Stockley
- Department of Lung Function and Sleep, University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK
| | - Robert A Stockley
- Department of Respiratory Medicine, University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK
| | - Elizabeth Sapey
- Centre for Translational Inflammation Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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15
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16
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Capron T, Bourdin A, Perez T, Chanez P. COPD beyond proximal bronchial obstruction: phenotyping and related tools at the bedside. Eur Respir Rev 2019; 28:28/152/190010. [PMID: 31285287 DOI: 10.1183/16000617.0010-2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 05/04/2019] [Indexed: 11/05/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is characterised by nonreversible proximal bronchial obstruction leading to major respiratory disability. However, patient phenotypes better capture the heterogeneously reported complaints and symptoms of COPD. Recent studies provided evidence that classical bronchial obstruction does not properly reflect respiratory disability, and symptoms now form the new paradigm for assessment of disease severity and guidance of therapeutic strategies. The aim of this review was to explore pathways addressing COPD pathogenesis beyond proximal bronchial obstruction and to highlight innovative and promising tools for phenotyping and bedside assessment. Distal small airways imaging allows quantitative characterisation of emphysema and functional air trapping. Micro-computed tomography and parametric response mapping suggest small airways disease precedes emphysema destruction. Small airways can be assessed functionally using nitrogen washout, probing ventilation at conductive or acinar levels, and forced oscillation technique. These tests may better correlate with respiratory symptoms and may well capture bronchodilation effects beyond proximal obstruction.Knowledge of inflammation-based processes has not provided well-identified targets so far, and eosinophils probably play a minor role. Adaptative immunity or specific small airways secretory protein may provide new therapeutic targets. Pulmonary vasculature is involved in emphysema through capillary loss, microvascular lesions or hypoxia-induced remodelling, thereby impacting respiratory disability.
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Affiliation(s)
- Thibaut Capron
- Clinique des Bronches, Allergies et Sommeil, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Arnaud Bourdin
- Université de Montpellier, PhyMedExp, INSERM, CNRS, CHU de Montpellier, Dept of Respiratory Diseases, Montpellier, France
| | - Thierry Perez
- Dept of Respiratory Diseases, CHU Lille, Center for Infection and Immunity of Lille, INSERM U1019 - CNRS UMR 8204, Université Lille Nord de France, Lille, France
| | - Pascal Chanez
- Clinique des Bronches, Allergies et Sommeil, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Aix Marseille Université, Marseille, France .,Aix Marseille Université, INSERM, INRA, CV2N, Marseille, France
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17
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Yammine S, Ramsey KA, Skoric B, King L, Latzin P, Rosenow T, Hall GL, Ranganathan SC. Single-breath washout and association with structural lung disease in children with cystic fibrosis. Pediatr Pulmonol 2019; 54:587-594. [PMID: 30758143 DOI: 10.1002/ppul.24271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/16/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND In children with cystic fibrosis (CF) lung clearance index (LCI) from multiple-breath washout (MBW) correlates with structural lung disease. As a shorter test, single-breath washout (SBW) represents an attractive alternative to assess the ventilation distribution, however, data for the correlation with lung imaging are lacking. METHODS We assessed correlations between phase III slope (SIII) of double-tracer gas SBW, nitrogen MBW indices (LCI and moment ratios for overall ventilation distribution, Scond, and Sacin for conductive and mainly acinar ventilation, respectively) and structural lung disease assessed by chest computed tomography (CT) in children with CF. RESULTS In a prospective cross-sectional study data from MBW, SBW, and chest CT were obtained in 32 children with CF with a median (range) age of 8.2 (5.2-16.3) years. Bronchiectasis was present in 24 (75%) children and air trapping was present in 29 (91%). Median (IQR) SIII of SBW was -138.4 (150.6) mg/mol. We found no association between SIII with either the MBW outcomes or CT scores (n = 23, association with bronchiectasis extent r = 0.10, P = 0.64). LCI and Scond were associated with bronchiectasis extent (n = 23, r = 0.57, P = 0.004; r = 0.60, P = 0.003, respectively). CONCLUSIONS Acinar ventilation inhomogeneity measured by SBW was not associated with structural lung disease on CT. Double-tracer SBW added no benefit to indices measured by MBW.
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Affiliation(s)
| | - Kathryn A Ramsey
- University Children's Hospital Bern, Bern, Switzerland.,Telethon Kids Institute, Subiaco, Australia
| | - Billy Skoric
- Respiratory Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Louise King
- Respiratory Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - Tim Rosenow
- Telethon Kids Institute, Subiaco, Australia.,Centre for Child Health Research, University of Western Australia, Subiaco, Australia
| | - Graham L Hall
- Telethon Kids Institute, Subiaco, Australia.,Centre for Child Health Research, University of Western Australia, Subiaco, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Western Australia, Australia
| | - Sarath C Ranganathan
- Respiratory Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Australia
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18
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Olofson J, Bake B, Bergman B, Ullman A, Svärdsudd K. Prediction of COPD and Related Events Improves by Combining Spirometry and the Single Breath Nitrogen Test. COPD 2019; 15:424-431. [PMID: 30822242 DOI: 10.1080/15412555.2018.1538330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) develops in small airways. Severity of small airway pathology relates to progression and mortality. The present study evaluated the prediction of COPD of a validated test for small airway disease, i.e. a slope of the alveolar plateau of the single breath nitrogen test (N2-slope). The N2-slope, spirometry, age, smoking habits, and anthropometric variables at baseline were obtained in a population-based sample (n = 592). The cohort was followed for first COPD events (first hospital admission of COPD or related conditions or death from COPD) during 38 years. During follow-up, 52 subjects (8.8%) had a first COPD event, of which 18 (3.0%) died with a first COPD diagnosis. In the proportional hazard regression analysis adjusted for age and smoking habits, the cumulative COPD event incidence increased from 5% among those with high forced expired volume in one second (FEV1) to 25% among those with low FEV1, while increasing from 4% among those with the lowest N2-slope to 26% among those with the highest. However, combining the N2-slope and FEV1 resulted in considerable synergy in the prediction of first COPD event and even more so when taking account of smoking habits. The cumulative COPD event incidence rate was 75% among heavy smokers with the highest N2-slope and lowest FEV1, and less than 1% among never smokers with the lowest N2-slope and highest FEV1. Thus, combining the results of the single breath N2-slope and FEV1 considerably improved the prediction of COPD events as compared to either test alone.
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Affiliation(s)
- Jan Olofson
- a Department of Respiratory Medicine and Allergology , Institute of Medicine, Sahlgrenska Academy at University of Gothenburg , Gothenburg , Sweden
| | - Björn Bake
- a Department of Respiratory Medicine and Allergology , Institute of Medicine, Sahlgrenska Academy at University of Gothenburg , Gothenburg , Sweden
| | - Bengt Bergman
- a Department of Respiratory Medicine and Allergology , Institute of Medicine, Sahlgrenska Academy at University of Gothenburg , Gothenburg , Sweden
| | - Anders Ullman
- b COPD Center Sahlgrenska University Hospital , Institute of Medicine, Sahlgrenska Academy at University of Gothenburg , Gothenburg , Sweden
| | - Kurt Svärdsudd
- c Department of Public Health and Caring Sciences , Family Medicine and Preventive Medicine Section, Uppsala University , Uppsala , Sweden
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19
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Bossé Y. The Strain on Airway Smooth Muscle During a Deep Inspiration to Total Lung Capacity. JOURNAL OF ENGINEERING AND SCIENCE IN MEDICAL DIAGNOSTICS AND THERAPY 2019; 2:0108021-1080221. [PMID: 32328568 PMCID: PMC7164505 DOI: 10.1115/1.4042309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/06/2018] [Indexed: 02/05/2023]
Abstract
The deep inspiration (DI) maneuver entices a great deal of interest because of its ability to temporarily ease the flow of air into the lungs. This salutary effect of a DI is proposed to be mediated, at least partially, by momentarily increasing the operating length of airway smooth muscle (ASM). Concerningly, this premise is largely derived from a growing body of in vitro studies investigating the effect of stretching ASM by different magnitudes on its contractility. The relevance of these in vitro findings remains uncertain, as the real range of strains ASM undergoes in vivo during a DI is somewhat elusive. In order to understand the regulation of ASM contractility by a DI and to infer on its putative contribution to the bronchodilator effect of a DI, it is imperative that in vitro studies incorporate levels of strains that are physiologically relevant. This review summarizes the methods that may be used in vivo in humans to estimate the strain experienced by ASM during a DI from functional residual capacity (FRC) to total lung capacity (TLC). The strengths and limitations of each method, as well as the potential confounders, are also discussed. A rough estimated range of ASM strains is provided for the purpose of guiding future in vitro studies that aim at quantifying the regulatory effect of DI on ASM contractility. However, it is emphasized that, owing to the many limitations and confounders, more studies will be needed to reach conclusive statements.
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Affiliation(s)
- Ynuk Bossé
- Université Laval, Faculty of Medicine, Department of Medicine, IUCPQ, M2694, Pavillon Mallet, Chemin Sainte-Foy, Québec, QC G1V 4G5, Canada e-mail:
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20
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Gove K, Wilkinson T, Jack S, Ostridge K, Thompson B, Conway J. Systematic review of evidence for relationships between physiological and CT indices of small airways and clinical outcomes in COPD. Respir Med 2018; 139:117-125. [DOI: 10.1016/j.rmed.2018.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/21/2018] [Accepted: 05/06/2018] [Indexed: 10/17/2022]
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21
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Young HM, Guo F, Eddy RL, Maksym G, Parraga G. Oscillometry and pulmonary MRI measurements of ventilation heterogeneity in obstructive lung disease: relationship to quality of life and disease control. J Appl Physiol (1985) 2018. [PMID: 29543132 DOI: 10.1152/japplphysiol.01031.2017] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Ventilation heterogeneity is a hallmark finding in obstructive lung disease and may be evaluated using a variety of methods, including multiple-breath gas washout and pulmonary imaging. Such methods provide an opportunity to better understand the relationships between structural and functional abnormalities in the lungs, and their relationships with important clinical outcomes. We measured ventilation heterogeneity and respiratory impedance in 100 subjects [50 patients with asthma, 22 ex-smokers, and 28 patients with chronic obstructive pulmonary disease (COPD)] using oscillometry and hyperpolarized 3He magnetic resonance imaging (MRI) and determined their relationships with quality of life scores and disease control/exacerbations. We also coregistered MRI ventilation maps to a computational airway tree model to generate patient-specific respiratory impedance predictions for comparison with experimental measurements. In COPD and asthma patients, respectively, forced oscillation technique (FOT)-derived peripheral resistance (5-19 Hz) and MRI ventilation defect percentage (VDP) were significantly related to quality of life (FOT: COPD ρ = 0.4, P = 0.004; asthma ρ = -0.3, P = 0.04; VDP: COPD ρ = 0.6, P = 0.003; asthma ρ = -0.3, P = 0.04). Patients with poorly controlled asthma (Asthmatic Control Questionnaire >2) had significantly increased resistance (5 Hz: P = 0.01; 5-19 Hz: P = 0.006) and reactance (5 Hz: P = 0.03). FOT-derived peripheral resistance (5-19 Hz) was significantly related to VDP in patients with asthma and COPD patients (asthma: ρ = 0.5, P < 0.001; COPD: ρ = 0.5, P = 0.01), whereas total respiratory impedance was related to VDP only in patients with asthma (resistance 5 Hz: ρ = 0.3, P = 0.02; reactance 5 Hz: ρ = -0.5, P < 0.001). Model-predicted and FOT-measured reactance (5 Hz) were correlated in patients with asthma (ρ = 0.5, P = 0.001), whereas in COPD patients, model-predicted and FOT-measured resistance (5-19 Hz) were correlated (ρ = 0.5, P = 0.004). In summary, in patients with asthma and COPD patients, we observed significant, independent relationships for FOT-measured impedance and MRI ventilation heterogeneity measurements with one another and with quality of life scores. NEW & NOTEWORTHY In 100 patients, including patients with asthma and ex-smokers, 3He MRI ventilation heterogeneity and respiratory system impedance were correlated and both were independently related to quality of life scores and asthma control. These findings demonstrated the critical relationships between respiratory system impedance and ventilation heterogeneity and their role in determining quality of life and disease control. These observations underscore the dominant role that abnormalities in the lung periphery play in ventilation heterogeneity that results in patients' symptoms.
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Affiliation(s)
- Heather M Young
- Robarts Research Institute, Western University , London, Ontario , Canada.,Department of Medical Biophysics, Western University , London, Ontario , Canada
| | - Fumin Guo
- Robarts Research Institute, Western University , London, Ontario , Canada.,Graduate Program in Biomedical Engineering, Western University , London, Ontario , Canada
| | - Rachel L Eddy
- Robarts Research Institute, Western University , London, Ontario , Canada.,Department of Medical Biophysics, Western University , London, Ontario , Canada
| | - Geoffrey Maksym
- School of Biomedical Engineering, Dalhousie University , Halifax, Nova Scotia , Canada
| | - Grace Parraga
- Robarts Research Institute, Western University , London, Ontario , Canada.,Department of Medical Biophysics, Western University , London, Ontario , Canada.,Graduate Program in Biomedical Engineering, Western University , London, Ontario , Canada
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22
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Deus CAL, Vigário PS, Guimarães FS, Lopes AJ. Nitrogen single-breath washout test for evaluating exercise tolerance and quality of life in patients with chronic obstructive pulmonary disease. ACTA ACUST UNITED AC 2018; 51:e7059. [PMID: 29490001 PMCID: PMC5856443 DOI: 10.1590/1414-431x20177059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 12/07/2017] [Indexed: 12/26/2022]
Abstract
Pulmonary function tests (PFTs) traditionally used in clinical practice do not accurately predict exercise intolerance in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to assess whether the nitrogen single-breath washout (N2SBW) test explains exercise intolerance and poor quality of life in stable COPD patients. This cross-sectional study included 31 patients with COPD subjected to PFTs (including the N2SBW test) and a cardiopulmonary exercise test (CPET). Patients were also evaluated using the following questionnaires: the COPD assessment test (CAT), the 36-Item Short Form Health Survey (SF36) and St. George's Respiratory Questionnaire (SGRQ). Peak oxygen uptake (peak VO2) was negatively correlated with the phase III slope of the N2SBW (SIIIN2) (r=-0.681, P<0.0001) and positively correlated with forced expiratory volume in one second (FEV1; r=0.441, P=0.013). Breathing reserve was negatively correlated with SIIIN2, closing volume/vital capacity, and residual volume (RV) (r=-0.799, P<0.0001; r=-0.471, P=0.007; r=-0.401, P=0.025, respectively) and positively correlated with FEV1, forced vital capacity (FVC) and FEV1/FVC (r=0.721; P<0.0001; r=0.592, P=0.0004; r=0.670, P<0.0001, respectively). SIIIN2 and CAT were independently predictive of VO2 and breathing reserve at peak exercise. RV, FVC, and FEV1 were independently predictive of the SF36-physical component summary, SF36-mental component summary, and breathing reserve, respectively. The SGRQ did not present any independent variables that could explain the model. In stable COPD patients, inhomogeneity of ventilation explains a large degree of exercise intolerance assessed by CPETs and, to a lesser extent, poor quality of life.
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Affiliation(s)
- C A L Deus
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brasil
| | - P S Vigário
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brasil
| | - F S Guimarães
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brasil
| | - A J Lopes
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brasil
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23
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Kjellberg S, Viklund E, Robinson PD, Zetterström O, Olin AC, Gustafsson P. Utility of single versus multiple breath washout in adult asthma. Clin Physiol Funct Imaging 2018; 38:936-943. [PMID: 29368419 DOI: 10.1111/cpf.12503] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 12/19/2017] [Indexed: 11/30/2022]
Abstract
Nitrogen multiple breath washout (N2 MBW) is a sensitive method to identify peripheral airway involvement in asthma, but is a time-consuming test. The N2 vital capacity single breath (VC SBW) test offers greater time efficiency, but concordance with N2 MBW is poorly understood. The prevalence of peripheral airway abnormality was determined by N2 MBW and N2 SBW tests in 194 asthmatic subjects aged 18-1 years. N2 MBW data were related to findings in 400 healthy controls, aged 17-71 years, while N2 SBW data were compared to findings in 224 healthy controls, aged 15-65 years, to derive equipment-specific reference values. Amongst asthmatic subjects, relationships between N2 SBW and N2 MBW outcomes were studied. N2 SBW relationship with clinical history, spirometry, blood eosinophils and fraction exhaled nitric oxide (FENO) data was also explored. The prevalence of peripheral airway involvement (i.e. abnormal ventilation distribution) determined by N2 SBW-derived phase III slope (N2 SIII ) was 24·7%, compared to 44% determined by N2 MBW-derived lung clearance index (LCI) (P<0·001). Predictors of abnormal N2 SIII were older age, smoking history and lower FEV1. N2 SBW offers lower sensitivity than N2 MBW to detect small airway dysfunction in adult asthma, but may be a marker of more severe disease.
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Affiliation(s)
- S Kjellberg
- Department of Pediatrics, Skaraborg Hospital Skövde, Skövde, Sweden
- The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - E Viklund
- The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department for Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
| | - P D Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - O Zetterström
- Allergy Centre, Skaraborg Hospital Skövde, Skövde, Sweden
| | - A-C Olin
- The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department for Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
| | - P Gustafsson
- Department of Pediatrics, Skaraborg Hospital Skövde, Skövde, Sweden
- The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Allergy Centre, Skaraborg Hospital Skövde, Skövde, Sweden
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24
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Nyilas S, Baumeler L, Tamm M, Halter JP, Savic S, Korten I, Meyer A, Singer F, Passweg JR, Latzin P, Stolz D. Inert Gas Washout in Bronchiolitis Obliterans Following Hematopoietic Cell Transplantation. Chest 2017; 154:157-168. [PMID: 29275133 DOI: 10.1016/j.chest.2017.12.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/27/2017] [Accepted: 12/01/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Bronchiolitis obliterans syndrome (BOS) is a leading cause of chronic graft-vs-host disease (cGvHD) and is associated with mortality after allogeneic hematopoietic stem cell transplantation (alloHSCT). The nitrogen multiple breath washout test (N2-MBW) measures ventilation inhomogeneity, a biomarker of central and peripheral airway obstruction. The aim of this study was to examine ventilation inhomogeneity according to cGvHD score and histologically defined bronchiolitis obliterans (BO). METHODS This single-center prospective cross-sectional study included 225 adults (mean age, 52.8 years; median, 5.4 years [interquartile range, 2.0-11 years]) after alloHSCT. Outcomes were global (lung clearance index [LCI]) and acinar ventilation inhomogeneity index (SACIN) from N2-MBW. Patients were categorized into five groups: (1) no cGvHD and no obstruction (cGvHD overall score 0 and FEV1/FVC ≥ 70) (2) cGvHD and no obstruction (cGvHD overall score 1-3 and FEV1/FVC ≥ 70), (3) BOS with or without cGvHD (if available, no BO on histologic examination, and FEV1/FVC < 70), (4) histologically proven BO, and (5) diffuse parenchymal lung disease other than BO. RESULTS The LCI and SACIN differed significantly between groups (P < .001) and increased progressively according to cGvHD score. In BO, the LCI and SACIN were elevated in 95.5% and 81.8% of patients, respectively, whereas FEV1/FVC was abnormal in only 56.5% of patients, respectively. CONCLUSIONS N2-MBW is highly sensitive for detecting abnormal lung function in patients following alloHSCT. LCI and SACIN seem to be promising biomarkers of lung involvement in cGvHD.
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Affiliation(s)
- Sylvia Nyilas
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, University of Bern, Bern, Switzerland; Department of Pediatric Pneumology, University Children's Hospital Basel, Switzerland
| | - Luzia Baumeler
- Clinic of Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel, Basel, Switzerland
| | - Michael Tamm
- Clinic of Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel, Basel, Switzerland
| | - Jörg P Halter
- Division of Hematology, University Hospital Basel, Basel, Switzerland
| | - Spasenija Savic
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Insa Korten
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, University of Bern, Bern, Switzerland
| | - Anja Meyer
- Clinic of Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel, Basel, Switzerland
| | - Florian Singer
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, University of Bern, Bern, Switzerland
| | - Jakob R Passweg
- Division of Hematology, University Hospital Basel, Basel, Switzerland
| | - Philipp Latzin
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, University of Bern, Bern, Switzerland; Department of Pediatric Pneumology, University Children's Hospital Basel, Switzerland
| | - Daiana Stolz
- Clinic of Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel, Basel, Switzerland.
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25
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Mandal J, Roth M, Papakonstantinou E, Sun Q, Costa L, Boeck L, Scherr A, Rakic J, Louis R, Milenkovic B, Boersma W, Kostikas K, Blasi F, Aerts J, Rohde G, Lacoma A, Torres A, Welte T, Tamm M, Stolz D. Treatment with long acting muscarinic antagonists stimulates serum levels of irisin in patients with COPD. Pulm Pharmacol Ther 2017; 48:111-116. [PMID: 29066215 DOI: 10.1016/j.pupt.2017.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/18/2017] [Indexed: 12/28/2022]
Abstract
Long acting muscarinic antagonists (LAMA) are currently considered the therapeutic mainstay for patients with COPD and have been shown to improve clinical outcomes including symptoms, exercise capacity and airflow limitation. Irisin, is a newly discovered hormone-like myokine generated by skeletal muscle cells in response to exercise and it is suggested to regulate energy expenditure and exercise capacity. The aim of the present study was to investigate if treatment with LAMA alters serum irisin levels in patients with COPD. Irisin was assessed by ELISA in the serum of 506 patients with COPD, GOLD II-IV, with a smoking history >10 PY, who were included in the PROMISE-COPD cohort. The effect of inhaled LAMA on serum irisin levels was evaluated in a proof-of-concept cohort of 40 COPD patients. Univariate linear regression analysis revealed that there was a significant negative association of irisin with age-adjusted Charlson score (p = 0.003) and a positive association of irisin with 6-min walking distance (6MWD) (p = 0.018) and treatment with LAMA (p = 0.004) but not with LABA or ICS. Multivariate analysis revealed that the association of irisin with LAMA treatment remains significant after adjustment for age-adjusted score and 6MWD. In the proof-of-concept cohort a single inhalation of LAMA stimulated serum irisin levels after 4 h. These findings imply that treatment of COPD patients with LAMA increase circulating irisin, thus explaining some of the beneficial extra-pulmonary effects of these drugs when used in the treatment of COPD.
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Affiliation(s)
- Jyotshna Mandal
- Clinic of Pulmonary Medicine, University Hospital Basel and Respiratory Cell Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Michael Roth
- Clinic of Pulmonary Medicine, University Hospital Basel and Respiratory Cell Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Eleni Papakonstantinou
- Clinic of Pulmonary Medicine, University Hospital Basel and Respiratory Cell Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Qingzhu Sun
- Clinic of Pulmonary Medicine, University Hospital Basel and Respiratory Cell Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Luigi Costa
- Clinic of Pulmonary Medicine, University Hospital Basel and Respiratory Cell Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Lucas Boeck
- Clinic of Pulmonary Medicine, University Hospital Basel and Respiratory Cell Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Andreas Scherr
- Clinic of Pulmonary Medicine, University Hospital Basel and Respiratory Cell Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Janko Rakic
- Clinic of Pulmonary Medicine, University Hospital Basel and Respiratory Cell Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | | | | | - Wim Boersma
- Department of Respiratory Diseases, Northwest Hospital Group, Alkmaar, The Netherlands
| | | | - Francesco Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Cardio-thoracic Unit and Cystic Fibrosis Adult Center Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Italy
| | | | - Gernot Rohde
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alicia Lacoma
- Microbiology, Hospital Universitari Germans Trais i Pujol, Badalona, Spain; Universitat Autònoma de Barcelona, CIBER Enfermedades Respiratorias (CIBERES) Instituto de Salud Carlos III, Spain
| | | | - Tobias Welte
- Pneumology, Medizinische Hochschule, Hannover, Germany
| | - Michael Tamm
- Clinic of Pulmonary Medicine, University Hospital Basel and Respiratory Cell Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Daiana Stolz
- Clinic of Pulmonary Medicine, University Hospital Basel and Respiratory Cell Research, Department of Biomedicine, University of Basel, Basel, Switzerland.
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26
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Stockley JA, Cooper BG, Stockley RA, Sapey E. Small airways disease: time for a revisit? Int J Chron Obstruct Pulmon Dis 2017; 12:2343-2353. [PMID: 28848335 PMCID: PMC5557120 DOI: 10.2147/copd.s138540] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
It is increasingly acknowledged that delays in the diagnosis of chronic inflammatory lung conditions have hampered our understanding of pathogenesis and thus our ability to design efficacious therapies. This is particularly true for COPD, where most patients are diagnosed with moderate-to-severe airflow obstruction and little is known about the inflammatory processes present in early disease. There is great interest in developing screening tests that can identify those most at risk of developing COPD before airflow obstruction has developed for the purpose of research and clinical care. Landmark pathology studies have suggested that damage to the small airways precedes the development of airflow obstruction and emphysema and, thus, presents an opportunity to identify those at risk of COPD. However, despite a number of physiological tests being available to assess small airways function, none have been adopted into routine care in COPD. The reasons that tests of small airways have not been utilized widely include variability in test results and a lack of validated reference ranges from which to compare results for some methodologies. Furthermore, population studies have not consistently demonstrated their ability to diagnose disease. However, the landscape may be changing. As the equipment that delivers tests of small airways become more widely available, reference ranges are emerging and newer methodologies specifically seek to address variability and difficulty in test performance. Moreover, there is evidence that while tests of small airways may not be helpful across the full range of established disease severity, there may be specific groups (particularly those with early disease) where they might be informative. In this review, commonly utilized tests of small airways are critically appraised to highlight why these tests may be important, how they can be used and what knowledge gaps remain for their use in COPD.
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Affiliation(s)
| | | | | | - Elizabeth Sapey
- Institute of Inflammation and Ageing, Centre for Translational Inflammation Research, University of Birmingham, Edgbaston, Birmingham, UK
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27
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Port J, Tao Z, Junger A, Joppek C, Tempel P, Husemann K, Singer F, Latzin P, Yammine S, Nagel JH, Kohlhäufl M. A simple method to reconstruct the molar mass signal of respiratory gas to assess small airways with a double-tracer gas single-breath washout. Med Biol Eng Comput 2017; 55:1975-1987. [PMID: 28357624 DOI: 10.1007/s11517-017-1633-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 03/13/2017] [Indexed: 01/13/2023]
Abstract
For the assessment of small airway diseases, a noninvasive double-tracer gas single-breath washout (DTG-SBW) with sulfur hexafluoride (SF6) and helium (He) as tracer components has been proposed. It is assumed that small airway diseases may produce typical ventilation inhomogeneities which can be detected within one single tidal breath, when using two tracer components. Characteristic parameters calculated from a relative molar mass (MM) signal of the airflow during the washout expiration phase are analyzed. The DTG-SBW signal is acquired by subtracting a reconstructed MM signal without tracer gas from the signal measured with an ultrasonic sensor during in- and exhalation of the double-tracer gas for one tidal breath. In this paper, a simple method to determine the reconstructed MM signal is presented. Measurements on subjects with and without obstructive lung diseases including the small airways have shown high reliability and reproducibility of this method.
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Affiliation(s)
- Johannes Port
- Institut für Biomedizinische Technik, Universität Stuttgart, Stuttgart, Germany.
| | - Ziran Tao
- Institut für Biomedizinische Technik, Universität Stuttgart, Stuttgart, Germany
| | - Annika Junger
- Institut für Biomedizinische Technik, Universität Stuttgart, Stuttgart, Germany
| | - Christoph Joppek
- Institut für Biomedizinische Technik, Universität Stuttgart, Stuttgart, Germany
| | - Philipp Tempel
- Institut für Biomedizinische Technik, Universität Stuttgart, Stuttgart, Germany
| | - Kim Husemann
- Klinik Schillerhöhe, Zentrum für Pneumologie und Thoraxchirurgie, Robert-Bosch-Hospital, Gerlingen, Germany.,Internistische Facharztpraxis für Pneumologie, Allergologie, Thoraxonkologie, Bronchoskopie und Schlafmedizin, MVZ Klinikum Kempten GmbH, Kempten, Germany
| | - Florian Singer
- University Children's Hospital Zurich, Zurich, Switzerland
| | - Philipp Latzin
- University Children's Hospital Basel, Basel, Switzerland
| | - Sophie Yammine
- University Children's Hospital Basel, Basel, Switzerland
| | - Joachim H Nagel
- Institut für Biomedizinische Technik, Universität Stuttgart, Stuttgart, Germany
| | - Martin Kohlhäufl
- Klinik Schillerhöhe, Zentrum für Pneumologie und Thoraxchirurgie, Robert-Bosch-Hospital, Gerlingen, Germany
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28
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Silva BRA, Rufino R, Costa CH, Vilela VS, Levy RA, Lopes AJ. Ventilation distribution and small airway function in patients with systemic sclerosis. REVISTA PORTUGUESA DE PNEUMOLOGIA 2017; 23:132-138. [PMID: 28258938 DOI: 10.1016/j.rppnen.2017.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 12/09/2016] [Accepted: 01/09/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Despite the importance of traditional pulmonary function tests (PFTs) in managing systemic sclerosis (SSc), many patients with pulmonary disease diagnosed by computed tomography (CT) present with normal PFTs. OBJECTIVE To evaluate the efficacy of the nitrogen single-breath washout (N2SBW) test in diagnosing SSc and to correlate N2SBW parameters with the PFT indexes used in the follow-up of these patients, clinical data, and CT findings. METHODS Cross-sectional study in which 52 consecutive SSc patients were subjected to spirometry, body plethysmography, analysis of the diffusing capacity for carbon monoxide (DLCO), analysis of respiratory muscle strength, N2SBW testing, and CT analysis. RESULTS Twenty-eight patients had a forced vital capacity (FVC) that was <70% of the predicted value. In the N2SBW test, 44 patients had a phase III slope (Phase III slopeN2SBW) that was >120% of the predicted value, while 15 patients had a closing volume/vital capacity (CV/VC) that was >120% of the predicted value. A significant difference in Phase III slopeN2SBW was observed when the patients with predominant traction bronchiectasis and honeycombing were compared to the patients with other CT patterns (p<0.0001). The Phase III slopeN2SBW was correlated with FVC (rs=-0.845, p<0.0001) and DLCO (rs=-0.600, p<0.0001), and the CV/VC was correlated with FVC (rs=-0.460, p=0.0006) and residual volume/total lung capacity (rs=0.328, p=0.017). CONCLUSION Ventilation heterogeneity is a frequent finding in SSc patients that is associated with restrictive damage, changes in pulmonary diffusion, and CT patterns. In addition, approximately one-third of the patients presented with findings that were compatible with small airway disease.
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Affiliation(s)
- B R A Silva
- Laboratory of Respiratory Physiology, State University of Rio de Janeiro, and Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - R Rufino
- Department of Pulmonology, State University of Rio de Janeiro, and Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - C H Costa
- Department of Pulmonology, State University of Rio de Janeiro, and Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - V S Vilela
- Department of Rheumatology, State University of Rio de Janeiro, and Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - R A Levy
- Department of Rheumatology, State University of Rio de Janeiro, and Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - A J Lopes
- Laboratory of Respiratory Physiology, State University of Rio de Janeiro, and Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
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