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Leite LR, Queiroz KCV, Coelho CC, Vergara AA, Donadio MVF, Aquino EDS. FUNCTIONAL PERFORMANCE IN THE MODIFIED SHUTTLE TEST IN CHILDREN AND ADOLESCENTS WITH CYSTIC FIBROSIS. ACTA ACUST UNITED AC 2020; 39:e2019322. [PMID: 32785464 PMCID: PMC7418338 DOI: 10.1590/1984-0462/2021/39/2019322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/19/2020] [Indexed: 11/21/2022]
Abstract
Objective: To evaluate factors associated with the performance of children and
adolescents with cystic fibrosis (CF) in the Modified Shuttle Test (MST) and
compare it with healthy children and adolescents. Methods: This is a cross-sectional study, with children and adolescents divided into
two groups: cystic fibrosis (CFG) and control (CG). Variables evaluated in
the MST: walking distance, test level, heart rate variation (∆Hr), post-test
mean arterial pressure (MAP Pt) and peripheral oxygen saturation variation
(∆SPO2). Statistical analysis included Mann Whitney and
Spearman coefficient tests, being significant p<0.05. Results: Sixty individuals aged 6-16 years old were evaluated. Anthropometric data
was similar between groups. Differences between groups were shown for:
baseline heart rate (BHr), peak heart rate (PHr), ∆Hr, recovery heart rate
(RHr), post-test respiratory rate (PtBr), saturation variables, peripheral
oxygen level (SpO2B) and level test. The ∆Hr and MAP Pt had a
moderate positive correlation with distance and level test for both groups
(respectively: r=0.6 / p<0.001; r=0.6 / p<0.001). In CFG, the level
test had a significant association (r=0.4 - p=0.02) with
%FEV1. Conclusions: Children with cystic fibrosis presented functional limitation in the
Modified Shuttle Test, which was influenced by lung function.
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Bisch AL, Wheatley CM, Baker SE, Peitzman ER, Van Iterson EH, Laguna TA, Morgan WJ, Snyder EM. Cystic Fibrosis Transmembrane Conductance Regulator Genotype, Not Circulating Catecholamines, Influences Cardiovascular Function in Patients with Cystic Fibrosis. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2019; 13:1179548419835788. [PMID: 30956528 PMCID: PMC6442074 DOI: 10.1177/1179548419835788] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 01/30/2019] [Indexed: 01/07/2023]
Abstract
Background: Cystic fibrosis (CF) is a genetic disease affecting multiple organ systems of the body and is characterized by mutation in the gene coding for the cystic fibrosis transmembrane conductance regulator (CFTR). Previous work has shown that a single dose of aβ-agonist increases cardiac output (Q) and stroke volume (SV) and decreases systemic vascular resistance (SVR) in healthy subjects. This effect is attenuated in patients with CF; however, the mechanism is unknown. Potential explanations for this decreased cardiovascular response to a β-agonist in CF include inherent cardiovascular deficits secondary to the CFTR mutation, receptor desensitization from prolonged β-agonist use as part of clinical care, or inhibited drug delivery to the bloodstream due to mucus buildup in the lungs. This study sought to determine the effects of endogenous epinephrine (EPI) and norepinephrine (NE) on cardiovascular function in CF and to evaluate the relationship between cardiovascular function and CFTR F508del mutation. Methods: A total of 19 patients with CF and 31 healthy control subjects completed an assessment of Q (C2H2 rebreathing), SV (calculated from Q and heart rate [HR]), Q and SV indexed to body surface area (BSA, QI, and SVI, respectively), SVR (through assessment of Q and mean arterial blood pressure [MAP]), and HR (from 12-lead electrocardiogram [ECG]) at rest along with plasma measures of EPI and NE. We compared subjects by variables of cardiovascular function relative to EPI and NE, and also based on genetic variants of the F508del mutation (homozygous deletion for F508del, heterozygous deletion for F508del, or no deletion of F508del). Results: Cystic fibrosis patients demonstrated significantly lower BSA (CF = 1.71 ± 0.05 m2 vs healthy = 1.84 ± 0.04 m2, P = .03) and SVI (CF = 30.6 ± 2.5 mL/beat/m2 vs healthy = 39.9 ± 2.5 mL/beat/m2, P = .02) when compared with healthy subjects. Cystic fibrosis patients also demonstrated lower Q (CF = 4.58 ± 0.36 L/min vs healthy = 5.71 ± 0.32 L/min, P = .03) and SV (CF = 54 ± 5.5 mL/beat vs healthy = 73.3 ± 4.5 mL/beat, P = .01), and a higher HR (CF = 93.2 ± 3.9 bpm vs healthy = 80.5 ± 2.7 bpm, P < .01) and SVR (CF = 2082 ± 156 dynes*s/cm−5 vs healthy = 1616 ± 74 dynes*s/cm−5, P = .01) compared with healthy subjects. Furthermore, CF patients demonstrated a lower SV (P < .01) corrected for NE when compared with healthy subjects. No significant differences were seen in HR or Q relative to NE, or SVR relative to EPI. Differences were seen in SV (F(2,14) = 7.982, P < .01) and SV index (F(2,14) = 2.913, P = .08) when patients with CF were stratified according to F508del mutation (number of deletions). Conclusions: Individuals with CF have lower cardiac and peripheral hemodynamic function parameters at rest. Furthermore, these results suggest that impairment in cardiovascular function is likely the result of F508del CFTR genotype, rather than receptor desensitization or inhibited drug delivery.
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Affiliation(s)
- Alexander L Bisch
- Department of Kinesiology, University of Minnesota, Minneapolis, MN, USA
| | - Courtney M Wheatley
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Sarah E Baker
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth R Peitzman
- Department of Biology, Health Science Center, University of Wisconsin La Crosse, La Crosse, WI, USA
| | | | - Theresa A Laguna
- Division of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Wayne J Morgan
- Arizona Respiratory Center, The University of Arizona, Tucson, AZ, USA
| | - Eric M Snyder
- Department of Kinesiology, University of Minnesota, Minneapolis, MN, USA
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3
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Wheatley CM, Baker SE, Daines CM, Phan H, Martinez MG, Morgan WJ, Snyder EM. Influence of the Vibralung Acoustical Percussor on pulmonary function and sputum expectoration in individuals with cystic fibrosis. Ther Adv Respir Dis 2019; 12:1753466618770997. [PMID: 29697011 PMCID: PMC5961921 DOI: 10.1177/1753466618770997] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The Vibralung Acoustical Percussor is a new airway clearance therapy (ACT) utilizing intrapulmonary sound waves in addition to positive expiratory pressure (PEP). We evaluated the safety of the Vibralung and collected preliminary data on its ability to mediate sputum expectoration in individuals with cystic fibrosis (CF). Methods: Over two separate studies, 10 and 11 mild to moderate CF patients were recruited for study I and II, respectively. Study I: Vibralung was used for 20 min with either no sound (NS: PEP only) or sound (S: PEP and sound) on randomized visits. Pulmonary function, diffusion capacity of the lungs for carbon monoxide and nitric oxide (DLCO/DLNO), symptoms, and peripheral oxygen saturation (SpO2) were measured at baseline and at 1 and 4 h post treatment. Expectorated sputum was collected over 4 h post treatment. Study II: over 5 days of in-hospital therapy, the Vibralung or vibratory vest therapy (Vest) were used for two therapy sessions per day, with sputum collected for 20 min following each therapy and pulmonary function accessed pre and post each 5-day period (days 1–5 or 7–11) in a randomized crossover design. Results: Vibralung usage resulted in no change from baseline to 4 h post in pulmonary function, SpO2 or symptoms (p > 0.05). At 4 h post therapy, the DLCO- and DLNO-derived measure of alveolar–capillary unit function (DM/VC) showed improvement (DM/VC = 12.5 ± 5.5 versus 7.3 ± 18.8% change, S versus NS) with no difference between S and NS (p = 0.74). Sputum expectoration was similar between S and NS conditions (wet sputum = 10.5 ± 4.6 versus 9.9 ± 3.2 g, S versus NS, p = 0.25). There were no differences in the improvement in pulmonary function between Vibralung and Vest during either 5-day period during the hospital stay. Conclusions: Vibralung was well tolerated and caused no detrimental changes in pulmonary function metrics. The Vibralung appears to be a safe ACT in individuals with CF.
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Affiliation(s)
- Courtney M Wheatley
- Department of Cardiovascular Diseases, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ, USA
| | - Sarah E Baker
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ, USA
| | - Cori M Daines
- Department of Pediatrics-Pediatric Pulmonology and Sleep, University of Arizona, Tucson, AZ, USA Banner-University Medical Center, Tucson, AZ, USA
| | - Hanna Phan
- Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ, USA Department of Pediatrics-Pediatric Pulmonology and Sleep, University of Arizona, Tucson, AZ, USA
| | - Marina G Martinez
- Arizona Clinical Research Center, University of Arizona, Tucson, AZ, USA
| | - Wayne J Morgan
- Department of Pediatrics-Pediatric Pulmonology and Sleep, University of Arizona, Tucson, AZ, USA Banner-University Medical Center, Tucson, AZ, USA
| | - Eric M Snyder
- Department of Kinesiology, University of Minnesota, Minneapolis, MN, USA; and Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ, USA
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4
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Van Iterson EH, Baker SE, Wheatley CM, Morgan WJ, Olson TP, Snyder EM. Exercise Stroke Volume in Adult Cystic Fibrosis: A Comparison of Acetylene Pulmonary Uptake and Oxygen Pulse. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2018; 12:1179548418790564. [PMID: 30083061 PMCID: PMC6073827 DOI: 10.1177/1179548418790564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 06/28/2018] [Indexed: 12/19/2022]
Abstract
Cardiac hemodynamic assessment during cardiopulmonary exercise testing (CPET) is proposed to play an important role in the clinical evaluation of individuals with cystic fibrosis (CF). Cardiac catheterization is not practical for routine clinical CPET. Use of oxygen pulse (O2pulse) as a noninvasive estimate of stroke volume (SV) has not been validated in CF. This study tested the hypothesis that peak exercise O2pulse is a valid estimate of SV in CF. Measurements of SV via the acetylene rebreathe technique were acquired at baseline and peak exercise in 17 mild-to-moderate severity adult CF and 25 age-matched healthy adults. We calculated O2pulse=V.O2HR. Baseline relationships between SV and O2pulse were significant in CF (r = .80) and controls (r = .40), persisting to peak exercise in CF (r = .63) and controls (r = .73). The standard error of estimate for O2pulse-predicted SV with respect to measured SV was similar at baseline (14.1 vs 20.1 mL) and peak exercise (18.2 vs 13.9 mL) for CF and controls, respectively. These data suggest that peak exercise O2pulse is a valid estimate of SV in CF. The ability to noninvasively estimate SV via O2pulse during routine clinical CPET can be used to improve test interpretation and advance our understanding of the impact cardiac dysfunction has on exercise intolerance in CF.
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Affiliation(s)
| | - Sarah E Baker
- College of Pharmacy, The University of Arizona, Tucson, AZ, USA.,Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | - Courtney M Wheatley
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.,College of Pharmacy, The University of Arizona, Tucson, AZ, USA
| | - Wayne J Morgan
- Department of Pediatrics, The University of Arizona, Tucson, AZ, USA
| | - Thomas P Olson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Eric M Snyder
- College of Pharmacy, The University of Arizona, Tucson, AZ, USA.,School of Kinesiology, University of Minnesota, Minneapolis, MN, USA
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5
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Munkholm M, Marott JL, Bjerre-Kristensen L, Madsen F, Pedersen OF, Lange P, Nordestgaard B, Mortensen J. Reference equations for pulmonary diffusing capacity of carbon monoxide and nitric oxide in adult Caucasians. Eur Respir J 2018; 52:13993003.00677-2015. [DOI: 10.1183/13993003.00677-2015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 05/19/2018] [Indexed: 11/05/2022]
Abstract
The aim of this study was to determine reference equations for the combined measurement of diffusing capacity of the lung for carbon monoxide (CO) and nitric oxide (NO) (DLCONO). In addition, we wanted to appeal for consensus regarding methodology of the measurement including calculation of diffusing capacity of the alveolo-capillary membrane (Dm) and pulmonary capillary volume (Vc).DLCONO was measured in 282 healthy individuals aged 18–97 years using the single-breath technique and a breath-hold time of 5 s (true apnoea period). The following values were used: 1) specific conductance of nitric oxide (θNO)=4.5 mLNO·mLblood−1·min−1·mmHg−1; 2) ratio of diffusing capacity of the membrane for NO and CO (DmNO/DmCO)=1.97; and 3) 1/red cell CO conductance (1/θCO)=(1.30+0.0041·mean capillary oxygen pressure)·(14.6/Hb concentration in g·dL−1).Reference equations were established for the outcomes of DLCONO, including DLCO and DLNO and the calculated values Dm and Vc. Independent variables were age, sex, height and age squared.By providing new reference equations and by appealing for consensus regarding the methodology, we hope to provide a basis for future studies and clinical use of this novel and interesting method.
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6
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Wheatley CM, Baker SE, Taylor BJ, Keller-Ross ML, Chase SC, Carlson AR, Wentz RJ, Snyder EM, Johnson BD. Influence of Inhaled Amiloride on Lung Fluid Clearance in Response to Normobaric Hypoxia in Healthy Individuals. High Alt Med Biol 2017; 18:343-354. [PMID: 28876128 DOI: 10.1089/ham.2017.0032] [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: 11/13/2022] Open
Abstract
Wheatley, Courtney M., Sarah E. Baker, Bryan J. Taylor, Manda L. Keller-Ross, Steven C. Chase, Alex R. Carlson, Robert J. Wentz, Eric M. Snyder, and Bruce D. Johnson. Influence of inhaled amiloride on lung fluid clearance in response to normobaric hypoxia in healthy individuals. High Alt Med Biol 18:343-354, 2017. AIM To investigate the role of epithelial sodium channels (ENaC) on lung fluid clearance in response to normobaric hypoxia, 20 healthy subjects were exposed to 15 hours of hypoxia (fraction of inspired oxygen [FiO2] = 12.5%) on two randomized occasions: (1) inhaled amiloride (A) (1.5 mg/5 mL saline); and (2) inhaled saline placebo (P). Changes in lung fluid were assessed through chest computed tomography (CT) for lung tissue volume (TV), and the diffusion capacity of the lungs for carbon monoxide (DLCO) and nitric oxide (DLNO) for pulmonary capillary blood volume (VC). Extravascular lung water (EVLW) was derived as TV-VC and changes in the CT attenuation distribution histograms were reviewed. RESULTS Normobaric hypoxia caused (1) a reduction in EVLW (change from baseline for A vs. P, -8.5% ± 3.8% vs. -7.9% ± 5.2%, p < 0.05), (2) an increase in VC (53.6% ± 28.9% vs. 53.9% ± 52.3%, p < 0.05), (3) a small increase in DLCO (9.6% ± 29.3% vs. 9.9% ± 23.9%, p > 0.05), and (4) CT attenuation distribution became more negative, leftward skewed, and kurtotic (p < 0.05). CONCLUSION Acute normobaric hypoxia caused a reduction in lung fluid that was unaffected by ENaC inhibition through inhaled amiloride. Although possible amiloride-sensitive ENaC may not be necessary to maintain lung fluid balance in response to hypoxia, it is more probable that normobaric hypoxia promotes lung fluid clearance rather than accumulation for the majority of healthy individuals. The observed reduction in interstitial lung fluid means alveolar fluid clearance may not have been challenged.
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Affiliation(s)
- Courtney M Wheatley
- 1 Department of Pharmaceutical Science, University of Arizona , Tucson, Arizona
| | - Sarah E Baker
- 1 Department of Pharmaceutical Science, University of Arizona , Tucson, Arizona
| | - Bryan J Taylor
- 2 Division of Cardiovascular Diseases, Mayo Clinic , Rochester, Minnesota
| | | | - Steven C Chase
- 2 Division of Cardiovascular Diseases, Mayo Clinic , Rochester, Minnesota
| | - Alex R Carlson
- 2 Division of Cardiovascular Diseases, Mayo Clinic , Rochester, Minnesota
| | - Robert J Wentz
- 2 Division of Cardiovascular Diseases, Mayo Clinic , Rochester, Minnesota
| | - Eric M Snyder
- 1 Department of Pharmaceutical Science, University of Arizona , Tucson, Arizona
| | - Bruce D Johnson
- 2 Division of Cardiovascular Diseases, Mayo Clinic , Rochester, Minnesota
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7
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Intra-session and inter-session variability of nitric oxide pulmonary diffusing capacity in adults with cystic fibrosis. Respir Physiol Neurobiol 2017; 246:33-38. [PMID: 28782664 DOI: 10.1016/j.resp.2017.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/30/2017] [Accepted: 08/01/2017] [Indexed: 11/24/2022]
Abstract
We evaluated the intra-session and inter-session variability of the diffusing capacity of nitric oxide (DLNO), carbon monoxide (DLCO), alveolar-capillary membrane diffusing capacity for carbon monoxide (DMCO) and pulmonary capillary blood volume (Vc) in patients with cystic fibrosis (CF). Patients performed single-breath diffusing capacity measurements during all of 3 consecutive study visits. Precision of gas diffusing parameters was quantified by within-subject standard deviation (SDws) and coefficient of variation (CV). Intra-session and inter-session reproducibility was determined by SDws*2.77. 15 clinically stable patients were included. The intra-session precision of gas diffusing parameters improved over the study visits. The inter-session SDws for DLNO, DLCO, DMCO, and Vc was 4.8, 1.3, 2.4, and 4.3, respectively. Reproducibility was 13.3, 3.8, 6.7 and 12.0mLmin-1mmHg-1; CV was 4.4, 4.7, 4.4 and 5.8%, respectively. The intra-session variability of DLNO, DLCO, DMCO and Vc improves with breath-hold maneuver training in test-naïve patients with CF, indicating a learning effect. Inter-session reproducibility data are lower than those previously reported in healthy subjects.
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8
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Can the measurement of pulmonary diffusing capacity for nitric oxide replace the measurement of pulmonary diffusing capacity for carbon monoxide? Respir Physiol Neurobiol 2017; 241:9-16. [DOI: 10.1016/j.resp.2016.11.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/17/2016] [Accepted: 11/18/2016] [Indexed: 11/19/2022]
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9
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Giraud X, Le-Dong NN, Hogben K, Martinot JB. The measurement of DLNO and DLCO: A manufacturer's perspective. Respir Physiol Neurobiol 2017; 241:36-44. [PMID: 28214604 DOI: 10.1016/j.resp.2017.02.006] [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: 10/28/2016] [Revised: 02/06/2017] [Accepted: 02/10/2017] [Indexed: 02/01/2023]
Abstract
The simultaneous measurement of the lung transfer factor for carbon monoxide (DLCO) and nitric oxide (DLNO) is now available as a powerful method for studying the alveolar-capillary gas exchange. However, application of the DLNO-CO technique in daily settings is still limited by some technical drawbacks. This paper provides a manufacturer's overview of the measuring principles, technical challenges and current available solutions for implementing the DLNO-CO measurement in to a marketed device. This includes the recent developments in technology for NO sensors, latest findings on NO uptake and new statistical methods.
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Affiliation(s)
- X Giraud
- Medisoft-MGCD, Sorinnes, Belgium
| | - N N Le-Dong
- RespiSom Private Research Medical Center, Namur, Belgium.
| | - K Hogben
- Medisoft-MGCD, Sorinnes, Belgium
| | - J B Martinot
- CHU-UCL Namur, Place Louise Godin 15, 5000, Namur, Belgium
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10
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Kriemler S, Radtke T, Christen G, Kerstan-Huber M, Hebestreit H. Short-Term Effect of Different Physical Exercises and Physiotherapy Combinations on Sputum Expectoration, Oxygen Saturation, and Lung Function in Young Patients with Cystic Fibrosis. Lung 2016; 194:659-64. [DOI: 10.1007/s00408-016-9888-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 04/23/2016] [Indexed: 11/30/2022]
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11
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Van Iterson EH, Wheatley CM, Baker SE, Morgan WJ, Snyder EM. The relationship between cardiac hemodynamics and exercise tolerance in cystic fibrosis. Heart Lung 2016; 45:283-90. [PMID: 27045901 PMCID: PMC4860124 DOI: 10.1016/j.hrtlng.2016.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 02/22/2016] [Accepted: 03/03/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Individuals with cystic fibrosis (CF) have reduced pulmonary function and exercise tolerance. Additionally, these individuals may develop abnormal cardiac function. The implications of abnormal cardiac function on exercise tolerance are unclear in CF. OBJECTIVE Study relationships between exercise cardiac hemodynamics and exercise tolerance in CF. METHODS 17 CF and 25 controls participated in cardiopulmonary exercise testing to measure exercise duration and peak workload (PW). Cardiac index (QI) was measured using acetylene rebreathe and oxygen uptake (VO2) breath-by-breath. Forced expiratory volume in 1-second (FEV1) was performed at rest. RESULTS Peak QI was 6.7 ± 0.5 vs. 9.1 ± 0.3 mL/min/m(2), CF vs. controls, respectively (P < 0.05). Linear regressions between QI (R(2) = 0.63 and 0.51) and exercise duration or PW were stronger than VO2 (R(2) = 0.35 and 0.37) or FEV1 (R(2) = 0.34 and 0.36) in CF, respectively (P < 0.05). CONCLUSION These data are clinically relevant suggesting attenuated cardiac function in addition to low airway function relate to exercise tolerance in CF.
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Affiliation(s)
- Erik H. Van Iterson
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
- School of Kinesiology, University of Minnesota, Cooke Hall, 1900 University Ave SE. Minneapolis, MN 55455
| | - Courtney M. Wheatley
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
- College of Pharmacy, University of Arizona, 1295 N Martin Ave, Tucson, AZ 85721
| | - Sarah E. Baker
- College of Pharmacy, University of Arizona, 1295 N Martin Ave, Tucson, AZ 85721
- Department of Anesthesiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Wayne J. Morgan
- Department of Pediatrics, University of Arizona, 1501 N. Campbell Avenue, Room 3301, Tucson, AZ 85724
| | - Eric M. Snyder
- School of Kinesiology, University of Minnesota, Cooke Hall, 1900 University Ave SE. Minneapolis, MN 55455
- College of Pharmacy, University of Arizona, 1295 N Martin Ave, Tucson, AZ 85721
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12
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Coffman KE, Taylor BJ, Carlson AR, Wentz RJ, Johnson BD. Optimizing the calculation of DM,CO and VC via the single breath single oxygen tension DLCO/NO method. Respir Physiol Neurobiol 2015; 221:19-29. [PMID: 26521031 DOI: 10.1016/j.resp.2015.10.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/08/2015] [Accepted: 10/25/2015] [Indexed: 11/26/2022]
Abstract
Alveolar-capillary membrane conductance (D(M,CO)) and pulmonary-capillary blood volume (V(C)) are calculated via lung diffusing capacity for carbon monoxide (DL(CO)) and nitric oxide (DL(NO)) using the single breath, single oxygen tension (single-FiO2) method. However, two calculation parameters, the reaction rate of carbon monoxide with blood (θ(CO)) and the D(M,NO)/D(M,CO) ratio (α-ratio), are controversial. This study systematically determined optimal θ(CO) and α-ratio values to be used in the single-FiO2 method that yielded the most similar D(M,CO) and V(C) values compared to the 'gold-standard' multiple-FiO2 method. Eleven healthy subjects performed single breath DL(CO)/DL(NO) maneuvers at rest and during exercise. D(M,CO) and V(C) were calculated via the single-FiO2 and multiple-FiO2 methods by implementing seven θ(CO) equations and a range of previously reported α-ratios. The RP θ(CO) equation (Reeves, R.B., Park, H.K., 1992. Respiration Physiology 88 1-21) and an α-ratio of 4.0-4.4 yielded DM,CO and VC values that were most similar between methods. The RP θ(CO) equation and an experimental α-ratio should be used in future studies.
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Affiliation(s)
- Kirsten E Coffman
- Mayo Graduate School, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA.
| | - Bryan J Taylor
- Sport & Health Sciences, University of Exeter, Heavitree Road, Exeter, UK; Division of Cardiovascular Diseases, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA.
| | - Alex R Carlson
- Division of Cardiovascular Diseases, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA.
| | - Robert J Wentz
- Division of Cardiovascular Diseases, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA.
| | - Bruce D Johnson
- Division of Cardiovascular Diseases, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA.
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13
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Van Iterson EH, Karpen SR, Baker SE, Wheatley CM, Morgan WJ, Snyder EM. Impaired cardiac and peripheral hemodynamic responses to inhaled β₂-agonist in cystic fibrosis. Respir Res 2015; 16:103. [PMID: 26341519 PMCID: PMC4560914 DOI: 10.1186/s12931-015-0270-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/19/2015] [Indexed: 11/25/2022] Open
Abstract
Background Pulmonary system dysfunction is a hallmark of cystic fibrosis (CF) disease. In addition to impaired cystic fibrosis transmembrane conductance regulator protein, dysfunctional β2-adrenergic receptors (β2AR) contribute to low airway function in CF. Recent observations suggest CF may also be associated with impaired cardiac function that is demonstrated by attenuated cardiac output (Q), stroke volume (SV), and cardiac power (CP) at both rest and during exercise. However, β2AR regulation of cardiac and peripheral vascular tissue, in-vivo, is unknown in CF. We have previously demonstrated that the administration of an inhaled β-agonist increases SV and Q while also decreasing SVR in healthy individuals. Therefore, we aimed to assess cardiac and peripheral hemodynamic responses to the selective β2AR agonist albuterol in individuals with CF. Methods 18 CF and 30 control (CTL) subjects participated (ages 22 ± 2 versus 27 ± 2 and BSA = 1.7 ± 0.1 versus 1.8 ± 0.0 m2, both p < 0.05). We assessed the following at baseline and at 30- and 60-minutes following nebulized albuterol (2.5mg diluted in 3.0mL of normal saline) inhalation: 12-lead ECG for HR, manual sphygmomanometry for systolic and diastolic blood pressure (SBP and DBP, respectively), acetylene rebreathe for Q and SV. We calculated MAP = DBP + 1/3(SBP–DBP); systemic vascular resistance (SVR) = (MAP/Q)•80; CP = Q•MAP; stroke work (SW) = SV•MAP; reserve (%change baseline to 30- or 60-minutes). Hemodynamics were indexed to BSA (QI, SVI, SWI, CPI, SVRI). Results At baseline, CF demonstrated lower SV, SVI, SW, and SWI but higher HR than CTL (p < 0.05); other measures did not differ. At 30-minutes, CF demonstrated higher HR and SVRI, but lower Q, SV, SVI, CP, CPI, SW, and SWI versus CTL (p < 0.05). At 60-minutes, CF demonstrated higher HR, SVR, and SVRI, whereas all cardiac hemodynamics were lower than CTL (p < 0.05). Reserves of CP, SW, and SVR were lower in CF versus CTL at both 30 and 60-minutes (p < 0.05). Conclusions Cardiac and peripheral hemodynamic responsiveness to acute β2AR stimulation via albuterol is attenuated in individuals with CF, suggesting β2AR located in cardiac and peripheral vascular tissue may be dysfunctional in this population.
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Affiliation(s)
- Erik H Van Iterson
- School of Kinesiology, University of Minnesota, Cooke Hall, 1900 University Ave SE., Minneapolis, MN, 55455, USA. .,Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Stephen R Karpen
- College of Pharmacy, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85721, USA.
| | - Sarah E Baker
- College of Pharmacy, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85721, USA. .,Department of Anesthesiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Courtney M Wheatley
- College of Pharmacy, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85721, USA. .,Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Wayne J Morgan
- Department of Pediatrics, University of Arizona, 1501 N. Campbell Avenue, Room 3301, Tucson, AZ, 85724, USA.
| | - Eric M Snyder
- School of Kinesiology, University of Minnesota, Cooke Hall, 1900 University Ave SE., Minneapolis, MN, 55455, USA. .,College of Pharmacy, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85721, USA.
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Wheatley CM, Baker SE, Morgan MA, Martinez MG, Morgan WJ, Wong EC, Karpen SR, Snyder EM. Effects of exercise intensity compared to albuterol in individuals with cystic fibrosis. Respir Med 2014; 109:463-74. [PMID: 25749641 DOI: 10.1016/j.rmed.2014.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 12/02/2014] [Accepted: 12/04/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although exercise is a vital component of the therapy prescribed to individuals with cystic fibrosis (CF), it is not a priority due to a finite amount of treatment time and the view that exercise is not as beneficial as pharmacological treatments by many individuals with CF. We sought to compare the therapeutic benefits of exercise and their prescribed bronchodilator albuterol. METHODS CF (n = 14) and healthy (n = 16) subjects completed three visits, a baseline screening with VO2 max test and two treatment visits. On the two treatment visits, subjects completed spirometry and diffusing capacity of the lungs for nitric oxide (DLNO) maneuvers either at baseline, 60, and 110 min post-albuterol administration, or at baseline and the midway point of three separate 15 min exercise bouts at low, moderate and vigorous intensity (25, 50 and 65% of the maximum workload, respectively). RESULTS With moderate exercise the increase in DLNO was double (39 ± 8 vs 15 ± 6% change) and the level of bronchodilation similar (23% change) when compared to 110 min post-albuterol in individuals with CF. During exercise FVC became reduced (-309 ± 66 mL with moderate exercise) and the increase in FEV1 was attenuated (103 ± 39 vs 236 ± 58 mL, exercise vs. albuterol) when compared with the response to albuterol in individuals with CF. Epinephrine (EPI) release increased 39, 72 and 144% change with low, moderate and vigorous intensity exercise respectively for individuals with CF, but this increase was blunted when compared to healthy subjects. CONCLUSION Our results suggest that moderate intensity exercise is the optimal intensity for individuals with CF, as low intensity exercise increases EPI less than 50% and vigorous intensity exercise is over taxing, such that airflow can be restricted. Although the duration of the beneficial effect is uncertain, exercise can promote greater improvements in gas diffusion and comparable bronchodilation when compared to albuterol.
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Affiliation(s)
- Courtney M Wheatley
- Department of Pharmacy Practice & Science, University of Arizona, Tucson, AZ, USA; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
| | - Sarah E Baker
- Department of Pharmacy Practice & Science, University of Arizona, Tucson, AZ, USA; Department of Kinesiology, University of Minnesota, Minneapolis, MN, USA.
| | - Mary A Morgan
- Department of Pharmacy Practice & Science, University of Arizona, Tucson, AZ, USA.
| | - Marina G Martinez
- Department of Pharmacy Practice & Science, University of Arizona, Tucson, AZ, USA.
| | - Wayne J Morgan
- Department of Pediatrics- Pulmonology, Allergy and Immunology, University of Arizona, Tucson, AZ, USA.
| | - Eric C Wong
- Department of Pharmacy Practice & Science, University of Arizona, Tucson, AZ, USA.
| | - Stephen R Karpen
- Department of Pharmacy Practice & Science, University of Arizona, Tucson, AZ, USA.
| | - Eric M Snyder
- Department of Pharmacy Practice & Science, University of Arizona, Tucson, AZ, USA; Department of Kinesiology, University of Minnesota, Minneapolis, MN, USA.
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Fitzgerald NM, Kennedy B, Fitzgerald DA, Selvadurai H. Diffusion capacity of carbon monoxide (DLCO) pre- and post-exercise in children in health and disease. Pediatr Pulmonol 2014; 49:782-9. [PMID: 24395764 DOI: 10.1002/ppul.22925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 07/30/2013] [Indexed: 11/10/2022]
Abstract
RATIONALE A decrease in diffusion capacity for carbon monoxide (DLCO) after exercise has been reported in healthy adults. There is limited information for post-exercise DLCO available in children either in health or in disease. OBJECTIVES To evaluate (1) reproducibility of DLCO measures in children, (2) differences in DLCO between elite athletic swimmers (AS), stable cystic fibrosis patients (CF), and healthy controls (Con) at rest; and (3) after a maximal treadmill exercise test. METHODS Participants performed spirometry and DLCO at baseline, a maximal treadmill exercise test and repeated DLCO measures for 2 hr after cessation of exercise. RESULTS The mean (SD) co-efficient of variation between baseline DLCO tests was 2.49% (1.86%). In girls, the mean baseline DLCO (ml/min/mmHg) was 18.61 (4.15) in CF, 22.32 (4.79) in controls and 27.18 (5.33) in AS. In boys: 23.68 (5.31) in CF, 28.09 (9.95) in controls and 37.75 (9.46) in AS. Baseline DLCO was significantly higher in AS than in CF patients (P < 0.01). In girls post-exercise, the greatest mean decrease in DLCO from baseline was -7.50% to -12.83% and in boys -6.92% to -17.71%. The decline in DLCO was less important in the athletes than the other groups (P < 0.05). CONCLUSIONS DLCO is highly repeatable in children. AS have an increased DLCO at rest compared to both children with CF and controls. There is a decline from baseline to post-exercise DLCO and while there are disease-specific differences, the general pattern of change in DLCO measures after exercise is similar in children to adults.
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Affiliation(s)
- Nicholas M Fitzgerald
- University of New South Wales, Sydney, Australia; Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia
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Wheatley CM, Morgan WJ, Cassuto NA, Foxx-Lupo WT, Daines CL, Morgan MA, Phan H, Snyder EM. Exhaled breath condensate detects baseline reductions in chloride and increases in response to albuterol in cystic fibrosis patients. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2013; 7:79-90. [PMID: 24367235 PMCID: PMC3869628 DOI: 10.4137/ccrpm.s12882] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Impaired ion regulation and dehydration is the primary pathophysiology in cystic fibrosis (CF) lung disease. A potential application of exhaled breath condensate (EBC) collection is to assess airway surface liquid ionic composition at baseline and in response to pharmacological therapy in CF. Our aims were to determine if EBC could detect differences in ion regulation between CF and healthy and measure the effect of the albuterol on EBC ions in these populations. Baseline EBC Cl−, DLCO and SpO2 were lower in CF (n = 16) compared to healthy participants (n = 16). EBC Cl− increased in CF subjects, while there was no change in DLCO or membrane conductance, but a decrease in pulmonary-capillary blood volume in both groups following albuterol. This resulted in an improvement in diffusion at the alveolar-capillary unit, and removal of the baseline difference in SpO2 by 90-minutes in CF subjects. These results demonstrate that EBC detects differences in ion regulation between healthy and CF individuals, and that albuterol mediates increases in Cl− in CF, suggesting that the benefits of albuterol extend beyond simple bronchodilation.
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Affiliation(s)
- Courtney M Wheatley
- Department of Pharmacy Practice and Science, University of Arizona, Tucson, Arizona
| | - Wayne J Morgan
- Department of Pediatrics- Pulmonology, Allergy and Immunology, University of Arizona, Tucson, Arizona
| | - Nicholas A Cassuto
- Department of Pharmacy Practice and Science, University of Arizona, Tucson, Arizona
| | - William T Foxx-Lupo
- Department of Pharmacy Practice and Science, University of Arizona, Tucson, Arizona
| | - Cori L Daines
- Department of Pediatrics- Pulmonology, Allergy and Immunology, University of Arizona, Tucson, Arizona
| | - Mary A Morgan
- Department of Pharmacy Practice and Science, University of Arizona, Tucson, Arizona
| | - Hanna Phan
- Department of Pharmacy Practice and Science, University of Arizona, Tucson, Arizona. ; Department of Pediatrics- Pulmonology, Allergy and Immunology, University of Arizona, Tucson, Arizona
| | - Eric M Snyder
- Department of Pharmacy Practice and Science, University of Arizona, Tucson, Arizona
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Abstract
There is comparatively little data on diffusion capacity in children during exercise. With the advent of improved technology, there is an increasing interest in exercise testing of children in order to predict the evolution of lung disease. In addition to the standard measure of exercise capacity, the VO(2max), interest is evolving in the consequences of alterations in diffusion capacity which may be unmasked with exercise. This review will consider what is known about diffusion capacity with exercise in children with well documented lung disease in the form of cystic fibrosis, healthy controls and swimmers as elite athletes with the largest lung volumes.
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Baker SE, Wong EC, Wheatley CM, Foxx-Lupo WT, Martinez MG, Morgan MA, Sprissler R, Morgan WJ, Snyder EM. Genetic variation of SCNN1A influences lung diffusing capacity in cystic fibrosis. Med Sci Sports Exerc 2013; 44:2315-21. [PMID: 22776878 DOI: 10.1249/mss.0b013e318266ebc3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Epithelial Na channels (ENaCs) play a crucial role in ion and fluid regulation in the lung. In cystic fibrosis (CF), Na hyperabsorption results from ENaC overactivity, leading to airway dehydration. Previous work has demonstrated functional genetic variation of SCNN1A (the gene encoding the ENaC α-subunit), manifesting as an alanine (A) to threonine (T) substitution at amino acid 663, with the αT663 variant resulting in a more active channel. METHODS We assessed the influence of genetic variation of SCNN1A on the diffusing capacity of the lungs for carbon monoxide (DLCO) and nitric oxide (DLNO), together with alveolar-capillary membrane conductance (DM), pulmonary capillary blood volume, and alveolar volume (VA) at rest and during peak exercise in 18 patients with CF (10 homozygous for αA663 (AA group) and 8 with at least one T663 allele (AT/TT group)). Because of the more active channel, we hypothesized that the AT/TT group would show a greater increase in DLCO, DLNO, and DM with exercise because of exercise-mediated ENaC inhibition and subsequent attenuation of Na hyperabsorption. RESULTS The AT/TT group had significantly lower pulmonary function, weight, and body mass index than the AA group. Both groups had similar peak workloads, relative peak oxygen consumptions, and cardiopulmonary responses to exercise. The AT/TT group demonstrated a greater increase in DLNO, DLNO/VA, and DM in response to exercise (% increases: DLNO = 18 ± 11 vs 41 ± 38; DLNO/VA = 14 ± 21 vs 40 ± 37; DM = 15 ± 11 vs 41 ± 38, AA vs AT/TT, respectively). There were no differences between groups in absolute diffusing capacity measures at peak exercise. CONCLUSION These results suggest that genetic variation of the α-subunit of ENaC differentially affects the diffusing capacity response to exercise in patients with CF.
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Affiliation(s)
- Sarah E Baker
- Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ, USA
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Baker SE, Wheatley CM, Cassuto NA, Foxx-Lupo WT, Sprissler R, Snyder EM. Genetic variation of αENaC influences lung diffusion during exercise in humans. Respir Physiol Neurobiol 2011; 179:212-8. [PMID: 21893217 DOI: 10.1016/j.resp.2011.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 08/08/2011] [Accepted: 08/15/2011] [Indexed: 11/15/2022]
Abstract
Exercise, decompensated heart failure, and exposure to high altitude have been shown to cause symptoms of pulmonary edema in some, but not all, subjects, suggesting a genetic component to this response. Epithelial Na(+) Channels (ENaC) regulate Na(+) and fluid reabsorption in the alveolar airspace in the lung. An increase in number and/or activity of ENaC has been shown to increase lung fluid clearance. Previous work has demonstrated common functional genetic variants of the α-subunit of ENaC, including an A→T substitution at amino acid 663 (αA663T). We sought to determine the influence of the T663 variant of αENaC on lung diffusion at rest and at peak exercise in healthy humans. Thirty healthy subjects were recruited for study and grouped according to their SCNN1A genotype [n=17 vs. 13, age=25±7 years vs. 30±10 years, BMI=23±4 kg/m(2) vs. 25±4 kg/m(2), V(O2 peak) = 95±30%pred. vs. 100±31%pred., mean±SD, for AA (homozygous for αA663) vs. AT/TT groups (at least one αT663), respectively]. Measures of the diffusing capacity of the lungs for carbon monoxide (DL(CO)), the diffusing capacity of the lungs for nitric oxide (DL(NO)), alveolar volume (V(A)), and alveolar-capillary membrane conductance (D(M)) were taken at rest and at peak exercise. Subjects expressing the AA polymorphism of ENaC showed a significantly greater percent increase in DL(CO) and DL(NO), and a significantly greater decrease in systemic vascular resistance from rest to peak exercise than those with the AT/TT variant (DL(CO)=51±12% vs. 36±17%, DL(NO)=51±24% vs. 32±25%, SVR=-67±3 vs. -50±8%, p<0.05). The AA ENaC group also tended to have a greater percent increase in DL(CO)/VA from rest to peak exercise, although this did not reach statistical significance (49±26% vs. 33±26%, p=0.08). These results demonstrate that genetic variation of the α-subunit of ENaC at amino acid 663 influences lung diffusion at peak exercise in healthy humans, suggesting differences in alveolar Na(+) and, therefore, fluid handling. These findings could be important in determining who may be susceptible to pulmonary edema in response to various clinical or environmental conditions.
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Affiliation(s)
- Sarah E Baker
- Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ 85721, United States
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Current World Literature. Curr Opin Pulm Med 2011; 17:484-8. [DOI: 10.1097/mcp.0b013e32834c7beb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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