A comprehensive approach to lung function in bronchiectasis

Abstract

A comprehensive approach to lung function in bronchiectasis ABSTRACT Background: International guidelines recommend simple spirometry for bronchiectasis patients. However, pulmonary pathophysiology of bronchiectasis is very complex and still poorly understood. Our objective was to characterize lung function in bronchiectasis and identify specific functional sub-groups. Methods:This was a multicenter, prospective, observational study enrolling consecutive adults with bronchiectasis during stable sate. Patients underwent body-plethysmography before and after acute bronchodilation testing, diffusing lung capacity (DL CO ) with a 3-year follow up. Air trapping and hyperinflation were a residual volume (RV)>120%predicted and a total lung capacity>120%predicted. Acute reversibility was: ΔFEV 1 ≥12% and 200 ml from baseline (FEV 1rev ) and ΔRV ≥10% reduction from baseline (RV rev ). Sensitivity analyses included different reversibility cutoffs and excluded patients with concomitant asthma or chronic obstructive pulmonary disease.Results: 187 patients were enrolled (median age: 68 years; 29.4% males).Pathophysiological abnormalities often overlapped and were distributed as follows: air trapping (70.2%), impaired DL CO (55.7%), airflow obstruction (41.1%), hyperinflation (15.7%) and restriction (8.0%). 9.7% of patients had normal lung function. RV rev (17.6%) was more frequent than FEV 1rev (4.3%). Similar proportions were found after multiple sensitivity analyses. Compared with non-reversible patients, patients with RV rev had more severe obstruction (mean(SD) FEV 1 %pred: 83.0% (24.4) vs 68.9% (26.2); P=0.02) and air trapping (RV%pred, 151.9% (26.6) vs 166.2% (39.9); P=0.028). Conclusions:Spirometry alone does not encompass the variety of pathophysiological characteristics in bronchiectasis. Air trapping and diffusion impairment, not airflow obstruction, represent the most common functional abnormalities. RV rev is related to worse lung function and might be considered in bronchiectasis' workup and for patients' functional stratification. Demographics

Characterization of the severity of dyspnea in patients with bronchiectasis: correlation with clinical, functional, and tomographic aspects

“…Recently, two studies confirmed the high prevalence of air trapping among patients with bronchiectasis. 33 , 34 Radovanovic et al 33 demonstrated the presence of air trapping in 70.2% of their sample, whereas an obstructive pattern was present in only 41.1%. This variability in the identification of patterns on pulmonary function testing can be explained by the different characteristics of the populations studied.…”

Is bronchiectasis really a disease?

“…Physiologically, bronchiectasis is classically characterised by obstructive air flow limitation. However, in a prospective multicentre study of 187 patients with bronchiectasis, only 41% had obstruction on spirometry, while 58% had a normal spirogram [48]. Another study of 277 patients found an obstructive pattern in 43%, and 28.7% had a restrictive or mixed pattern [49].…”

Pulmonary rehabilitation for bronchiectasis: if not now, when?

“…In this study, questions regarding generalisability come to mind. The median MRC dyspnoea score in the bronchiectasis patients was 3 on a 1-5 scale ("I walk slower than people of the same age on the level because of breathlessness or have to stop for breath when walking at my own pace on the level") [17], higher than in two large studies of unselected bronchiectasis patients, in which it was 2 [18] and 1 [19]. Thus the study patients may not be representative of the broader population of bronchiectasis patients.…”