Airway Responsiveness Measured by Forced Oscillation Technique in Severely Obese Patients, before and after Bariatric Surgery

Zerah-Lancner, Françoise; Boyer, Laurent; Rézaiguia-Delclaux, Saïda; d’Ortho, Marie-Pia; Drouot, Xavier; Guilloteau-Schoennagel, Isabelle; Ribeil, Stephan; Delclaux, Christophe; Adnot, Serge; Tayar, Claude

doi:10.3109/02770903.2011.613508

Cited by 24 publications

(18 citation statements)

References 31 publications

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“…The residual abnormality in R 5−20 suggests distal airway dysfunction that may relate to residual bronchial hyperreactivity that has been observed in response to methacholine post weight loss despite normalization of resting lung volume. [42] Of note, the present study included data mostly of female subjects in accord with the population concurring to the Bellevue Hospital Bariatric Center therefore if gender differences exist in the effects of restoration of lung volume on airway responsiveness, they could not be identified in the present study. [15].…”

Section: Discussionmentioning

confidence: 97%

Airway Dysfunction in Obesity: Response to Voluntary Restoration of End Expiratory Lung Volume

et al. 2014

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IntroductionAbnormality in distal lung function may occur in obesity due to reduction in resting lung volume; however, airway inflammation, vascular congestion and/or concomitant intrinsic airway disease may also be present. The goal of this study is to 1) describe the phenotype of lung function in obese subjects utilizing spirometry, plethysmography and oscillometry; and 2) evaluate residual abnormality when the effect of mass loading is removed by voluntary elevation of end expiratory lung volume (EELV) to predicted FRC.Methods100 non-smoking obese subjects without cardio-pulmonary disease and with normal airflow on spirometry underwent impulse oscillometry (IOS) at baseline and at the elevated EELV.ResultsFRC and ERV were reduced (44±22, 62±14% predicted) with normal RV/TLC (29±9%). IOS demonstrated elevated resistance at 20 Hz (R20, 4.65±1.07 cmH2O/L/s); however, specific conductance was normal (0.14±0.04). Resistance at 5–20 Hz (R5−20, 1.86±1.11 cmH2O/L/s) and reactance at 5 Hz (X5, −2.70±1.44 cmH2O/L/s) were abnormal. During elevation of EELV, IOS abnormalities reversed to or towards normal. Residual abnormality in R5−20 was observed in some subjects despite elevation of EELV (1.16±0.8 cmH2O/L/s). R5−20 responded to bronchodilator at baseline but not during elevation of EELV.ConclusionsThis study describes the phenotype of lung dysfunction in obesity as reduction in FRC with airway narrowing, distal respiratory dysfunction and bronchodilator responsiveness. When R5−20 normalized during voluntary inflation, mass loading was considered the predominant mechanism. In contrast, when residual abnormality in R5−20 was demonstrable despite return of EELV to predicted FRC, mechanisms for airway dysfunction in addition to mass loading could be invoked.

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Section: Discussionmentioning

confidence: 97%

Airway Dysfunction in Obesity: Response to Voluntary Restoration of End Expiratory Lung Volume

et al. 2014

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“…Higher respiratory resistance with smaller lung volumes has been reported in morbidly obese people, but in our study, this finding was not reproduced; on the contrary, we found even better lung volumes, which could be an attribute of a bigger thoracic cage. 21,22 Recent results have included deep inspiration avoidance added to the methacholine protocol of bronchoconstriction to assess for other physiological measurements, but without further results. 23 We face the possibility that methacholine might not be a suitable technique for assessing BHR in the obese population.…”

Section: Discussionmentioning

confidence: 99%

Effect of obesity on bronchial hyperreactivity among Latino children

et al. 2013

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“…These symptoms are unresponsive to bronchodilators, but improvements have been widely reported with weight loss (33,35). Surprisingly, spirometry often shows little or no change in lung function with weight loss (1,31,33,47), which makes it challenging to explore the mechanisms that link obesity and weight loss to changes in lung function and associated pathologies. Furthermore, lung function is typically assessed in the upright position, but the respiratory symptoms of obesity worsen in the supine position (10) and are thought to contribute to sleep disturbances (42).…”

Section: Introductionmentioning

confidence: 99%

“…These changes can be assessed by using oscillometry to calculate respiratory system resistance (Rrs) and reactance (Xrs). Indeed, several studies have used oscillometry to report significant improvements in lung mechanics at 12-24 mo after weight loss surgery (1,31,47); however, it is not clear whether these changes are either directly related to the mechanical effects of weight loss or to other factors such as metabolic effects that are associated with weight loss but with a different temporal course (34). By investigating the changes in lung mechanics early after weight loss surgery, the mechanisms linking obesity and weight loss to changes in lung function may be better assessed.…”

Section: Introductionmentioning

confidence: 99%

Improvement in upright and supine lung mechanics with bariatric surgery affects bronchodilator responsiveness and sleep quality

Peters

Dechman

Hernández

et al. 2018

Journal of Applied Physiology

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Obesity and weight-loss have complex effects on respiratory physiology, but these have been insufficiently studied, particularly at early time points following weight-loss surgery and in the supine position. We evaluated 15 severely obese female participants before, and 5 weeks and 6 months after bariatric surgery using the Pittsburgh Sleep Quality Index (PSQI), spirometry, plethysmography, and oscillometry to measure respiratory system mechanics. Oscillometry and spirometry were conducted in the upright and supine position, and pre- and post-bronchodilation with 200µg of salbutamol. At 5 weeks post-surgery, weight-loss was 11.9±2.7kg with no effect on spirometric outcomes and a slight effect on oscillometric outcomes. However, at 6 months, weight-loss was 21.4±7.1kg with a 14.1±6.1% and 17.8±5.4% reduction in upright and supine Rrs,6, respectively. Ers also decreased by 25.7±9.4% and 20.2±7.2% in the upright and supine positions. No changes were observed in spirometry, but sleep quality improved from PSQI of 8.4±3.5 to 4.1±2.9. Bronchodilator responsiveness was low at baseline but increased significantly post-surgery, and this response was comparable to the improvement in Rrs produced by weight-loss. Modeling the impedance spectra with a two-compartment model demonstrated that improvements in lung mechanics with weight-loss begin in the upper or central compartment of the lungs and progress to include the peripheral compartment. Respiratory mechanics are impaired in the severely obese and is associated with poor sleep quality, but these improved substantially with weight-loss. Our data provide new evidence that severely obese individuals may have poor sleep quality due to abnormal respiratory mechanics that weight-loss improves.

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Airway Responsiveness Measured by Forced Oscillation Technique in Severely Obese Patients, before and after Bariatric Surgery

Abstract: Airway responsiveness is not related to BMI or to SAS. AHR in severely obese patients might be related to distal airway obstruction or low relative airway size.

Cited by 24 publications

References 31 publications

Airway Dysfunction in Obesity: Response to Voluntary Restoration of End Expiratory Lung Volume

Airway Dysfunction in Obesity: Response to Voluntary Restoration of End Expiratory Lung Volume

Effect of obesity on bronchial hyperreactivity among Latino children

Improvement in upright and supine lung mechanics with bariatric surgery affects bronchodilator responsiveness and sleep quality

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