Cardiopulmonary exercise testing and second-line pulmonary function tests to detect obstructive pattern in symptomatic smokers with borderline spirometry

Marco, Fabiano Di; Terraneo, Silvia; Job, Sara; Rinaldo, Rocco Francesco; Papa, Giuseppe Francesco Sferrazza; Roggi, Maria Adelaide; Santus, Pierachille; Centanni, Stefano

doi:10.1016/j.rmed.2017.04.006

Cited by 14 publications

(18 citation statements)

References 29 publications

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“…This accords with recent work showing that smokers with preserved FEV 1 had evidence of small airways damage, gas trapping, and impaired gas transfer. 23 , 24 Abnormality in single-breath nitrogen washout in symptomatic smokers and in MBW parameters in asymptomatic smokers (>10 pack years) has also been previously demonstrated. 24 , 25 The particular advantages of LCI as an outcome for assessing these early changes is that the methodology is standardized, 14 with good reproducibility, and with apparently good sensitivity.…”

Section: Discussionmentioning

confidence: 80%

Feasibility and challenges of using multiple breath washout in COPD

Bell¹,

Lawrence²,

Singh³

et al. 2018

COPD

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BackgroundLung clearance index (LCI), derived from multiple-breath washout (MBW), is a well-established assessment of ventilation inhomogeneity in cystic fibrosis but has not been widely applied in other conditions characterized by heterogeneous airways disease, such as COPD. The aim of this study was to evaluate the sensitivity, repeatability, and practicality of LCI in patients with COPD.MethodsFifty-four COPD patients completed MBW using nitrogen as the washout tracer gas (MBWN2, measured using an Exhalyzer™ device), spirometry, and plethysmography. Twenty patients repeated MBWN2, MBWSF6 (using a separate Innocor™ gas analyzer to measure washout of the exogenous trace sulphur hexafluoride), and spirometry at a second visit ≥24 hours later.ResultsMean (SD) COPD LCI measured by nitrogen washout (LCIN2) was 12.1 (2.2); mean (SD) LCI Z-score 5.8 (2.0). LCIN2 increased across Global Initiative for Obstructive Lung Disease stages 1 to 3 and was abnormal (Z-score >1.65) in all COPD patients, including those with forced expiratory volume in 1 second (FEV1) ≥80% predicted. LCI was repeatable (median intra-test coefficient of variation 4.1%) and reproducible (limits of agreement −1.8 to 1.6) after mean of 16 days. Functional residual capacity (FRC) measurements were significantly greater using nitrogen than SF6 or plethysmography: mean FRC measured by nitrogen washout (FRCN2) 139% predicted versus FRC measured by plethysmography 125% predicted, p<0.0001.ConclusionLCI is most suitable as a measure of early airways disease in COPD in those with well-preserved FEV1, with similar repeatability and limitations to that observed in cystic fibrosis. Using the Exhalyzer system to perform MBWN2, however, appeared to substantially over-read FRC. This discrepancy needs addressing before FRCN2 measurements made using this device can be reliably deployed.

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Section: Discussionmentioning

confidence: 80%

Feasibility and challenges of using multiple breath washout in COPD

Bell¹,

Lawrence²,

Singh³

et al. 2018

COPD

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“…In line with previous FOT results in smokers and mild COPD patients, and in contrast with the study of Di Marco et al, the resistive parameters presented a highly significant increase (R0, R4, Rm; Table 1 ). 6 , 13 , 49 – 51 In the study of Shinke et al approximately 60% of the studied smokers showed elevated resistance. 52 Using an impulse-oscillation system, Frantz et al and Elbehairy et al showed that pulmonary resistance can indicate abnormalities earlier than conventional spirometric parameters, while Crim et al found increased resistance values in subjects with mild COPD.…”

Section: Discussionmentioning

confidence: 95%

“…The results of the present study are in line with this proposition, and with previous works showing that marked impairments were observed in subjects with mild airway obstruction and symptomatic smokers with borderline spirometry. 8 , 49 …”

Section: Discussionmentioning

confidence: 99%

Forced oscillation technique for early detection of the effects of smoking and COPD: contribution of fractional-order modeling

Ribeiro¹,

Faria²,

Lopes³

et al. 2018

COPD

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PurposeThe aim of the present study was to evaluate the performance of the forced oscillation technique (FOT) for the early diagnosis of the effects of smoking and COPD. The contributions of the integer-order (InOr) and fractional-order (FrOr) models were also evaluated.Patients and methodsIn total, 120 subjects were analyzed: 40 controls, 40 smokers (20.3±9.3 pack-years) and 40 patients with mild COPD.ResultsInitially, it was observed that traditional FOT parameters and the InOr and FrOr models provided a consistent description of the COPD pathophysiology. Mild COPD introduced significant increases in the FrOr inertance, damping factor and hysteresivity (P<0.0001). These parameters were significantly correlated with the spirometric parameters of central and small airway obstruction (P<0.0001). The diagnostic accuracy analyses indicated that FOT parameters and InOr modeling may adequately identify these changes (area under the receiver operating characteristic curve – AUC >0.8). The use of FrOr modeling significantly improved this process (P<0.05), allowing the early diagnosis of smokers and patients with mild COPD with high accuracy (AUC >0.9).ConclusionFrOr modeling improves our knowledge of modifications that occur in the early stages of COPD. Additionally, the findings of the present study provide evidence that these models may play an important role in the early diagnosis of COPD, which is crucial for improving the clinical management of the disease.

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“…It can identify tobacco smokers at risk of developing chronic obstructive pulmonary disease (COPD) (Macklem, 1972) and has been validated against histopathological proven structural peripheral airway abnormalities in the human lung (Cosio et al, 1978), and remains the only ventilation inhomogeneity marker to be validated in this way. The N 2 VC SBW test remains in use in many laboratories today (Mikamo et al, 2013;Boeck et al, 2016;Di Marco et al, 2017), mainly because of its time-effectiveness, yet the correlation between N 2 MBW and N 2 SBW remains largely unknown, and remains an important gap in current knowledge for clinicians interested in inert gas washout techniques. The N 2 VC SBW test remains in use in many laboratories today (Mikamo et al, 2013;Boeck et al, 2016;Di Marco et al, 2017), mainly because of its time-effectiveness, yet the correlation between N 2 MBW and N 2 SBW remains largely unknown, and remains an important gap in current knowledge for clinicians interested in inert gas washout techniques.…”

Section: Introductionmentioning

confidence: 99%

“…Specific to adult asthma, S III steepness correlates with disease severity as determined by asthma exacerbation frequency (Bourdin et al, 2006). The N 2 VC SBW test remains in use in many laboratories today (Mikamo et al, 2013;Boeck et al, 2016;Di Marco et al, 2017), mainly because of its time-effectiveness, yet the correlation between N 2 MBW and N 2 SBW remains largely unknown, and remains an important gap in current knowledge for clinicians interested in inert gas washout techniques.…”

Section: Introductionmentioning

confidence: 99%

Utility of single versus multiple breath washout in adult asthma

Kjellberg

Viklund

Robinson

et al. 2018

Clin Physio Funct Imaging

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Nitrogen multiple breath washout (N MBW) is a sensitive method to identify peripheral airway involvement in asthma, but is a time-consuming test. The N vital capacity single breath (VC SBW) test offers greater time efficiency, but concordance with N MBW is poorly understood. The prevalence of peripheral airway abnormality was determined by N MBW and N SBW tests in 194 asthmatic subjects aged 18-1 years. N MBW data were related to findings in 400 healthy controls, aged 17-71 years, while N 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 N SBW and N MBW outcomes were studied. N 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 N SBW-derived phase III slope (N S ) was 24·7%, compared to 44% determined by N MBW-derived lung clearance index (LCI) (P<0·001). Predictors of abnormal N S were older age, smoking history and lower FEV N SBW offers lower sensitivity than N MBW to detect small airway dysfunction in adult asthma, but may be a marker of more severe disease.

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Cardiopulmonary exercise testing and second-line pulmonary function tests to detect obstructive pattern in symptomatic smokers with borderline spirometry

Cited by 14 publications

References 29 publications

Feasibility and challenges of using multiple breath washout in COPD

Feasibility and challenges of using multiple breath washout in COPD

Forced oscillation technique for early detection of the effects of smoking and COPD: contribution of fractional-order modeling

Utility of single versus multiple breath washout in adult asthma

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