Current Needs Assessment for Using Lung Clearance Index for Asthma in Clinical Practice

Chérrez-Ojeda, Iván; Robles‐Velasco, Karla; Osorio, María F.; Calderón, J. H.; Bernstein, Jonathan A.

doi:10.1007/s11882-022-01025-2

Cited by 5 publications

(3 citation statements)

References 44 publications

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“…In future studies, methods beyond spirometry could be used to provide additional insights. For example, computerized tomography scans and functional magnetic resonance imaging could be used to assess mucus plugs and their contribution to airway obstruction [ 32 ]; the lung clearance index could be used to assess severe airway obstruction, small-airway disease, and bronchoreversibility [ 33 , 34 ]; and the forced oscillation technique could be employed to examine bronchodilator response and asthma control [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of Tezepelumab on Lung Function in Patients With Severe, Uncontrolled Asthma in the Phase 3 NAVIGATOR Study

Menzies-Gow,

Ambrose,

Colice

et al. 2023

Adv Ther

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Introduction: Severe asthma is associated with airway inflammation and airway obstruction. In the phase 3 NAVIGATOR study, tezepelumab treatment significantly improved pre-bronchodilator forced expiratory volume in 1 s (FEV 1 ) compared with placebo in patients with severe, uncontrolled asthma. This analysis assessed the effect of tezepelumab versus placebo on additional lung function parameters in patients from NAVIGATOR. Methods: NAVIGATOR was a multicenter, randomized, double-blind, placebo-controlled study. Patients (12-80 years old) receiving medium-or high-dose inhaled corticosteroids and at least one additional controller medication, with or without oral corticosteroids, were randomized 1:1 to tezepelumab 210 mg or placebo subcutaneously every 4 weeks for 52 weeks. Changes from baseline to week 52 in pre-bronchodilator FEV 1 , post-bronchodilator FEV 1 , forced vital capacity (FVC), pre-bronchodilator FEV 1 /FVC ratio, pre-bronchodilator forced expiratory flow between 25 and 75% of vital capacity (FEF 25-75 ), and morning and evening peak expiratory flow (PEF) were assessed. Results: Tezepelumab treatment improved all evaluated lung function parameters over 52 weeks compared with placebo [least-squares mean difference (95% confidence interval): pre-

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Section: Discussionmentioning

confidence: 99%

Effect of Tezepelumab on Lung Function in Patients With Severe, Uncontrolled Asthma in the Phase 3 NAVIGATOR Study

Menzies-Gow,

Ambrose,

Colice

et al. 2023

Adv Ther

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“…Patients presenting with air trapping and no airflow obstruction by spirometry, as observed in our patient, suggest the involvement of small rather than large airways [ 3 , 10 ], which can be caused by mucus impaction, a primary abnormality of the pulmonary microvasculature (endotheliitis and microthrombosis) or constrictive bronchiolitis that produce a ventilation/perfusion mismatch [ 8 ]. It can be detected by two methods: oscillometry and MBW through its lung clearance index (LCI) and Functional Residual Capacity (FRC) [ 5 ]. Both have shown advantages over spirometry as a way to monitor "silent" airway remodeling, being useful tools for tracking the progression of early structural airway disease that are currently undetected with spirometry [ 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…SAD is the inflammation of peripheral bronchioles with ≤ 2 mm internal diameter due to direct bronchiole or vascular lesions, or by immune responses associated with interstitial and bronchial alterations [ 4 ]. Non-conventional PFTs, such as the forced oscillation technique (FOT) and multiple breathing washout (MBW) [ 5 ], can detect SAD and complement conventional tests. We present a case of persistent respiratory symptoms assessed by CT scan, FOT, and MBW over a period of three years, attributable to the SAD findings.…”

Section: Introductionmentioning

confidence: 99%

Small airway disease in post-acute COVID-19 syndrome, a non-conventional approach in three years follow-up of a patient with long COVID: a case report

Cherrez-Ojeda,

Osorio,

Robles-Velasco

et al. 2023

J Med Case Reports

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Background Small airways disease (SAD), a novel finding described in post-acute COVID-19 patients, should be suspected when respiratory symptoms continue, air trapping persists on expiratory CT scans, and imaging findings fail to improve despite objectively better conventional pulmonary function test (PFT) parameters. The forced oscillation technique (FOT) and Multiple breathing washout (MBW) are both very sensitive methods for detecting anomalies in the peripheral airways. Case presentation We discuss the case of a 60-year-old Hispanic patient who had severe COVID-19 pneumonia and developed dyspnea, fatigue, and limited daily activity a year later. The PFTs revealed restrictive lung disease, as seen by significant diffusing capacity of the lungs for carbon monoxide (DLCO) decrease, severe desaturation, and poor 6-min walk test (6MWT) performance. The patient was treated with lowering corticosteroids as well as pulmonary rehabilitation (PR). During the 24-month follow-up, the dyspnea and fatigue persisted. On PFTs, 6MWT performance and restricted pattern improved slightly, but MBW discovered significant ventilatory inhomogeneity. FOT revealed substantial peripheral airway obstructive abnormalities. On CT scans, air trapping and ground-glass opacities (GGO) improved somewhat. The patient used a bronchodilator twice a day and low-dose inhaled corticosteroids (160 µg of budesonide and 4.5 µg of formoterol fumarate dihydrate) for nine months. PR sessions were resuming. The restricting parameters were stabilized and the DLCO had normalized after 36 months, with a 6MWT performance of 87% but significant desaturation. The CT scan revealed traction bronchiectasis, low GGO, and persistent air trapping. Without normalization, FOT and MBW scores improved, indicating small airway disease. Conclusions The necessity of integrating these tests when detecting SAD is emphasized in our paper. This article lays the foundation for future research into the best ways to manage and monitor SAD in post-acute COVID-19 patients.

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Oscillometry in severe asthma: the state of the art and future perspectives

Menzella

Antonicelli²,

Cottini³

et al. 2023

Expert Review of Respiratory Medicine

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Current Needs Assessment for Using Lung Clearance Index for Asthma in Clinical Practice

Cited by 5 publications

References 44 publications

Effect of Tezepelumab on Lung Function in Patients With Severe, Uncontrolled Asthma in the Phase 3 NAVIGATOR Study

Effect of Tezepelumab on Lung Function in Patients With Severe, Uncontrolled Asthma in the Phase 3 NAVIGATOR Study

Small airway disease in post-acute COVID-19 syndrome, a non-conventional approach in three years follow-up of a patient with long COVID: a case report

Oscillometry in severe asthma: the state of the art and future perspectives

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