Effect of heliox breathing on flow limitation in chronic heart failure patients

Pecchiari, Matteo; Anagnostakos, Theocharis; D’Angelo, Emanuela; Roussos, Charis; Nanas, Serafim; Koutsoukou, Antonia

doi:10.1183/09031936.00117508

Cited by 9 publications

(11 citation statements)

References 32 publications

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“…Initially, the latter is histologically characterised by denuded epithelium, rupture of alveolar airway attachments, and increased number of polymorphonuclear leukocytes [6][7][8]. Studies in which heliox (80% He/20% O 2 ) was administered in COPD and chronic heart failure patients also provided corroborative evidence that EFLT was located in the peripheral airways [2][3][4][5]. EFLT promotes dynamic pulmonary hyperinflation and intrinsic positive end-expiratory pressure (PEEPi) with concurrent dyspnoea and exercise limitation [9].…”

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confidence: 84%

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Physiological techniques for detecting expiratory flow limitation during tidal breathing

Koulouris¹,

Hardavella²

2011

Eur Respir Rev

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Patients with severe chronic obstructive pulmonary disease (COPD) often exhale along the same flow-volume curve during quiet breathing as they do during the forced expiratory vital capacity manoeuvre, and this has been taken as an indicator of expiratory flow limitation at rest (EFLT). Therefore, EFLT, namely attainment of maximal expiratory flow during tidal expiration, occurs when an increase in transpulmonary pressure causes no increase in expiratory flow. EFLT leads to small airway injury and promotes dynamic pulmonary hyperinflation, with concurrent dyspnoea and exercise limitation. In fact, EFLT occurs commonly in COPD patients (mainly in Global Initiative for Chronic Obstructive Lung Disease III and IV stage), in whom the latter symptoms are common, but is not exclusive to COPD, since it can also be detected in other pulmonary and nonpulmonary diseases like asthma, acute respiratory distress syndrome, heart failure and obesity, etc. The existing up to date physiological techniques of assessing EFLT are reviewed in the present work. Among the currently available techniques, the negative expiratory pressure has been validated in a wide variety of settings and disorders. Consequently, it should be regarded as a simple, noninvasive, practical and accurate new technique.

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confidence: 84%

“…It is located beyond the seventh (i.e. from the eighth onwards) generation during tidal breathing [2][3][4][5].…”

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confidence: 99%

Physiological techniques for detecting expiratory flow limitation during tidal breathing

Koulouris¹,

Hardavella²

2011

Eur Respir Rev

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“…Alternatively, FVC is also used as an indicator of small airways function, more specifically of airway closure and trapped air beyond them [23,24,25,26]. Another way to identify the small airway content from forced expiration is by examining the density dependence of forced expiratory flows, comparing air and heliox [27,28,29]. There is probably no easy way of extracting small airway information from spirometry in a disease state which involves more than a pure small airway change.…”

Section: Spirometrymentioning

confidence: 99%

Physiological Measurement of the Small Airways

Verbanck¹

2012

Respiration

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Noninvasive physiological measurements are reviewed that have been reported in the literature with the specific aim being to study the small airways in lung disease. This has mostly involved at-the-mouth noninvasive measurement of flow, pressure or inert gas concentration, with the intent of deriving one or more indices that are representative of small airway structure and function. While these measurements have remained relatively low-tech, the effort and sophistication increasingly reside with the interpretation of such indices. When aspiring to derive information at the mouth about structural and mechanical processes occurring several airway generations away in a complex cyclically changing cul-de-sac structure, conceptual or semi-quantitative lung models can be valuable. Two assumptions that are central to small airway structure-function measurement are that of an average airway change at a given peripheral lung generation and of a parallel heterogeneity in airway changes. While these are complementary pieces of information, they can affect certain small airways tests in confounding ways. We critically analyzed the various small airway tests under review, while contending that negative outcomes of these tests are probably a true reflection of the fact that no change occurred in the small airways. Utmost care has been taken to not favor one technique over another, given that most current small airways tests still have room for improvement in terms of rendering their content more specific to the small airways. One way to achieve this could consist of the coupling of signals collected at the mouth to spatial information gathered from imaging in the same patient.

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“…With the supine position, a translocation of blood volume back to the thoracic cavity is known to occur and in cases of left ventricular insufficiency, this shift can noticeably increase capillary and venous vascular pressures in the pulmonary circulation (Linderholm et al 1962). It has been suggested that in HF patients, this shift in fluid volume contributes to vascular distension and/or interstitial edema, subsequently leading to thoracic space limitations, compression of the airways, and ultimately to the observed increase in expiratory flow limitations commonly observed while lying down versus while seated in this patient population (Linderholm et al 1962; Yap et al 2000; Martin-Du Pan et al 2004; Torchio et al 2006; Pecchiari et al 2009). We believe that our results are consistent with these findings in that while we saw a decline in PF in both HF and CTRL groups, the decline in PF was only correlated with the increase in Δ Q̇ aw for the HF group (Figure 2).…”

Section: Discussionmentioning

confidence: 98%

Effect of supine posture on airway blood flow and pulmonary function in stable heart failure

Ceridon¹,

Morris²,

Olson³

et al. 2011

Respiratory Physiology & Neurobiology

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Background The aim of this study was to determine the relationship between body position, pulmonary function (PF) and bronchial blood flow (Qaw) in a group of heart failure (HF) and control subjects. Methods Thirty-six subjects were studied: 24 stable, ambulatory HF patients (HF: LVEF=27±6%, age=65±9yr) and 12 age- and sex-matched controls (CTRL: LVEF=60±7%, age=62±8yr). Measures of Q̇aw (soluble gas method) and PF were collected upright and following 30 min in the supine position. Results Q̇aw was similar between groups and remained unchanged with body position. Declines in forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) with the supine position were observed in both groups; declines in forced expiratory flow 25–75% (FEF25–75) and FEF 75% (FEF75) with the supine position were observed in the HF group only. Changes in Q̇aw were related to changes in PF only in the HF patient groups (ΔFVC, %predicted, r=−0.45, p<0.04, ΔFEV1 r=−0.61, p<0.01, ΔFEV1 %predicted, r=−0.45, p<0.04). Conclusion These data demonstrate that relationships between postural changes in Q̇aw and PF exist only in the HF population and that the bronchial circulation may contribute to postural PF decline in HF.

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Effect of heliox breathing on flow limitation in chronic heart failure patients

Cited by 9 publications

References 32 publications

Physiological techniques for detecting expiratory flow limitation during tidal breathing

Physiological techniques for detecting expiratory flow limitation during tidal breathing

Physiological Measurement of the Small Airways

Effect of supine posture on airway blood flow and pulmonary function in stable heart failure

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