Functional state of the small airways in patients with bronchial asthma associated with obesity

Abstract

Aim. To assess the functional status of the small Airways in patients with bronchial asthma associated with obesity, by body plethysmography. Materials and methods. 65 patients with bronchial asthma of mild severity, partially controlled course, including 30 patients with normal body weight and 35 patients with obesity of I degree were examined. Control group-30 healthy volunteers. Examined forced vital capacity (FVC), forced expiratory volume in first second (FEV1) ratio of FEV1 to FVC (FEV1/FVC), maximum volumetric exhalation rate after 25.50 and 75% FVC (MEF75, MEF50, MEF25), average flow velocity in the exhalation interval 25-75% of FVC (MMEF25-75). Method bodyplethysmography was evaluated in bronchial resistance, functional residual capacity (FRC), residual volume of the lungs (RV), total lung capacity (TLC), the percentage of RV/TLC. Results. Patients with bronchial asthma with obesity showed a reduction of indicators of bronchial obstruction: FEV1 of 14% (p=0.02), FEV1/FVC by 14% (p=0.001), MEF75 30% (p=0.001), MEF50 by 35% (p=0.001), MEF25 by 44% (p=0.003), MMEF25-75 by 38% (p=0.001). The increase of bronchial resistance on inhalation in 2 times (p=0.001), on exhalation in 3.3 times (p=0.003) was found, which is typical for generalized bronchial obstruction at the proximal level. An increase in RV by 24% (p=0.03), TLC - by 9% (p=0.03), RV/TLC - by 18% (p=0.03), indicating the presence of "air traps" and dysfunction of the small respiratory tract. Conclusion. In patients with asthma of mild severity associated with obesity, both the central bronchis and the distal lung are affected, which are manifested by generalized bronchial obstruction, the formation of "air traps" and dysfunction of the small respiratory tract.

Specificities of small airways dysfunction development in patients with mild asthma

“…Among all flow-volume parameters in patients with asthma, RV is the most sensitive; it often deviates from the norm and is the last to return to a normal level in response to adequate therapy [20]. Increased RV is an indirect indicator of air trapping [20,21]. According to the published results, TLC is also elevated in asthma, but it can be within its normal range of values at the initial stages of the disease.…”

Possibilities of respiratory rehabilitation in correction of small airway dysfunction

“…Вместе с тем довольно сложно определить функциональные нарушения, обусловленные патологией МДП. В качестве критериев оценки поражения МДП сегодня рассматриваются данные импульсной осциллометрии, бодиплетизмографии, спирометрии [5,[17][18][19]. Критерием дисфункции МДП по данным бодиплетизмографии принято считать наличие «воздушных ловушек» (увеличение остаточного объема легких (ООЛ) и доли ООЛ в структуре общей емкости легких -ОЕЛ) и признаков гиперинфляции (увеличение функциональной остаточной емкости) [20,21].…”

“…С практической точки зрения более важно, что форсированная жизненная емкость легких (ФЖЕЛ) обратно коррелирует с ООЛ/ОЕЛ, указывая на формирование «воздушных ловушек» [22]. Помимо ФЖЕЛ среди спирометрических параметров для диагностики дисфункции МДП предлагается использовать такие показатели как объем форсированного выдоха за 1-ю секунду (ОФВ 1 ), средняя объемная скорость потока воздуха между 25 и 75% ФЖЕЛ в середине выдоха (СОС 25-75 ) [5,17]. Критерием импульсной осциллометрии, который предлагается использовать в качестве маркера дисфункции МДП, является патологическая абсолютная частотная зависимость резистанса (Rrs) на частоте осцилляций 5 и 20 Гц, а именно Rrs5-Rrs20 > 0,07 кПа•с/л [23].…”

Retrospective evaluation of the effects of Sugammadex and Neostigmine on the IgE and Eosinophil Cationic Protein in Morbid Obese Patients

“…Obesity affects several systems in the human body negatively, mostly affecting the distal airways in the respiratory system adversely, leading to emerging symptoms of bronchial asthma [ 9 ]. Bronchospasm can be the only symptom of sugammadex-related anaphylaxis [ 10 ].…”