impulse oscillometry in Small airway dysfunction in asthmatics and its utility in asthma control

Sharshar, Ragia S.

doi:10.1183/13993003.congress-2018.pa1700

Cited by 3 publications

(7 citation statements)

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“…The LAR response is representative of more severe disease, 2 suggesting that DR (mild/moderate) asthmatics are biologically closer to more severe asthmatics than their SR (mild/moderate) counterparts. This theory was further supported by the strong correlation, at both baseline and during the late phase, to clinical markers of peripheral obstruction (decreased X5 and increased AX) that has been reported in uncontrolled asthma with airway neutrophilia 30 . Our previous report on this same cohort also shows a high involvement of the peripheral airways in the DR 26 .…”

Section: Discussionsupporting

confidence: 75%

“…The increased number of neutrophils in the DR airways at baseline was confirmed by staining for neutrophil‐specific MPO in bronchial biopsies ( p = .026; Figure 2A, B). The number of neutrophils in the tissue at baseline correlated with increased lung elasticity (measured as airway reactance and might reflect more peripheral obstruction 30 ) at both baseline and during the late phase (Figure 2C, D—see Table for p values).…”

Section: Resultsmentioning

confidence: 95%

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Neutrophil phenotypes in bronchial airways differentiate single from dual responding allergic asthmatics

Burg

Stenberg

Ekstedt

et al. 2022

Clin Experimental Allergy

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Introduction: Allergic asthmatics with both an early (EAR) and a late allergic reaction (LAR) following allergen exposure are termed 'dual responders' (DR), while 'single responders' (SR) only have an EAR. Mechanisms that differentiate DR from SR are largely unknown, particularly regarding the role and phenotypes of neutrophils.Therefore, we aimed to study neutrophils in DR and SR asthmatics.Methods: Thirty-four allergic asthmatics underwent an inhaled allergen challenge, samples were collected before and up to 24 h post-challenge. Cell differentials were counted from bronchial lavage, alveolar lavage and blood; and tissue neutrophils were quantified in immune-stained bronchial biopsies. Lavage neutrophil nuclei lobe segmentation was used to classify active (1-4 lobes) from suppressive neutrophils (≥5 lobes). Levels of transmigration markers: soluble (s)CD62L and interleukin-1Ra, and activity markers: neutrophil elastase (NE), DNA-histone complex and dsDNA were measured in lavage fluid and plasma. Results:Compared with SR at baseline, DR had more neutrophils in their bronchial airways at baseline, both in the lavage (p = .0031) and biopsies (p = .026) and elevated bronchial neutrophils correlated with less antitransmigratory IL-1Ra levels (r = −0.64).DR airways had less suppressive neutrophils and more 3-lobed (active) neutrophils (p = .029) that correlated with more bronchial lavage histone (p = .020) and more plasma NE (p = .0016). Post-challenge, DR released neutrophil extracellular trap factors in the blood earlier and had less pro-transmigratory sCD62L during the late phase (p = .0076) than in SR. Conclusion:DR have a more active airway neutrophil phenotype at baseline and a distinct neutrophil response to allergen challenge that may contribute to the development of an LAR. Therefore, neutrophil activity should be considered during targeted diagnosis and bio-therapeutic development for DR.

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Section: Discussionsupporting

confidence: 75%

Section: Resultsmentioning

confidence: 95%

Neutrophil phenotypes in bronchial airways differentiate single from dual responding allergic asthmatics

Burg

Stenberg

Ekstedt

et al. 2022

Clin Experimental Allergy

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“…Despite greater disease burden, these urban populations are underrepresented in research leading to underdiagnosis and undertreatment of OLDs [28,43]. Oscillometry has been shown to correlate with patient self-reported symptoms of COPD and asthma [9,14,15] and has been used to assess disease burden [16][17][18][19]. Compared to spirometry, oscillometry is easier to perform.…”

Section: Discussionmentioning

confidence: 99%

“…Oscillometry results are analyzed by a computer program that compares the patient's results to normative data based on the patient's demographic information, thereby individualizing results [13]. Oscillometry has been found to correlate with patient self-reported symptoms of chronic obstructive pulmonary disease (COPD) and asthma [9,14,15] and to be as sensitive as spirometry in assessing lung disease in epidemiological studies [16][17][18][19]. Despite its ability to detect small airway disease and disease burden, it is unclear whether oscillometry can distinguish between asthma and COPD diagnoses [20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Lung disease burden assessment by oscillometry in a systematically disadvantaged urban population experiencing homelessness or at-risk for homelessness in Ottawa, Canada from a prospective observational study

et al. 2022

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Rationale Oscillometry is an emerging technique that offers some advantages over spirometry as it does not require forced exhalation and may detect early changes in respiratory pathology. Obstructive lung disease disproportionately impacts people experiencing homelessness with a high symptoms burden, yet oscillometry is not studied in this population. Objectives To assess lung disease and symptom burden using oscillometry in people experiencing homelessness or at-risk of homelessness using a community-based participatory action research approach (The Bridge Model™). Methods Of 80 recruited, 55 completed baseline oscillometry, 64 completed spirometry, and all completed patient-reported outcomes with demographics, health, and respiratory symptom related questionnaires in the Participatory Research in Ottawa: Management and Point-of-Care for Tobacco Dependence project. Using a two-tail t-test, we compared mean oscillometry values for airway resistance (R5–20), reactance area under the curve (Ax) and reactance at 5 Hz (X5) amongst individuals with fixed-ratio method (FEV1/FVC ratio < 0.70) and LLN (FEV1/FVC ratio ≤ LLN) spirometry diagnosed chronic obstructive pulmonary disease (COPD). We compared mean oscillometry parameters based on participants’ COPD assessment test (CAT) scores using ANOVA test. Results There was no significant difference between the pre- and post- bronchodilator values of R5–20 and Ax for the fixed ratio method (p = 0.63 and 0.43) and the LLN method (p = 0.45 and 0.36). There was a significant difference in all three of the oscillometry parameters, R5–20, Ax and X5, based on CAT score (p = 0.009, 0.007 and 0.05, respectively). There was a significant difference in R5–20 and Ax based on the presence of phlegm (p = 0.03 and 0.02, respectively) and the presence of wheeze (p = 0.05 and 0.01, respectively). Oscillometry data did not correlate with spirometry data, but it was associated with CAT scores and correlated with the presence of self-reported symptoms of phlegm and wheeze in this population. Conclusions Oscillometry is associated with respiratory symptom burden and highlights the need for future studies to generate more robust data regarding the use of oscillometry in systematically disadvantaged populations where disease burden is disproportionately higher than the general population. TrialRegistration: ClinicalTrails.gov—NCT03626064, Retrospective registered: August 2018, https://clinicaltrials.gov/ct2/show/NCT03626064

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“…One study suggested small airways evaluated by IOS indices, R5-R20 and X5 and AX correlated more strongly with clinical symptoms (assessed by the asthma control test (ACT) score) than spirometry. 76 …”

Section: The Diagnostic Challenge Of Asthma; Can Tests Of Small Airways Help?mentioning

confidence: 99%

The diagnosis of asthma. Can physiological tests of small airways function help?

2021

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Asthma is a common, chronic, and heterogeneous disease with a global impact and substantial economic costs. It is also associated with significant mortality and morbidity and the burden of undiagnosed asthma is significant. Asthma can be difficult to diagnose as there is no gold standard test and, while spirometry is central in diagnosing asthma, it may not be sufficient to confirm or exclude the diagnosis. The most commonly reported spirometric measures (forced expiratory volume in one second (FEV1) and forced vital capacity assess function in the larger airways. However, small airway dysfunction is highly prevalent in asthma and some studies suggest small airway involvement is one of the earliest disease manifestations. Moreover, there are new inhaled therapies with ultrafine particles that are specifically designed to target the small airways. Potentially, tests of small airways may more accurately diagnose early or mild asthma and assess the response to treatment than spirometry. Furthermore, some assessment techniques do not rely on forced ventilatory manoeuvres and may, therefore, be easier for certain groups to perform. This review discusses the current evidence of small airways tests in asthma and future research that may be needed to further assess their utility.

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impulse oscillometry in Small airway dysfunction in asthmatics and its utility in asthma control

Cited by 3 publications

References 0 publications

Neutrophil phenotypes in bronchial airways differentiate single from dual responding allergic asthmatics

Neutrophil phenotypes in bronchial airways differentiate single from dual responding allergic asthmatics

Lung disease burden assessment by oscillometry in a systematically disadvantaged urban population experiencing homelessness or at-risk for homelessness in Ottawa, Canada from a prospective observational study

The diagnosis of asthma. Can physiological tests of small airways function help?

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