Lung Clearance Index (LCI) and diffusion capacity of the lung (DLCO) in children with rheumatic disease

Hildebrandt, Julia; Rahn, Anja; Keßler, Anja; Speth, Fabian; Fischer, Dagmer-Christiane; Ballmann, Manfred

doi:10.1183/13993003.congress-2020.170

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“…In other settings, DLCO and the LCI are used for the early detection of lung function impairment, e.g., in patients with CF or rheumatic diseases, as they are noninvasive, easy to perform, and repeatable, even for children, but as shown in this study, this is also the case for people over 65 with an ECOG 0-2 [ 34 , 35 , 36 ]. Several studies underline the sensitivity of the DLCO and LCI values and thus their suitedness for the very early detection of impaired lung function, even before any decline is evident in the spirometry results [ 31 , 37 , 38 , 39 , 40 ]. This assumption stands in concordance with our results as, besides FEF25–75%, no relevant decreased lung function was detectable, nor were any clinical symptoms seen, but the most sensitive LCI value was already showing pulmonary function impairment during longer ICB treatment.…”

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Lung Clearance Index as a Screening Parameter of Pulmonary Impairment in Patients under Immune Checkpoint Therapy: A Pilot Study

Steinbach,

Eska,

Weitzel

et al. 2024

Cancers

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Background: Immune checkpoint blockade (ICB) has presented a breakthrough in the treatment of malignant tumors and increased the overall survival of patients with various tumor entities. ICB may also cause immune-related adverse events, such as pneumonitis or interstitial lung disease. The lung clearance index (LCI) is a multiple-breath washout technique offering information on lung pathology in addition to conventional spirometry. It measures the degree of pulmonary ventilation inhomogeneity and allows early detection of pulmonary damage, especially that to peripheral airways. Methods: This cross-sectional study compared the lung function of patients with melanoma or metastatic cutaneous squamous cell carcinoma who received programmed cell death 1 (PD-1) and cytotoxic T-Lymphocyte-associated Protein 4 (CTLA-4) antibodies, alone or in combination, to age- and sex-matched controls. Lung function was assessed using spirometry, according to American Thoracic Society and European Respiratory Society standards, the LCI, and a diffusion capacity of carbon monoxide (DLCO) measurement. Results: Sixty-one screened patients and thirty-eight screened controls led to nineteen successfully included pairs. The LCI in the ICB-treated patients was 8.41 ± 1.15 (mean ± SD), which was 0.32 higher compared to 8.07 ± 1.17 in the control group, but the difference was not significant (p = 0.452). The patients receiving their ICB therapy for under five months showed a significantly lower LCI (7.98 ± 0.77) compared to the ICB patients undergoing therapy for over five months (9.63 ± 1.22) at the point of testing (p = 0.014). Spirometric analysis revealed that the forced expiratory volume between 25 and 75% of the forced vital capacity (FEF25-75%) in the ICB-treated patients was significantly reduced (p = 0.047) compared to the control group. DLCO (%predicted and adjusted for hemoglobin) was 94.4 ± 19.7 in the ICB patients and 93.4 ± 21.7 in the control group (p = 0.734). Conclusions: The patients undergoing ICB therapy showed slightly impaired lung function compared to the controls. Longer periods of ICB treatment led to deterioration of the LCI, which may be a sign of a subclinical inflammatory process. The LCI is feasible and may be easily integrated into the clinical daily routine and could contribute to early detection of pulmonary (auto-)inflammation.

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