Prevalence and clinical correlates of small airway obstruction in patients with systemic sclerosis

Abstract

Objectives This study aims to assess the prevalence and clinical correlates of small airway obstruction (SAO) in patients with systemic sclerosis (SSc). Methods Sixty-nine consecutive patients with SSc (63 women and 6 men) were included. Lung function tests, including assessment of lung diffusing capacity, were performed in all patients. Patients were considered to have SAO when the maximal expiratory flow at 25% of the forced vital capacity (MEF 25 ) was lower than 60% as predicted. High-resolution computed tomography (HRCT) of the lung was performed in all patients with MEF 25 < 60%. We assessed the relationship of SAO in our patients with large airway obstruction, decreased lung diffusing capacity, HRCT findings, disease duration, disease subtype, scleroderma-specific antibodies, and smoking. Results SAO was noticed in 46/69 (66.6%) of patients with SSc. Restrictive lung disease was found in 4/69 (5.8%), obstruction of large airways in 18/69 (26.1%), and decreased lung diffusing capacity in 47/69 (68.1%) of patients. No difference in gender, age, disease duration, disease subtype, and scleroderma-specific antibodies was found between patients with and without SAO. Eighteen out of forty-six (39.1%) patients with SAO had decreased forced expiratory volume in 1 sec (FEV 1 ) and the Tiffeneau-Pinelli index, indicating presence of coexistent large airway obstruction. Twenty out of forty-six (43.5%) patients with SAO had associated decreased lung diffusing capacity, while 8/46 (17.4%) of patients had isolated SAO. HRCT patterns of interstitial lung disease (ILD) were found more frequently in patients with SAO and decreased lung diffusing capacity, compared with patients with SAO and normal diffusing capacity (75% vs 11.5%, p = 0.008). We have noticed that tobacco smokers among SSc patients with SAO have more common associated obstructive lung disease on spirometry (58.8% vs 15.4%, p = 0.004). On the other hand, isolated SAO and SAO associated with impaired diffusing capacity were equally frequent among smokers and non-smokers. Conclusion Patients with SSc have commonly SAO. It can be considered clinical feature of undiagnosed asthma or chronic obstructive pulmonary disease (COPD), if isolated or associated with large airway obstruction, especially in tobacco smokers. On the other hand, SAO associated with decreased lung diffusing capacity was found to be not related to smoking, and may indicate a possible prominent bronchiolar involvement within SSc-related interstitial lung disease

Can home rehabilitation impact impulse oscillometry and lung ultrasound findings in patients with scleroderma-associated interstitial lung disease? A pilot study

“…Interestingly, we observed that three-fourths of the patients had altered IOS, and more than two-thirds had SAD diagnosed by an increase in R4-R20. In line with our findings, Ostojic and Vujovic [ 5 ] detected SAD in 66.6% of patients with scleroderma, although they used the maximal expiratory flow at 25% of the forced vital capacity to diagnose SAD. Unlike these studies, Bonifazi et al [ 7 ] used IOS and Silva et al [ 22 ] used the nitrogen single-breath washout test and observed SAD in 21.5% and 28.8% of patients with scleroderma, respectively.…”

“…Unlike these studies, Bonifazi et al [ 7 ] used IOS and Silva et al [ 22 ] used the nitrogen single-breath washout test and observed SAD in 21.5% and 28.8% of patients with scleroderma, respectively. These differences may be explained at least in part by the varied frequencies of interstitial involvement, as SAD may indicate possible prominent bronchiolar involvement in scleroderma-related ILD [ 5 , 23 ].…”

“…Small airway disease (SAD) is a common finding in scleroderma and is detected in up to two-thirds of cases [ 5 ]. Similarly, ILD is a frequent complication in scleroderma, with up to 80% of patients presenting with pulmonary fibrosis [ 6 ].…”

Clinical characteristics associated with small airways disease in systemic sclerosis

“…However, only 69 patients were included in that study and the authors did not perform multivariable analyses to evaluate the associations between SAD and clinical features of SSc. 23 Our findings complement that study by demonstrating that SAD in SSc is both prevalent and associated with common comorbid conditions in these patients.…”

Small airway dysfunction in Chinese patients with idiopathic pulmonary fibrosis

“…In the recent years growing interest has focused on the involvement of small airway in various bronchiolar and interstitial lung diseases [18][19][20][21]. Previous studies have found histopathological evidence for SAD in patients with IPF.…”