Relationship between peripheral airway function and patient-reported outcomes in COPD: a cross-sectional study

Haruna, Akane; Oga, Toru; Muro, Shigeo; Ohara, Tadashi; Satô, Susumu; Marumo, Satoshi; Kinose, Daisuke; Terada, Kunihiko; Nishioka, Midori; Ogawa, Emiko; Hoshino, Yuma; Hirai, Toyohiro; Chin, Kazuo; Mishima, Michiaki

doi:10.1186/1471-2466-10-10

Cited by 76 publications

(63 citation statements)

References 46 publications

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“…Although the symptoms score was strongly related to FEV1 % pred, RV/TLC % pred and LCI, LCI was the sole predictor of SGRQ total score in multivariate analysis. This suggests that respiratory quality of life following HSCT may be affected by peripheral airway dysfunction as measured by ventilation heterogeneity in a global sense and is in keeping with similar findings with FOT [43]. The absence of correlation between Sacin and both SGRQ total score and the symptoms score in this longitudinal cohort with five out of the 22 patients with clinical BO, suggests that abnormalities in the more peripheral diffusion-dependent airway compartment are too peripheral to impact on respiratory symptoms.…”

Section: Discussionsupporting

confidence: 81%

Small airways function declines after allogeneic haematopoietic stem cell transplantation

Lahzami¹,

Schoeffel²,

Pechey³

et al. 2011

Eur Respir J

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Bronchiolitis obliterans (BO) following allogeneic haematopoietic stem cell transplantation (HSCT) affects peripheral airways. Detection of BO is presently delayed by the low sensitivity of spirometry.We examined the relationship between peripheral airway function and time since HSCT, and compared it with spirometry and clinical indices in 33 clinically stable allogeneic HSCT recipients. The following measurements were performed: lung function, exhaled nitric oxide, forced oscillatory respiratory system resistance and reactance, acinar (Sacin) and conductive airways ventilation heterogeneity and lung clearance index (LCI) measured by multiple breath nitrogen washout. 22 patients underwent repeat visits from which short-term changes were examined.Median time post HSCT was 12 months. Eight patients were clinically diagnosed as having BO. In multivariate analysis, time since HSCT was predicted by Sacin and forced expiratory volume in 1 s % predicted. 20 patients had abnormal Sacin with normal spirometry, whereas none had airflow obstruction with normal Sacin. Sacin and LCI were the only measures to change significantly between two visits, with both worsening. Change in Sacin was the only parameter to correlate with change in chronic graft-versus-host disease grade.In conclusion, peripheral airways ventilation heterogeneity worsens with time after HSCT. Sacin may be more sensitive than spirometry in detecting BO at an early stage, which needs confirmation in a prospective study.

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Section: Discussionsupporting

confidence: 81%

Small airways function declines after allogeneic haematopoietic stem cell transplantation

Lahzami¹,

Schoeffel²,

Pechey³

et al. 2011

Eur Respir J

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“…Two studies from Japan note that X RS relates more closely with quality of life measures than FEV 1 in both patients with asthma 60 and COPD. 61 One of the benefits of the FOT is that one can separately measure inspiratory from expiratory parameters. Using this technique, Paredi and colleagues have shown that while whole breath impulse oscillometry could not differentiate patients with asthma and COPD, patients with COPD had higher mean expiratory X5 than those with asthma, which they thought might be due to enhanced dynamic airway narrowing on expiration in these patients.…”

Section: Measurement Of Airway Resistance By the Forced Oscillation Tmentioning

confidence: 99%

What Does Airway Resistance Tell Us About Lung Function?

2012

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SummarySpirometry is considered the primary method to detect the air flow limitation associated with obstructive lung disease. However, air flow limitation is the end-result of many factors that contribute to obstructive lung disease. One of these factors is increased airway resistance. Airway resistance is traditionally measured by relating air flow and driving pressure using body plethysmography, thus deriving airway resistance (R aw ), specific airway resistance (sR aw ), and specific airway conductance (sG aw ). Other methods to measure airway resistance include the forced oscillation technique (FOT), which allows calculation of respiratory system resistance (R RS ) and reactance (X RS ), and the interrupter technique, which allows calculation of interrupter resistance (R int ). An advantage of these other methods is that they may be easier to perform than spirometry, making them particularly suited to patients who cannot perform spirometry, such as young children, patients with neuromuscular disorders, or patients on mechanical ventilation. Since spirometry also requires a deep inhalation, which can alter airway resistance, these alternative methods may provide more sensitive measures of airway resistance. Furthermore, the FOT provides unique information about lung mechanics that is not available from analysis using spirometry, body plethysmography, or the interrupter technique. However, it is unclear whether any of these measures of airway resistance contribute clinically important information to the traditional measures derived from spirometry (FEV 1 , FVC, and FEV 1 /FVC). The purpose of this paper is to review the physiology and methodology of these measures of airway resistance, and then focus on their clinical utility in relation to each other and to spirometry.

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“…Although in COPD patients a significant correlation between SAD and quality of life (measured by St. George's Respiratory Questionnaire, SGRQ) and dyspnoea perception (measured by mMRC scale) [8] may occur, the exact role of SAD in the clinical presentation of COPD is not yet completely understood [9]. Moreover, it is not known whether SAD may have a relationship with the impact of disease.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Small-Airway Dysfunction among COPD Patients with Different GOLD Stages and Its Role in the Impact of Disease

et al. 2016

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Background: In chronic obstructive pulmonary disease (COPD) patients, small-airway dysfunction (SAD) is considered a functional hallmark of disease. However, the exact role of SAD in the clinical presentation of COPD is not yet completely understood; moreover, it is not known whether SAD may have a relationship with the impact of disease. Objectives: To evaluate the prevalence of SAD among COPD patients categorized by the old and the new GOLD classification and to ascertain whether there is a relationship between SAD and impact of disease measured by the COPD Assessment Test (CAT) questionnaire. Methods: We prospectively enrolled COPD outpatients from the University Hospital of Parma. Using the impulse oscillometry system (IOS), we assessed the fall in resistance from 5 to 20 Hz (R5-R20), reactance at 5 Hz (X5), and resonant frequency (F_Res) as markers of peripheral airway dysfunction. According to R5-R20 ≥0.07 or <0.07, the cohort was also categorized in patients with and without SAD, respectively. Results: We studied 202 patients. In both GOLD classifications, a progressive increasing distribution of R5-R20 and F_Res was reported with a decreasing of X5. Moreover, there was a significant correlation between R5-R20 and CAT (r = 0.527, p < 0.001). Finally, the presence of SAD (OR 11.96; 95% CI 4.53-31.58; p < 0.001) and use of ICS + LABA + LAMA (OR 5.31; 95% CI 1.88-15.02; p = 0.002) were independent predictors of higher impact (CAT score ≥10). Conclusion: In COPD patients, the presence of SAD, as assessed by IOS, progressively increases with GOLD classifications and it is closely related to the high impact of disease on health status.

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Relationship between peripheral airway function and patient-reported outcomes in COPD: a cross-sectional study

Cited by 76 publications

References 46 publications

Small airways function declines after allogeneic haematopoietic stem cell transplantation

Small airways function declines after allogeneic haematopoietic stem cell transplantation

What Does Airway Resistance Tell Us About Lung Function?

Prevalence of Small-Airway Dysfunction among COPD Patients with Different GOLD Stages and Its Role in the Impact of Disease

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