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Environmental Pollution (Barking, Essex... Aug 2023Exposure to phthalates and synthetic phenols is ubiquitous. Some of them are suspected to impact child respiratory health, although evidence still remains insufficient....
Exposure to phthalates and synthetic phenols is ubiquitous. Some of them are suspected to impact child respiratory health, although evidence still remains insufficient. This study investigated the associations between prenatal exposure to phthalates and phenols, individually and as a mixture, and child respiratory health assessed by objective lung function measures since 2 months of age. Among 479 mother-child pairs from the SEPAGES cohort, 12 phenols, 13 phthalate and 2 non-phthalate plasticizer metabolites were measured in 2 pools including each 21 urine samples collected at the 2nd and 3rd pregnancy trimesters. Lung function was measured at 2 months using tidal breathing flow-volume loops and nitrogen multiple-breath washout, and at 3 years using oscillometry. Asthma, wheezing, bronchitis and bronchiolitis were assessed by repeated questionnaires. A cluster-based analysis was applied to identify exposure patterns to phenols and phthalates. Adjusted associations between clusters as well as each individual exposure biomarker and child respiratory health were estimated by regression models. We identified four prenatal exposure patterns: 1) low concentrations of all biomarkers (reference, n = 106), 2) low phenols-moderate phthalates (n = 162), 3) high concentrations of all biomarkers except bisphenol S (n = 109), 4) high parabens-moderate other phenols-low phthalates (n = 102). At 2 months, cluster 2 infants had lower functional residual capacity and tidal volume and higher ratio of time to peak tidal expiratory flow to expiratory time (t/t) and cluster 3 had lower lung clearance index and higher t/t. Clusters were not associated with respiratory health at 3 years but in the single-pollutant models, parabens were associated with increased area of the reactance curve, bronchitis (methyl, ethyl parabens) and bronchiolitis (propyl paraben). Our results suggested that prenatal exposure to mixtures of phthalates reduced lung volume in early life. Single exposure analyses suggested associations of parabens with impaired lung function and increased risk of respiratory diseases.
Topics: Pregnancy; Female; Infant; Humans; Parabens; Environmental Exposure; Prenatal Exposure Delayed Effects; Environmental Pollutants; Phenols; Phthalic Acids; Bronchitis; Biomarkers
PubMed: 37178953
DOI: 10.1016/j.envpol.2023.121794 -
Annals of Allergy, Asthma & Immunology... Sep 2023In the year 2035, projections have estimated that 5% of the Scottish population will be morbidly obese defined as a body mass index (BMI) greater than or equal to 40...
BACKGROUND
In the year 2035, projections have estimated that 5% of the Scottish population will be morbidly obese defined as a body mass index (BMI) greater than or equal to 40 kg/m. Airway oscillometry is an effort-independent test akin to bronchial sonar which measures resistance and compliance.
OBJECTIVE
To evaluate the impact of obesity on lung mechanics using oscillometry.
METHODS
Clinical data for 188 patients with respiratory physician-diagnosed moderate-to-severe asthma were retrospectively collected and analyzed.
RESULTS
Obesity (BMI 30-39.9 kg/m) and morbid obesity (BMI ≥ 40 kg/m) were associated with a significantly worse heterogeneity of peripheral resistance between 5 Hz and 20 Hz and peripheral compliance as low-frequency reactance at 5 Hz and area under the reactance curve, as compared with normal weight (BMI 18.5-24.9 kg/m). Cluster analysis incorporating oscillometry identified a patient cohort who was older, obese, and female with combined impairment of spirometry and oscillometry coupled with more frequent severe exacerbations.
CONCLUSION
Obesity is associated with worse peripheral airway dysfunction in moderate-to-severe asthma, including a patient cluster who was older, obese, and female with more frequent exacerbations.
Topics: Humans; Adult; Female; Obesity, Morbid; Retrospective Studies; Oscillometry; Asthma; Lung; Spirometry
PubMed: 37209835
DOI: 10.1016/j.anai.2023.05.014 -
The Journal of Allergy and Clinical... Aug 2024The combination of an inhaled corticosteroid (ICS) and long-acting β-agonist (LABA) (ICS/LABA) has shown superiority in improving lung function (FEV) compared with an...
BACKGROUND
The combination of an inhaled corticosteroid (ICS) and long-acting β-agonist (LABA) (ICS/LABA) has shown superiority in improving lung function (FEV) compared with an ICS alone. The clinical effect of a ICS/LABA combination depends on the fine-particle fraction and the pulmonary deposition.
OBJECTIVE
We sought to compare the efficacy of 2 combinations of an ICS and LABA, namely, fluticasone propionate (FP) and formoterol (FORM) (FP/FORM) and fluticasone furoate (FF) and vilanterol (VI) (FF/VI), in asthmatic adolescents with chronic bronchial obstruction.
METHODS
FP/FORM (125 μg/5 μg, 2 doses twice daily via the k-haler [Mundipharma, Cambridge, UK]) and FF/VI (92 μg/22 μg, once daily via the Ellipta inhaler [GlaxoSmithKline]) were administered to adolescents aged 12 to 17 years who required regular antiasthmatic medication and had a ratio of FEV to forced vital capacity (FEV/FVC) less than -1.65 SD in a 2-sequence, 16-week crossover trial. The primary efficacy end point was change in FEV compared with baseline. Secondary end points were FEV/FVC ratio, maximal expiratory flow at 50% of the FVC, impulse oscillometry indices respiratory resistance at 5 Hz (R5), difference between R5 and respiratory resistance at 20 Hz (R20), area of reactance, and Asthma Control Test score.
RESULTS
Both ICS/LABA combinations resulted in a significant improvement in FEV and maximal expiratory flow at 50% of the FVC scores without any significant difference between FP/FORM and FF/VI, with 40% of patients with either treatment achieving a normal prebronchodilator FEV/FVC score. Neither area of reactance nor difference between R5 and R20 improved significantly with either treatment.
CONCLUSION
Both ICS/LABA combinations demonstrated significant improvements in FEV score. More than one-third of the asthmatic adolescents with prolonged bronchial obstruction achieved a normal prebronchodilator FEV/FVC ratio.
PubMed: 38826625
DOI: 10.1016/j.jacig.2024.100268 -
Journal of Investigational Allergology... Apr 2024Background: Static lung hyperinflation (SLH) measured using body plethysmography in patients with asthma is associated with poor outcomes. The severity of SLH may be... (Observational Study)
Observational Study
BACKGROUND AND OBJECTIVES
Background: Static lung hyperinflation (SLH) measured using body plethysmography in patients with asthma is associated with poor outcomes. The severity of SLH may be associated with small airway dysfunction (SAD), which can be measured using impulse oscillometry (IOS). Objective: This study aims to determine the correlation between SLH and SAD in patients with severe asthma and assess the improvement in SLH and SAD with treatment.
METHODS
We analyzed data from patients who were enrolled in the Taiwan Severe Asthma Registry, which comprises a prospective observational cohort. Plethysmography and IOS were performed regularly. The relationship between spirometry and IOS parameters was determined. Changes in the clinical outcomes in response to treatment were analyzed.
RESULTS
Of 107 patients with severe asthma, 83 (77.6%) had SLH based on an increased residual volume to total lung capacity ratio (RV/ TLC). Most patients were older women with worse pulmonary function and SAD than those without SLH. SAD, defined as increased airway resistance/reactance, was significantly correlated with SLH. Airway reactance at 5 Hz (X5) ≤-0.21 kPa/(L/s) detected SLH with an area under the receiver operating characteristic curve of 0.84 (P<.0001; sensitivity, 85.2%; and specificity, 83.3%). After 12 months, patients who received add-on biologics (vs those who did not) had significantly reduced exacerbations, fractional exhaled nitric oxide level, and blood eosinophil counts, as well as improved forced expiratory volume in the first second, X5, and a trend toward reduced RV/TLC ratio.
CONCLUSIONS
In severe asthma, airway reactance (X5) could be a novel parameter for assessing SLH.
Topics: Aged; Female; Humans; Asthma; Forced Expiratory Volume; Lung; Respiratory Function Tests; Spirometry; Prospective Studies
PubMed: 36645713
DOI: 10.18176/jiaci.0888 -
BMC Pulmonary Medicine Sep 2023We conducted a retrospective observational study to explore the potential application of impulse oscillometry (IOS) as an alternative to high-resolution computed... (Observational Study)
Observational Study
BACKGROUND
We conducted a retrospective observational study to explore the potential application of impulse oscillometry (IOS) as an alternative to high-resolution computed tomography (HRCT) for detecting pulmonary involvement in patients with rheumatoid arthritis (RA) because clinically evident interstitial lung disease (ILD) and airway involvement are common in this population.
METHODS
We enrolled 72 patients with RA who underwent pulmonary function tests (PFTs) and IOS between September 2021 and September 2022. We aimed to identify the PFT and IOS variables associated with lung diseases shown on HRCT images.
RESULTS
In our cohort of 72 patients, 48 underwent HRCT; of these, 35 had airway disease or ILD and 13 showed no obvious abnormalities on HRCT. Abnormal IOS and PFT parameters were observed in 34 and 23 patients, respectively, with abnormal HRCT images. The predicted percentages for forced vital capacity, the ratio of forced expiratory volume in the first one second to forced vital capacity, and forced mid-expiratory flow value were significantly lower in patients with abnormal HRCT. Lung resistance at 5 Hz, difference in resistance between 5 and 20 Hz, resonant frequency (Fres), and reactance area were higher in these patients and reactance at 5 Hz was lower. Compared to other parameters, Fres > 14.14 was significantly associated with alterations in HRCT and may be used as an indicator for monitoring disease.
CONCLUSION
Fres > 14.14 is significantly associated with lung involvement in RA patients. Performance of spirometry with IOS is more beneficial than spirometry alone for evaluating lung involvement in RA patients.
Topics: Humans; Adult; Oscillometry; Lung Diseases, Interstitial; Respiration Disorders; Respiratory Function Tests; Arthritis, Rheumatoid
PubMed: 37684581
DOI: 10.1186/s12890-023-02615-0 -
Diagnostics (Basel, Switzerland) Jul 2023Primary ciliary dyskinesia (PCD) is an autosomal recessive disorder that results from the dysfunction of motile cilia, which can cause chronic upper and lower...
Primary ciliary dyskinesia (PCD) is an autosomal recessive disorder that results from the dysfunction of motile cilia, which can cause chronic upper and lower respiratory infections leading to bronchiectasis. However, there is a need for additional tools to monitor the progression of bronchiectasis in PCD. The forced oscillation technique (FOT) is an effort-independent lung function test that can be used to evaluate respiratory mechanics. In this retrospective study, we aimed to describe the radiographic findings associated with respiratory impedance (resistance (Rrs) and reactance (Xrs)) measured by FOT in six adult PCD patients and one pediatric with the ( (c.921+3_921+6delAAGT (intronic)) founder mutation. We compared the radiographic findings on a high-resolution chest computed tomography (CT) scan with the FOT results. Our findings suggest that respiratory impedance measured by FOT may be a valuable tool for detecting and monitoring the progression of bronchiectasis in PCD patients with the ( (c.921+3_921+6delAAGT (intronic)) founder mutation. However, further research is necessary to validate these results and determine the sensitivity and specificity of bronchiectasis monitoring in PCD patients with other genetic mutations.
PubMed: 37443681
DOI: 10.3390/diagnostics13132287 -
Tuberculosis and Respiratory Diseases Apr 2024: Bronchiectasis is a chronic respiratory disease that leads to airway inflammation, destruction, and airflow limitation, which reflects its severity. Impulse...
BACKGROUND
: Bronchiectasis is a chronic respiratory disease that leads to airway inflammation, destruction, and airflow limitation, which reflects its severity. Impulse oscillometry (IOS) is a non-invasive method that uses sound waves to estimate lung function and airway resistance. The aim of this study was to assess the usefulness of IOS in predicting the severity of bronchiectasis.
METHODS
: We retrospectively reviewed the IOS parameters and clinical characteristics in 145 patients diagnosed with bronchiectasis between March 2020 and May 2021. Disease severity was evaluated using the FACED score, and patients were divided into mild and moderate/severe groups.
RESULTS
: Forty-four patients (30.3%) were in the moderate/severe group, and 101 (69.7%) were in the mild group. Patients with moderate/severe bronchiectasis had a higher airway resistance at 5 Hz (R5), a higher difference between the resistance at 5 and 20 Hz (R5-R20), a higher resonant frequency (Fres), and a higher area of reactance (AX) than patients with mild bronchiectasis. R5 ≥0.43, resistance at 20 Hz (R20) ≥0.234, R5-R20 ≥28.3, AX ≥1.02, reactance at 5 Hz (X5) ≤-0.238, and Fres ≥20.88 revealed significant univariable relationships with bronchiectasis severity (p<0.05). Among these, only X5 ≤-0.238 exhibited a significant multivariable relationship with bronchiectasis severity (p=0.039). The receiver operating characteristic curve for predicting moderate- to-severe bronchiectasis of FACED score based on IOS parameters exhibited an area under the curve of 0.809.
CONCLUSION
: The IOS assessed by the disease severity of FACED score can effectively reflect airway resistance and elasticity in bronchiectasis patients and serve as valuable tools for predicting bronchiectasis severity.
PubMed: 38783483
DOI: 10.4046/trd.2023.0160 -
Physiological Reports Dec 2023Pulmonary mechanics has been traditionally viewed as determined by lung size and physical factors such as frictional forces and tissue viscoelastic properties, but few...
Pulmonary mechanics has been traditionally viewed as determined by lung size and physical factors such as frictional forces and tissue viscoelastic properties, but few information exists regarding potential influences of cytokines and hormones on lung function. Concentrations of 28 cytokines and hormones were measured in saliva from clinically healthy scholar children, purposely selected to include a wide range of body mass index (BMI). Lung function was assessed by impulse oscillometry, spirometry, and diffusing capacity for carbon monoxide, and expressed as z-score or percent predicted. Ninety-six scholar children (55.2% female) were enrolled. Bivariate analysis showed that almost all lung function variables correlated with one or more cytokine or hormone, mainly in boys, but only some of them remained statistically significant in the multiple regression analyses. Thus, after adjusting by height, age, and BMI, salivary concentrations of granulocyte-macrophage colony-stimulating factor (GM-CSF) in boys were associated with zR5-R20 and reactance parameters (zX20, zFres, and zAX), while glucagon inversely correlated with resistances (zR5 and zR20). Thus, in physiological conditions, part of the mechanics of breathing might be influenced by some cytokines and hormones, including glucagon and GM-CSF. This endogenous influence is a novel concept that warrants in-depth characterization.
Topics: Male; Child; Humans; Female; Cytokines; Granulocyte-Macrophage Colony-Stimulating Factor; Cross-Sectional Studies; Glucagon; Lung
PubMed: 38086735
DOI: 10.14814/phy2.15861 -
Frontiers in Pediatrics 2023Evaluating oscillometry parameters separately for the inspiratory and expiratory breath phases and their within-breath differences can help to identify exercise-induced...
BACKGROUND
Evaluating oscillometry parameters separately for the inspiratory and expiratory breath phases and their within-breath differences can help to identify exercise-induced bronchoconstriction (EIB) in pediatric outpatients disclosing exercise-induced symptoms (EIS).
AIMS
To assess the response in impedance parameters following an exercise challenge in patients reporting EIS.
METHODS
Sixty-eight patients reporting EIS (34 asthmatics and 34 suspected of asthma, age mean = 10.8 years, range = 6.0-16.0) underwent an incremental treadmill exercise test. Spirometry was performed at baseline and 1, 5-, 10-, 15-, and 20-min post exercise. Oscillometry was performed at baseline and at 3- and 18-min post exercise. Bronchodilator response to 200 µg albuterol was then assessed. EIB was defined as a forced expiratory volume in 1 s (FEV) fall ≥10% from baseline. Expiratory and inspiratory resistance (Rrs) and reactance (Xrs), their -score (Ducharme et al. 2022), and their mean within-breath differences (ΔRrs = Rrs-Rrs, ΔXrs =Xrs-Xrs) were calculated. Receiver operating characteristic (ROC) curves and their areas (AUCs) were used to evaluate impedance parameters' performances in classifying EIB.
RESULTS
Asthmatic patients developed EIB more frequently than those suspected of asthma [18/34 (52.9%) vs. 2/34 (5.9%), < 0.001]. In the 20 subjects with EIB, Rrs, Rrs, Xrs, and Xrs peaked early (3'), and remained steady except for Xrs which recovered faster afterward. ΔXrs widened 18 min following the exercise and reversed sharply after bronchodilation (BD) (-1.81 ± 1.60 vs. -0.52 ± 0.80 cmHO × s/L, < 0.001). Cutoffs for EIB leading to the highest AUCs were a rise of 0.41 in -score Rrs (Se: 90.0%, Sp: 66.7%), and a fall of -0.64 in -score Xrs (Se: 90.0%, Sp: 75.0%). Accepting as having "positive" postexercise oscillometry changes those subjects who had both -scores beyond respective cutoffs, sensitivity for EIB was 90.0% (18/20) and specificity, 83.3% (40/48).
CONCLUSION
Oscillometry parameters and their within-breath differences changed markedly in pediatric patients presenting EIB and were restored after the bronchodilator. Strong agreement between -scores of inspiratory oscillometry parameters and spirometry supports their clinical utility, though larger studies are required to validate these findings in a broader population.
PubMed: 38274467
DOI: 10.3389/fped.2023.1324413 -
Open Respiratory Archives 2024The role of oscillometry in interstitial lung disease (ILD) is still unclear. The main objective of our study was to describe the parameters determined by oscillometry...
INTRODUCTION
The role of oscillometry in interstitial lung disease (ILD) is still unclear. The main objective of our study was to describe the parameters determined by oscillometry in these patients and compare them with those obtained in conventional respiratory function tests.
METHODS
This was a cross-sectional observational study. Patients with no respiratory disease and patients being followed up for ILD in the specialist unit of Hospital Universitario de Getafe, Madrid were included.
RESULTS
A total of 45 individuals were analyzed. Fifteen had no respiratory disease, 15 were ILD patients with mild functional impairment, and another 15 were ILD patients with severe impairment. None of the participants had an obstructive pattern on spirometry.Comparison between the three groups showed statistically significant differences in the values of R5-19, reactance at 5 Hz and reactance at 11 Hz. No differences were observed between the three groups in Delta Xrs. The study showed a strong correlation between total and inspiratory reactance at 5 Hz and forced vital capacity and diffusing capacity for carbon monoxide.
CONCLUSIONS
Our results suggest that the findings in ILD are characteristic of this disease and that they differ from those found in other diseases such as chronic obstructive pulmonary disease. It also seems that there are differences according to the degree of functional impairment of the patients. The results show a strong correlation with standard pulmonary function tests, so oscillometry could be a useful tool in patients with ILD who are unable to perform it, and could provide additional information.
PubMed: 38022789
DOI: 10.1016/j.opresp.2023.100278