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ERJ Open Research Apr 2020Advanced glycation end-products (AGEs) have been implicated in the pathophysiology of chronic obstructive pulmonary disease (COPD). However, the association between AGE...
BACKGROUND
Advanced glycation end-products (AGEs) have been implicated in the pathophysiology of chronic obstructive pulmonary disease (COPD). However, the association between AGE accumulation in the skin measured by skin autofluorescence (SAF) and lung function in healthy subjects has not been explored in detail. We use a population-based study of 50-64-year-olds to assess spirometry, diffusing capacity of the lung for carbon monoxide ( ) and impulse oscillometry (IOS) in relation to SAF.
METHODS
Participants with information on SAF, lung function and potential confounding variables were included from the Swedish Cardiopulmonary Bioimage Study (SCAPIS) cohort (spirometry, n=4111; , n=3889; IOS, n=3970). Linear regression was used to assess changes in lung function (as measured by spirometry (forced expiratory volume in 1 s (FEV), forced vital capacity (FVC) and FEV/FVC), and IOS (resistance measured at 5 ( ) and 20 Hz ( ), - , area of reactance, reactance measured at 5 Hz ( ), and resonant frequency)) by a 1-sd increase in SAF.
RESULTS
FEV, FVC and were significantly and inversely associated with SAF after adjustment for potential confounding factors (per 1-sd increase in SAF: FEV -0.03 L (95% CI -0.04- -0.02 L), p<0.001; FVC -0.03 L (95% CI -0.05- -0.02 L), p<0.001; -0.07 mmol·min·kPa (95% CI -0.11- -0.03 mmol·min·kPa), p<0.001). This association was also found in nonsmokers and in non-COPD subjects. Pulmonary reactance ( ) but not pulmonary resistance ( , and - ) was significantly associated with SAF (per 1-sd increase in SAF: -0.001 kPa·L·s (95% CI -0.003-0.00 kPa·L·s), p=0.042), which was mirrored in non-COPD patients but not in current nonsmokers.
CONCLUSIONS
AGE accumulation, as measured by SAF, is significantly associated with lung function decrements indicative of changes in the lung parenchyma.
PubMed: 32523964
DOI: 10.1183/23120541.00356-2019 -
Lung Aug 2019The forced oscillation technique (FOT) measures respiratory impedance during normal tidal breathing and requires minimal patient cooperation. (Comparative Study)
Comparative Study
BACKGROUND
The forced oscillation technique (FOT) measures respiratory impedance during normal tidal breathing and requires minimal patient cooperation.
OBJECTIVE
To compare IOS and AOS devices in patients with asthma and COPD.
METHODS
We compared two different FOT devices, namely impulse oscillometry using a loudspeaker (IOS: Jaeger Masterscreen) and airwave oscillometry using a vibrating mesh (AOS: Thorasys Tremoflo) for pre- and post-bronchodilator measurements in 84 patients with asthma and COPD.
RESULTS
The overall pattern of measurement bias was for higher resistance with IOS and higher reactance with AOS, this being the case in asthma and COPD separately. There were small but significantly higher values using IOS for resistance at 5 Hz (R5) and 20(19) Hz (R20(19)). In converse, values for reactance at 5 Hz (X5), reactance area (AX) and resonant frequency (Fres) were significantly higher using AOS but to a much larger extent. The difference in AX between devices was more pronounced in COPD than in asthma. Salbutamol reversibility as % change was greater in asthma than COPD patients with AX but not FEV1.
CONCLUSION
Our study showed evidence of better agreement for resistance than reactance when comparing IOS and AOS, perhaps inferring that AOS may be more sensitive at measuring reactance in patients with airflow obstruction.
Topics: Aged; Airway Resistance; Albuterol; Asthma; Bronchodilator Agents; Equipment Design; Female; Forced Expiratory Volume; Humans; Lung; Male; Maximal Midexpiratory Flow Rate; Middle Aged; Oscillometry; Predictive Value of Tests; Pulmonary Disease, Chronic Obstructive; Reproducibility of Results; Respiratory Function Tests; Retrospective Studies; Vital Capacity
PubMed: 31273438
DOI: 10.1007/s00408-019-00247-y -
Respirology (Carlton, Vic.) Aug 2020Abnormal peripheral airway function is an important feature of asthma and relates to asthma symptoms and poor asthma control. We aimed to determine whether peripheral...
BACKGROUND AND OBJECTIVE
Abnormal peripheral airway function is an important feature of asthma and relates to asthma symptoms and poor asthma control. We aimed to determine whether peripheral airway function, as measured by forced oscillatory impedance and multiple-breath nitrogen washout (MBNW), relates to symptom improvement in asthmatic participants with uncontrolled asthma, after stepping up to high-dose ICS/LABA treatment.
METHODS
A total of 19 subjects (14 females, mean age: 29.9 ± 13.6 years) with uncontrolled asthma, as defined by an ACQ5 > 1.5, taking 500 μg/day fluticasone equivalent or less, underwent spirometry, plethysmography, fractional exhaled FeNO, forced oscillatory resistance (Rrs ) and reactance (Xrs ), and indices of MBNW ventilation heterogeneity (lung clearance index (LCI), diffusion-convection-dependent (Sacin) and convection-dependent (Scond)). Measurements were made before and after 8 weeks of treatment with fluticasone/formoterol combination inhaler 250/10 μg, 2 puffs twice daily.
RESULTS
Treatment improved ACQ5 (P = 0.0002), FEV (P = 0.02), FVC (P = 0.04), FeNO (P = 0.0008), Xrs (P = 0.01), LCI (P = 0.0002), Sacin (P = 0.006) and Scond (P = 0.01). At baseline, ACQ5 correlated with Xrs (r = 0.52, P = 0.03) and Rrs (r = 0.55, P = 0.02). The improvement in ACQ5 was predicted by more abnormal baseline LCI (P = 0.03), Scond (P = 0.02) and Rrs (P = 0.006). Baseline Scond was the best predictor of a clinically meaningful improvement in asthma control (ΔACQ > 0.5, ROC-AUC = 0.91, P = 0.007).
CONCLUSION
Step-up to high-dose combination treatment in uncontrolled asthma is associated with improved peripheral airway function as measured by Xrs and MBNW. Baseline MBNW and FOT parameters correlated with the improvement in symptoms and may predict a positive response to up-titration in uncontrolled asthmatic patients.
Topics: Administration, Inhalation; Adrenal Cortex Hormones; Adrenergic beta-2 Receptor Agonists; Adult; Asthma; Drug Combinations; Female; Fluticasone; Formoterol Fumarate; Humans; Lung; Male; Nitrogen; Oscillometry; Pulmonary Ventilation; ROC Curve; Respiration; Respiratory Function Tests; Spirometry
PubMed: 32026586
DOI: 10.1111/resp.13772 -
Archivos de Bronconeumologia Jan 2020Small airway dysfunction (SAD) caused by smoking contributes to the early onset of airflow limitation (AFL), although its impact on patients' perception of health is...
INTRODUCTION
Small airway dysfunction (SAD) caused by smoking contributes to the early onset of airflow limitation (AFL), although its impact on patients' perception of health is largely unknown. We aimed to evaluate the frequency of SAD in active smokers without AFL, and to compare health-related quality of life (HRQoL) of non-smokers, smokers without SAD, smokers with SAD, and smokers with AFL.
METHODS
A total of 53 active smokers without AFL, 20 smokers with AFL, and 20 non-smokers completed the SF-36 and EuroQoL questionnaires and performed impulse oscillometry and spirometry. Pulmonary parenchymal attenuation was determined in inspiration and expiration. SAD was determined to exist when resistance at 5Hz (R5), the difference between R5 and R20, and reactance area (AX) exceeded the upper limit of normal.
RESULTS
In total, 35.8% of smokers without AFL had SAD. No differences were detected in spirometric parameters or pulmonary attenuation between smokers with or without AFL and non-smokers. However, smokers with SAD had worse scores on HRQoL questionnaires than smokers without SAD or non-smokers, and scores compared to smokers with AFL were intermediate. R5 and X5 were identified as independent determinants of HRQoL in smokers without AFL.
CONCLUSIONS
SAD is common in smokers without AFL, affecting one third of this population, and independently affecting their perception of health.
Topics: Humans; Lung; Quality of Life; Respiratory Function Tests; Smokers; Spirometry
PubMed: 30824207
DOI: 10.1016/j.arbres.2019.01.006 -
Respiratory Medicine Jun 2023Welders are exposed to gas and particle emissions that can cause severe lung disease, such as chronic obstructive pulmonary disease (COPD), a leading cause of mortality...
BACKGROUND
Welders are exposed to gas and particle emissions that can cause severe lung disease, such as chronic obstructive pulmonary disease (COPD), a leading cause of mortality and morbidity worldwide. It is difficult to detect COPD early and therefore mitigating measures may be delayed. The aim of this study was to investigate lung health in welders and evaluate new sensitive methods with potential to assess early onset pulmonary changes in occupational settings.
METHODS
This study assessed the lung health and symptoms in active welders (n = 28) and controls (n = 17). Lung measurements were performed with standard spirometry and new methods: airspace dimension assessment (AiDA), oscillometry, blood serum biomarkers (club cell secretory protein 16, surfactant protein D, matrix metalloproteinases, fibroblast, hepatocyte growth factor, interleukins), and one urine biomarker (desmosine).
RESULTS
According to spirometry measurements, all participants had normal lung function. However, prevalence of cough was significantly higher among welders compared with controls and lung changes were found in welders with the novel methods. Welders had significantly higher respiratory system resistance assessed with oscillometry, serum levels of metalloproteinases 9 and hepatocyte growth factor, compared with controls. Airspace dimensions were on average higher among welders compared with controls, but the difference was not significant. The number of welding years correlated with decreased respiratory system reactance and increased serum levels of matrix metalloproteinases 9, interleukin 6, and hepatocyte growth factor. Airspace dimension assessment indices were correlated with increasing levels of inflammatory markers and matrix metalloproteinases.
CONCLUSIONS
This study indicated the potential to use new and more sensitive methods for identification of changes in lungs when standard spirometry failed to do so.
Topics: Humans; Hepatocyte Growth Factor; Metal Workers; Respiratory Function Tests; Lung; Pulmonary Disease, Chronic Obstructive; Occupational Diseases; Occupational Exposure
PubMed: 37062499
DOI: 10.1016/j.rmed.2023.107244 -
Archives of Physical Medicine and... Aug 2021To investigate whether the decrease in dyspnea in neuromuscular diseases after air stacking (AS) occurs mostly in patients with decreased inspiratory muscle force and...
OBJECTIVE
To investigate whether the decrease in dyspnea in neuromuscular diseases after air stacking (AS) occurs mostly in patients with decreased inspiratory muscle force and ensuing chest wall restriction or heterogeneous ventilation across the lungs.
DESIGN
Interventional, before-after study.
SETTING
A neurorehabilitation inpatient and outpatient center.
PARTICIPANTS
Fifteen consecutive adult patients affected by neuromuscular diseases (N=15).
INTERVENTIONS
AS treatment.
MAIN OUTCOME MEASURES
Patients had vital capacity (VC) and sniff nasal inspiratory pressure (SNIP) measured. We measured Borg score, oxygen saturation, and ventilation heterogeneity across the lung as estimated from the difference between respiratory resistance at 5 and 19 Hz (R) with the forced oscillation technique before and 5, 30, 60, and 120 minutes after applying AS.
RESULTS
Before AS, Borg score was significantly related to R (r 0.46, P<.05) but not to VC % predicted, SNIP % predicted, and time since symptom onset. After AS, average Borg score gradually decreased (P=.005), whereas inspiratory flow resistance at 5 Hz, R and inspiratory reactance at 5 Hz tended to improve, despite not reaching statistical significance. The decrease in dyspnea at 60 and 120 minutes after AS significantly correlated with baseline R (r 0.49, P<.01 and r 0.29, P<.05, respectively), but not with VC % predicted, SNIP % predicted, time since symptom onset, and clinical severity score for patients affected by amyotrophic lateral sclerosis.
CONCLUSIONS
These findings suggest that dyspnea in neuromuscular diseases is related to heterogeneous ventilation rather than inspiratory muscle force and/or lung volumes decrease. Restoring ventilation distribution across the lungs with AS appears to improve dyspnea.
Topics: Aged; Dyspnea; Female; Humans; Male; Middle Aged; Neuromuscular Diseases; Respiratory Function Tests; Respiratory Muscles; Respiratory Therapy; Spirometry
PubMed: 33711277
DOI: 10.1016/j.apmr.2021.01.092 -
American Journal of Physiology. Lung... Dec 2020Recent clinical trials have shown improvements in neonatal outcomes after intratracheal administration of a combination of budesonide/surfactant (ITBS) in infants at...
Recent clinical trials have shown improvements in neonatal outcomes after intratracheal administration of a combination of budesonide/surfactant (ITBS) in infants at risk of bronchopulmonary dysplasia. However, the effect of ITBS on lung function and alveolar structure is not known. We aimed to determine the effect of ITBS on lung function, parenchymal structure, and inflammatory cytokine expression in a relevant preterm animal model for bronchopulmonary dysplasia. Premature neonatal rabbits were administered a single dose of ITBS on the day of delivery and exposed to 95% oxygen. Following 7 days of hyperoxia, in vivo forced oscillation and pressure-volume maneuvers were performed to examine pulmonary function. Histological and molecular analysis was performed to assess alveolar and extracellular matrix (ECM) morphology, along with gene expression of connective tissue growth factor (CTGF), IL-8, and CCL-2. ITBS attenuated the functional effect of hyperoxia-induced lung injury and limited the change to respiratory system impedance, measured using the forced oscillation technique. Treatment effects were most obvious in the small airways, with significant effects on small airway resistance and small airway reactance. In addition, ITBS mitigated the decrease in inspiratory capacity and static compliance. ITBS restricted alveolar septal thickening without altering the mean linear intercept and mitigated hyperoxia-induced remodeling of the ECM. These structural changes were associated with improved inspiratory capacity and lung compliance. Gene expression of CTGF, IL-8, and CCL-2 was significantly downregulated in the lung. Treatment with ITBS shortly after delivery attenuated the functional and structural consequences of hyperoxia-induced lung injury to of life in the preterm rabbit.
Topics: Animals; Budesonide; Disease Models, Animal; Humans; Hyperoxia; Lung Injury; Pulmonary Surfactants; Rabbits; Surface-Active Agents
PubMed: 32903026
DOI: 10.1152/ajplung.00162.2020 -
Wiener Klinische Wochenschrift May 2023After COVID-19 infection, persistent exercise intolerance, changes in lung function have been shown. Our aim is to investigate the correlation between impulse...
BACKGROUND
After COVID-19 infection, persistent exercise intolerance, changes in lung function have been shown. Our aim is to investigate the correlation between impulse oscillometry (IOS) parameters and exercise capacity by using incremental and endurance shuttle walk tests (ISWT, ESWT) and investigate the factors and parameters which might have an effect on both IOS parameters and exercise capacity tests.
METHOD
The patients who had a history of COVID-19 were enrolled into cross-sectional study according to inclusion criteria. The IOS parameters, ISWT, ESWT, smoking status, time since COVID-19 diagnosis, length of hospital stay, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), body mass index (BMI), fat-free mass index (FFMI), dyspnea, hospital anxiety-depression and fatigue severity scores were recorded.
RESULTS
The study comprised 72 patients, 71% of whom were male, with a mean age of 54 ± 10 years. After COVID-19 diagnosis, the median duration was 3 (min: 1, max: 5) months and 51 (71%) of the patients were hospitalized. The FEV1 and FVC values were in normal range. The area of reactance (AX), resonance frequency (Fres), reactance at 20 Hz (X20) and the difference between resonance at 20 and 5 Hz (R5-20) correlated with both ISWT and ESWT. The FEV1 correlated with all IOS parameters (p < 0.05). Reactance correlated with FFMI (p = 024, r = 0.267), different according to hospitalization (p = 0.02).
CONCLUSION
In COVID-19 survivors, there could be correlations between IOS parameters and exercise capacity; and between these parameters and FEV and FVC. Furthermore, small airway disease with normal spirometric functions could be related to decreased exercise capacity in COVID-19 survivors regardless of concomitant diseases, BMI, smoking status and time since COVID-19 diagnosis.
Topics: Humans; Male; Adult; Middle Aged; Female; Oscillometry; Cross-Sectional Studies; COVID-19 Testing; Exercise Tolerance; Spirometry; COVID-19
PubMed: 36583749
DOI: 10.1007/s00508-022-02137-5 -
COPD 2022Respiratory oscillometry allows measuring respiratory resistance and reactance during tidal breathing and may predict exacerbations in patients with chronic obstructive...
Physiological Impairments on Respiratory Oscillometry and Future Exacerbations in Chronic Obstructive Pulmonary Disease Patients without a History of Frequent Exacerbations.
Respiratory oscillometry allows measuring respiratory resistance and reactance during tidal breathing and may predict exacerbations in patients with chronic obstructive pulmonary disease (COPD). While the Global Initiative for Chronic Obstructive Lung Disease (GOLD) advocates the ABCD classification tool to determine therapeutic approach based on symptom and exacerbation history, we hypothesized that in addition to spirometry, respiratory oscillometry complemented the ABCD tool to identify patients with a high risk of exacerbations. This study enrolled male outpatients with stable COPD who were prospectively followed-up over 5 years after completing mMRC scale and COPD assessment test (CAT) questionnaires, post-bronchodilator spirometry and respiratory oscillometry to measure resistance, reactance, and resonant frequency (Fres), and emphysema quantitation on computed tomography. Total 134 patients were classified into the GOLD A, B, C, and D groups ( = 48, 71, 5, and 9) based on symptoms on mMRC and CAT and a history of exacerbations in the previous year. In univariable analysis, higher Fres was associated with an increased risk of exacerbation more strongly than other respiratory oscillometry indices. Fres was closely associated with forced expiratory volume in 1 sec (FEV). In multivariable Cox-proportional hazard models of the GOLD A and B groups, either lower FEV group or higher Fres group was associated with a shorter time to the first exacerbation independent of the GOLD group (A vs B) and emphysema severity. Adding respiratory oscillometry to the ABCD tool may be useful for risk estimation of future exacerbations in COPD patients without frequent exacerbation history.
Topics: Disease Progression; Emphysema; Forced Expiratory Volume; Humans; Male; Oscillometry; Pulmonary Disease, Chronic Obstructive; Spirometry
PubMed: 35392737
DOI: 10.1080/15412555.2022.2051005 -
Frontiers in Physiology 2019Lung mechanics using the forced oscillation technique (FOT) is suggested to be equivalent and more sensitive in determining exercise-induced bronchoconstriction (EIB)...
Lung mechanics using the forced oscillation technique (FOT) is suggested to be equivalent and more sensitive in determining exercise-induced bronchoconstriction (EIB) than spirometry. Dynamic alterations in minute ventilation (V) may affect this measurement. We investigated changes in FOT parameters post exercise challenge (EC) in people with asthma as compared to spirometry. The rate of recovery and any effect of raised V following exercise on FOT parameters were also assessed. Airway resistance (R) and reactance (X) at 5 Hz and V were measured prior to forced expiratory volume in 1 s (FEV) before and up to 20 min after a standard EC in people with asthma and healthy controls. Airway hyperresponsiveness to the hyperosmolar mannitol test was measured in the asthmatic subjects within 1 week of the EC. Baseline and sequential measures were assessed using repeated measures ANOVA and Pearson's correlation. Group demographics and recovery data were compared using an unpaired test. Subjects with current asthma ( = 19, mean ± SD age 28 ± 6 years) and controls ( = 10, 31 ± 5 years) were studied. Baseline FEV, R, X, and V were similar between groups ( > 0.09). Airway hyperresponsiveness was present in 12/19 asthmatic subjects. The EC max % change of R and X correlated with FEV ( > 0.90) and were only different to controls in those with asthma that responded by FEV criteria ( < 0.01). EC recovery of R was similar to FEV; however, X was greater ( = 0.03). Elevated V post EC did not affect the % change in FOT parameters across all subjects ( > 0.3). R and X were highly sensitive in determining a positive EC response (80-86%), but X was more specific (93 vs. 80%). FOT parameters tracked with forced maneuvers and were not influenced by increased ventilation following an exercise challenge designed to elicit EIB. FOT identified EIB similarly to spirometry in patients with asthma.
PubMed: 31803065
DOI: 10.3389/fphys.2019.01411