-
Pediatric Research Dec 2023The aim of this study was to describe the trajectory of oscillatory mechanics from the first week of life to term equivalent and evaluate whether oscillatory mechanics... (Observational Study)
Observational Study
BACKGROUND
The aim of this study was to describe the trajectory of oscillatory mechanics from the first week of life to term equivalent and evaluate whether oscillatory mechanics are associated with simultaneous lung disease in infants ≤32 weeks gestation.
METHODS
In this observational, longitudinal study, we enrolled 66 infants. Forced oscillations were applied using a neonatal mechanical ventilator (Fabian HFOi) that superimposed oscillations (10 Hz, amplitude 2.5 cmHO) on a positive end-expiratory pressure (PEEP). Measurements were performed at 5-7-9 cmHO of PEEP or the clinical pressure ±2 cmHO; they were repeated at 7, 14, 28 post-natal days, and 36 and 40 weeks post-menstrual age (PMA).
RESULTS
The mean (range) gestational age of study participants was 29.2 (22.9-31.9) weeks. Nineteen infants (29%) developed bronchopulmonary dysplasia (BPD). Respiratory system reactance was significantly lower (lower compliance), and respiratory system resistance was significantly higher in infants with developing BPD from 7 post-natal days to 36 weeks PMA. All oscillatory mechanics parameters were significantly associated with the simultaneous respiratory severity score (p < 0.001 for all).
CONCLUSIONS
Serial measurements of oscillatory mechanics allow differentiating lung function trajectory in infants with and without evolving BPD. Oscillatory mechanics significantly correlate with the severity of simultaneous lung disease.
IMPACT
The results of the present study suggest that respiratory system reactance, as assessed by respiratory oscillometry, allows the longitudinal monitoring of the progression of lung disease in very premature infants. This paper describes for the first time the trajectory of oscillatory mechanics in very preterm infants with and without evolving bronchopulmonary dysplasia from the first week of life to term equivalent. Serial respiratory oscillometry measurements allow the identification of early markers of evolving bronchopulmonary dysplasia and may help personalizing the respiratory management strategy.
Topics: Infant; Humans; Infant, Newborn; Cohort Studies; Bronchopulmonary Dysplasia; Longitudinal Studies; Infant, Premature; Infant, Premature, Diseases
PubMed: 37452113
DOI: 10.1038/s41390-023-02724-w -
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 -
Respiratory Medicine Oct 2023Bronchial thermoplasty is an effective intervention to improve respiratory symptoms and to reduce the rate of exacerbations in uncontrolled severe asthma. A reduction in...
INTRODUCTION
Bronchial thermoplasty is an effective intervention to improve respiratory symptoms and to reduce the rate of exacerbations in uncontrolled severe asthma. A reduction in airway smooth muscle is arguably the most widely discussed mechanisms accounting for these clinical benefits. Yet, this smooth muscle reduction should also translate into an impaired response to bronchodilator drugs. This study was designed to address this question.
METHODS
Eight patients with clinical indication for thermoplasty were studied. They were uncontrolled severe asthmatics despite optimal environmental control, treatment of comorbidities, and the use of high-dose inhaled corticosteroids and long-acting β-agonists. Lung function measured by spirometry and respiratory mechanics measured by oscillometry were examined pre- and post-bronchodilator (salbutamol, 400 μg), both before and at least 1 year after thermoplasty.
RESULTS
Consistent with previous studies, thermoplasty yielded no benefits in terms of baseline lung function and respiratory mechanics, despite improving symptoms based on two asthma questionnaires (ACQ-5 and ACT-5). The response to salbutamol was also not affected by thermoplasty based on spirometric readouts, including forced expiratory volume in 1 s (FEV), forced vital capacity (FVC), and FEV/FVC ratio. However, a significant interaction was observed between thermoplasty and salbutamol for two oscillometric readouts, namely reactance at 5 Hz (X) and reactance area (Ax), showing an attenuated response to salbutamol after thermoplasty.
CONCLUSIONS
Thermoplasty attenuates the response to a bronchodilator. We argue that this result is a physiological proof of therapeutic efficacy, consistent with the well-described effect of thermoplasty in reducing the amount of airway smooth muscle.
Topics: Humans; Bronchodilator Agents; Bronchial Thermoplasty; Asthma; Albuterol; Adrenal Cortex Hormones; Forced Expiratory Volume
PubMed: 37422022
DOI: 10.1016/j.rmed.2023.107340 -
Lung Aug 2023Respiratory mechanics and the role of sex hormones in pregnancy are not well elucidated. We examined longitudinal and positional changes in lung mechanics in pregnancy...
PURPOSE
Respiratory mechanics and the role of sex hormones in pregnancy are not well elucidated. We examined longitudinal and positional changes in lung mechanics in pregnancy and investigated the role of sex hormones.
METHODS
A longitudinal study enrolled 135 women with obesity in early pregnancy. Fifty-nine percent of women identified as White; median body mass index at enrollment was 34.4 kg/m. Women with respiratory disease were excluded. We obtained measurements of airway resistance and respiratory system reactance in various positions using impedance oscillometry and sex hormones in early and late pregnancy.
RESULTS
With pregnancy progression, there was a significant increase in resonant frequency (Fres) (p = 0.012), integrated area of low frequency reactance (AX) (p = 0.0012) and R5-R20Hz (p = 0.038) in the seated position, and a significant increase in R5Hz (p = 0.000), Fres (p = 0.001), AX (p < 0.001 = 0.000), and R5-R20Hz (p = 0.014) in the supine position. Compared to the seated position, the supine position was associated with a significant increase in R5Hz, R20Hz, X5Hz, Fres, and AX in early (p-values < 0.026) and late pregnancy (p-values ≤ 0.001). Changes in progesterone levels between early and late pregnancy predicted the change in R5, Fres, and AX (p-values ≤ 0.043).
CONCLUSION
Resistive and elastic loads increase with pregnancy progression and a change in body position from seated to supine increases resistive and elastic loads in both early and late pregnancies. The increase in airway resistance is primarily related to an increase in peripheral rather than central airways resistance. There was an association between the change in progesterone levels and airway resistance.
Topics: Humans; Female; Pregnancy; Pregnant Women; Overweight; Longitudinal Studies; Progesterone; Lung; Airway Resistance; Respiratory Mechanics; Obesity; Spirometry
PubMed: 37421433
DOI: 10.1007/s00408-023-00633-7 -
Environmental Research Oct 2023Poly- and perfluoroalkyl substances (PFAS) are used in a wide range of products. Experimental studies suggested impaired lung development and pro-inflammatory response...
BACKGROUND
Poly- and perfluoroalkyl substances (PFAS) are used in a wide range of products. Experimental studies suggested impaired lung development and pro-inflammatory response following exposure to some PFAS. We aimed to assess the associations between prenatal exposure to PFAS and children respiratory health.
METHODS
The study is based on 433 mother-child pairs. 26 PFAS were measured in maternal serum collected during pregnancy. Lung function parameters were measured at 2 months using tidal breathing flow-volume loops and multiple-breath nitrogen washout and at 36 months using oscillometry. Incidence of respiratory health diseases (asthma, wheeze, bronchitis, bronchiolitis) in the first 36 months of life was assessed by repeated questionnaires. A cluster-based analysis was applied to identify prenatal PFAS exposure patterns. Adjusted linear and logistic regressions were performed to assess the associations between PFAS exposure patterns as well as individual PFAS, and each respiratory health parameter.
RESULTS
We excluded 13 PFAS due to low quantification (<5%). Relying on the 13 remaining PFAS, we identified three exposure clusters, characterized by low (N = 163), medium (N = 236) and high (N = 51) pregnancy PFAS concentrations. Compared to children belonging to the low exposure group, children in the moderate exposure group had higher reactance at 7 Hz (X) and lower frequency dependence of resistance between 7 Hz and 19 Hz (R) at 36 months, suggesting better lung function. No association of any exposure metric was detected with respiratory diseases in the first 3 years of life.
CONCLUSIONS
Our study relying on both mixture and uni-pollutant analyses, does not provide evidence for a deleterious effect of prenatal PFAS exposure on respiratory health at an early age.
Topics: Pregnancy; Female; Humans; Prenatal Exposure Delayed Effects; Fluorocarbons; Environmental Pollutants; Asthma; Incidence; Alkanesulfonic Acids
PubMed: 37406719
DOI: 10.1016/j.envres.2023.116544 -
ERJ Open Research May 2023https://bit.ly/3AYRid6.
https://bit.ly/3AYRid6.
PubMed: 37377657
DOI: 10.1183/23120541.00070-2023 -
Pediatric Pulmonology Sep 2023
Topics: Infant, Newborn; Humans; Artifacts; Infant, Premature; Gestational Age
PubMed: 37341587
DOI: 10.1002/ppul.26553 -
Indian Journal of Endocrinology and... 2023Obesity is known to induce lung function impairment. Previous studies of decline in lung function associated with obesity are well established.
BACKGROUND
Obesity is known to induce lung function impairment. Previous studies of decline in lung function associated with obesity are well established.
MATERIALS AND METHODS
In this cross-sectional study, to evaluate the effects of different obesity indices on lung mechanics, healthy subjects (males-23 and females-22) were recruited. Anthropometric parameters like body mass index (BMI), waist circumference (WC), hip circumference (HC) and neck circumference (NC) were measured and waist-hip ratio (WHR) was derived. Spirometry, impulse oscillometry (IOS) and fractional exhaled nitric oxide (FeNO) measurements were performed to assess lung function. Subgroups were divided and analysed.
RESULTS
In males, increased WHR is associated with increased total airway resistance (R). BMI correlates positively with R, R% predicted, resistance at 20 Hz (R) and R% predicted; likewise, WHR shows a positive correlation with R. In females, increased WHR has significantly higher R, R% predicted, R, R% predicted, area of reactance (Ax), resonant frequency (Fres) and decreased reactance at 5 Hz (X), reactance at 20 Hz (X), X% predicted. The female group with higher WC shows significantly increased R, R% predicted, R, R% predicted, Ax, Fres and lower fixed ratio of forced expiratory volume in 1 s (FEV)/forced vital capacity (FVC), X, X, X% predicted. The group with higher NC has a lower FEV/FVC ratio. WHR positively correlated with R% predicted and Fres while WC correlated positively with R, R% predicted, Ax and Fres; same way, NC with X% predicted.
CONCLUSION
Obesity/overweight causes significant changes in lung volumes, capacity and airway mechanics, Higher WC and WHR are associated with significant changes in lung mechanics, which are more prominent in females than in males. NC is not associated with changes in lung mechanics.
PubMed: 37292068
DOI: 10.4103/ijem.ijem_363_22 -
BMC Research Notes Jun 2023To investigated the dynamic ventilatory responses and their influence on functional exercise capacity in patients with long-COVID-19 syndrome (LCS).
OBJECTIVE
To investigated the dynamic ventilatory responses and their influence on functional exercise capacity in patients with long-COVID-19 syndrome (LCS).
RESULTS
Sixteen LCS patients were subjected to resting lung function (spirometry and respiratory oscillometry-RO) and cardiopulmonary performance to exercise (Spiropalm®-equipped six-minute walk test-6MWT and cardiopulmonary exercise test-CPX). At rest, spirometry showed a normal, restrictive and obstructive pattern in 87.5%, 6.25% and 6.25% of participants, respectively. At rest, RO showed increased resonance frequency, increased integrated low-frequency reactance and increased difference between resistance at 4-20 Hz (R4-R20) in 43.7%, 50%, and 31.2% of participants, respectively. The median of six-minute walking distance (DTC6) was 434 (386-478) m, which corresponds to a value of 83% (78-97%) of predicted. Dynamic hyperinflation (DH) and reduced breathing reserve (BR) were detected in 62.5% and 12.5% of participants, respectively. At CPX, the median peak oxygen uptake (VO) was 19 (14-37) ml/kg/min. There was a significant correlation of 6MWD with both R4-R20 (r=-0.499, P = 0.039) and VO (r=0.628, P = 0.009). Our results indicate that DH and low BR are contributors to poor exercise performance, which is associated with peripheral airway disease. These are promising results considering that they were achieved with simple, portable ventilatory and metabolic systems.
Topics: Humans; Walk Test; Post-Acute COVID-19 Syndrome; COVID-19; Lung; Walking; Exercise Test; Pulmonary Disease, Chronic Obstructive
PubMed: 37291610
DOI: 10.1186/s13104-023-06374-3 -
Anales de Pediatria Jun 2023To determine the performance of spirometry and respiratory oscillometry (RO) in the prediction of severe asthma exacerbations (SAEs) in children.
OBJECTIVE
To determine the performance of spirometry and respiratory oscillometry (RO) in the prediction of severe asthma exacerbations (SAEs) in children.
METHODS
In a prospective study, 148 children (age 6-14 years) with asthma were assessed with RO, spirometry and a bronchodilator (BD) test. Based on the findings of spirometry and the BD test, they were classified into three phenotypes: air trapping (AT), airflow limitation (AFL) and normal. Twelve weeks later, they were re-evaluated in relation to the occurrence of SAEs. We analysed the performance of RO, spirometry and AT/AFL phenotypes for prediction of SAEs by means of positive and negative likelihood ratios, ROC curves with the corresponding areas under the curve (AUCs) and a multivariate analysis adjusted for potential confounders.
RESULTS
During the follow-up, 7.4% of patients had SAEs, and there were differences between phenotypes (normal, 2.4%; AFL, 17.9%; AT, 22.2%, P = .005). The best AUC corresponded to the forced expiratory flow between 25% and 75% of vital capacity (FEF): 0.787; 95% confidence interval, 0.600-0.973. Other significant AUCs were those for the reactance area (AX), forced expiratory volume in the first second (FEV), the post-BD change in forced vital capacity (FVC), and the FEV/FVC ratio. All of the variables had a low sensitivity for prediction of SAEs. The AT phenotype had the best specificity (93.8%; 95% CI, 87.9-97.0), but the positive and negative likelihood ratios were both significant only for the FEF. In the multivariate analysis, only some spirometry parameters were significative for prediction of SAEs (AT phenotype, FEF and FEV/FVC).
CONCLUSIONS
Spirometry performed better than RO for prediction of SAEs in the medium term in schoolchildren with asthma.
Topics: Humans; Prospective Studies; Oscillometry; Asthma; Lung; Spirometry; Bronchodilator Agents
PubMed: 37246048
DOI: 10.1016/j.anpede.2023.05.003