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Chest Feb 2024Irritant-induced asthma (IIA) may develop after acute inhalational exposure in individuals without preexisting asthma. The effect of bronchial thermoplasty to treat...
Irritant-induced asthma (IIA) may develop after acute inhalational exposure in individuals without preexisting asthma. The effect of bronchial thermoplasty to treat intractable, worsening IIA has not yet been described. We evaluated a previously healthy 52-year-old man after inhalation of an unknown white powder. His pulmonary function and symptoms/quality of life worsened over 4 years, despite maximal guidelines-based asthma therapy. We acquired Xe MRI and pulmonary function test measurements on three occasions including before and after bronchial thermoplasty treatment. Seven months after bronchial thermoplasty, improved MRI ventilation and oscillometry small airway resistance were observed. Spirometry and asthma control did not improve until 19 months after bronchial thermoplasty, 5.5 years postexposure. Together, oscillometry measurements of the small airways and Xe MRI provided effort-independent, sensitive, and objective measurements of response to therapy. Improved MRI and oscillometry small airway resistance measurements temporally preceded improved airflow obstruction and may be considered for complex asthma cases.
Topics: Male; Humans; Middle Aged; Bronchial Thermoplasty; Irritants; Quality of Life; Oscillometry; Asthma; Magnetic Resonance Imaging
PubMed: 38336440
DOI: 10.1016/j.chest.2023.09.010 -
PloS One 2024Pulmonary rehabilitation (PR) is recommended in people with post-acute COVID-19 syndrome (PACS), although there is a lack of studies evaluating its benefits via the most... (Observational Study)
Observational Study
BACKGROUND
Pulmonary rehabilitation (PR) is recommended in people with post-acute COVID-19 syndrome (PACS), although there is a lack of studies evaluating its benefits via the most commonly used primary endpoint: the six-minute walk test (6MWT). This study evaluated the effects of PR on the dynamics of ventilation measured during the 6MWT in patients with PACS and, secondarily, evaluated the association of these findings with measures of lung function and structure.
METHODS
This was an observational cross-sectional study of patients with PACS, in which 33 had undergone PR (PR-PACS group) and 32 had not undergone PR (NPR-PACS group). These patients underwent Spiropalm®-equipped 6MWT with measurement of inspiratory capacity (IC) to evaluate dynamic hyperinflation (DH). In addition, they performed spirometry, impulse oscillometry (IOS) and lung ultrasound (LUS).
RESULTS
Spirometry was abnormal in 21.2% and 31.3% of participants in the PR-PACS and NPR-PACS groups, respectively (p = 0.36). IOS was abnormal in 28.6% and 66.7% of participants in the PR-PACS and NPR-PACS groups, respectively (p = 0.003). LUS was altered in 39.4% and 43.8% of the participants in the PR-PACS and NPR-PACS groups, respectively (p = 0.72). The 6-min walk distance (6MWD) was greater in the PR-PACS group than in the NPR-PACS group (p = 0.001]. HD was observed in 6.1% and 37.5% of participants in the PR-PACS and NPR-PACS groups, respectively, with a significant difference in ΔIC (p<0.001). The 6MWD correlated significantly with several IOS parameters and with ΔIC.
CONCLUSIONS
Patients with PACS undergoing PR perform better in the 6MWT, with a higher 6MWD and less HD. In these patients, IOS is able to distinguish the effects of PR that are not differentiated by spirometry or LUS. Furthermore, the better the respiratory mechanics assessed by IOS and the less DH there was, the higher the performance in the 6MWT.
Topics: Humans; Cross-Sectional Studies; Pulmonary Disease, Chronic Obstructive; Physical Exertion; Post-Acute COVID-19 Syndrome; COVID-19; Lung; Spirometry
PubMed: 38306350
DOI: 10.1371/journal.pone.0296707 -
American Journal of Respiratory and... Mar 2024
Topics: Child; Child, Preschool; Humans; Oscillometry; Ghana; Air Pollution; Lung
PubMed: 38290112
DOI: 10.1164/rccm.202311-2197ED -
The Medical Journal of Malaysia Jan 2024Spirometry is considered as a 'gold standard' for diagnosis of asthma. Impulse oscillometry (IOS) is an alternative diagnostic tool which requires less cooperation by...
INTRODUCTION
Spirometry is considered as a 'gold standard' for diagnosis of asthma. Impulse oscillometry (IOS) is an alternative diagnostic tool which requires less cooperation by the participants. We performed a study to determine the correlation of IOS with bronchodilator reversibility from spirometry in asthmatic participants. We studied the correlation between forced expiratory flow (FEF) and differences between the resistance at 5Hz and 20Hz (R-R) in small airway disease (SAD) and the proportion of SAD diagnosed using IOS.
MATERIALS AND METHODS
This was a cross-sectional study involving 82 asthmatic participants in Hospital Canselor Tuanku Muhriz (HCTM), Universiti Kebangsaan Malaysia (UKM) conducted between December 2020 till January 2022. Participants performed pre- and post-bronchodilator IOS and spirometry within the same day. Correlation between spirometry and IOS parameters and FEF with IOS were determined and analysed.
RESULTS
The change of forced expiratory volume in 1 second (FEV1) was statistically correlated with a change of R5 in IOS. A decrement of 14.5% in R5 can be correlated with positive bronchodilator response (BDR) with a sensitivity of 63.9% and specificity of 60.9%, p=0.007. Pre-bronchodilator FEF correlated with all parameters of SAD in IOS, e.g., R-R, reactance at 5Hz (X5) and area of reactance (AX), p < 0.05. IOS detection for SAD is higher compared to FEF in the BDR negative group (91.3% vs 58.7%).
CONCLUSION
IOS detected both bronchodilator reversibility and SAD hence can be considered as an alternative tool to spirometry for diagnosis of asthma in adults. IOS detected SAD more than FEF, especially in BDR-negative group.
Topics: Adult; Humans; Bronchodilator Agents; Oscillometry; Tertiary Care Centers; Cross-Sectional Studies; Forced Expiratory Volume; Asthma; Pulmonary Disease, Chronic Obstructive
PubMed: 38287753
DOI: No ID Found -
Postepy Dermatologii I Alergologii Dec 2023Recent studies have indicated the significance of the peripheral airways in asthma control. Methods estimating airway resistance, air trapping, and ventilation...
INTRODUCTION
Recent studies have indicated the significance of the peripheral airways in asthma control. Methods estimating airway resistance, air trapping, and ventilation inhomogeneity are useful for assessing this area of the lung and have proven utility in the evaluation of asthma; however, it is unclear which method is most effective at characterising uncontrolled asthma.
AIM
To evaluate the diagnostic accuracy of various peripheral airway function measurements in the assessment of asthma control in children.
MATERIAL AND METHODS
Children with controlled ( = 35) and uncontrolled ( = 29) asthma performed a sequence of pulmonary function tests (i.e. spirometry, body plethysmography, oscillometry, nitrogen washout test, and exhaled nitric oxide). The diagnostic accuracy of each peripheral airway measure was evaluated by an area under the receiver operating characteristic curve (AUC).
RESULTS
Most peripheral airway parameters were significantly increased in children with uncontrolled asthma compared with children with controlled asthma. The measures with the highest diagnostic accuracy for asthma control were lung clearance index (LCI) (AUC = 0.76), with high specificity (0.97) and modest sensitivity (0.46), acinar ventilation heterogeneity (Sacin) (AUC = 0.73), with high sensitivity (0.85) and modest specificity (0.54), and resonance frequency (Fres) (AUC= 0.74), with perfect specificity (1.0) but low sensitivity (0.38).
CONCLUSIONS
LCI, Sacin and Fres had the highest discriminative capacity for distinguishing children with controlled and uncontrolled asthma among all evaluated peripheral airways measures. Discrepancies in the performance (i.e. sensitivity and specificity) of each parameter suggest that a combination may be most effective in determining asthma control status.
PubMed: 38282871
DOI: 10.5114/ada.2023.133831 -
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 -
Journal of Asthma and Allergy 2024Bronchodilator responsiveness (BDR) in asthma involves both the central and peripheral airways but is primarily relieved with beta-2-agonists and evaluated by...
BACKGROUND
Bronchodilator responsiveness (BDR) in asthma involves both the central and peripheral airways but is primarily relieved with beta-2-agonists and evaluated by spirometry. To date, antimuscarinics can be added as a reliever medication in more severe asthma. We hypothesize that combining both short-acting beta-2 agonist (SABA) and short-acting muscarinic antagonist (SAMA) could also improve the responsiveness in mild-moderate asthma. Therefore, we aimed to compare the direct effects of inhaling SABA alone, SAMA alone or combining both SABA and SAMA on the central and peripheral airways in asthma.
METHODS
Twenty-three patients with mild-moderate BDR in asthma performed dynamic spirometry and impulse oscillometry before (baseline) and multiple timepoints within an hour after inhalation of SABA (salbutamol), SAMA (ipratropium bromide), or both SABA and SAMA at three different visits.
RESULTS
The use of SAMA alone did not show any improvement compared to the use of SABA alone. Inhalation of SABA+SAMA, however, averaged either similar or better BDR than SABA alone in FEV, MMEF, FVC, R5, R20 and R5-R20. Inhaling SABA+SAMA reached a stable BDR in more patients within 0-10 minutes and also reached the FEV (Δ%)>12% faster (3.5 minutes) than inhaling SABA alone (5.1 minutes). Inhaling SABA+SAMA was significantly better than SAMA alone in FEV ( = 0.015), MMEF ( = 0.0059) and R20 ( = 0.0049). Using these three variables highlighted a subgroup (30%, including more males) of patients that were more responsive to inhaling SABA+SAMA than SABA alone.
CONCLUSION
Overall, combining SAMA with SABA was faster and more consistent at increasing the lung function than SABA alone or SAMA alone, and the additive effect was best captured by incorporating peripheral-related variables. Therefore, SAMA should be considered as an add-on reliever for mild-moderate patients with BDR in asthma.
PubMed: 38264293
DOI: 10.2147/JAA.S442217 -
Frontiers in Cardiovascular Medicine 2023Mercury sphygmomanometer (MS) has now been less and less used and no new devices have been manufactured (according to Minamata convention 2013). The application of the...
OBJECTIVE
Mercury sphygmomanometer (MS) has now been less and less used and no new devices have been manufactured (according to Minamata convention 2013). The application of the electronic sphygmomanometer (ES) in clinical practice has become increasingly common. However, reliable evidence for the use of the ES in high-altitude areas remains scarce. The purpose of this study was to validate the applicability of the ES in high altitude areas.
METHODS
In Luhuo County, Sichuan Province, China, 3,400 m above the sea level, two trained physicians measured the blood pressure (BP) of participants using both the mercury sphygmomanometer and the ES. Pearson correlation analysis and paired T-test, respectively, were used to compare the correlation and the difference between the BP values measured by the two devices. The applicability of the ES in high-altitude areas was evaluated according to the validation standards of the 2018 Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Collaboration Statement.
RESULTS
In this study, 257 participants were included. There was a strong correlation between BP values measured by the two devices, with correlation coefficients for systolic blood pressure (SBP) and diastolic blood pressure (DBP) of 0.97 and 0.93, respectively. Compared with the MS, the ES tended to measure the subjects' DBP (76.21 ± 13.29 mmHg vs. 76.53 ± 14.07 mmHg; = 0.557) accurately, but overestimate the SBP of the subjects (123.32 ± 22.25 mmHg vs. 121.34 ± 22.88 mmHg; < 0.001) to some extent. The consistency of the two devices in the classification of normal BP, prehypertension, and hypertension was 88.9%, 80.7%, and 89.2%, respectively.
CONCLUSIONS
In general, the utilization of ES at 3,400 m altitude successfully met the validation standards of the AAMI/ESH/ISO Collaboration Statement. The use of ES can be recommended at a high altitude, including up to 3,400 m. In addition, because the ES tended to overestimate SBP, we speculate that it may need to be calibrated in high-altitude areas.
PubMed: 38259316
DOI: 10.3389/fcvm.2023.1257444 -
Journal of Clinical Medicine Jan 2024induced sputum is used to assess different inflammatory phenotypes in asthma, but is not used routinely. We aimed to determine the proportion of inflammatory asthma...
BACKGROUND AND OBJECTIVES
induced sputum is used to assess different inflammatory phenotypes in asthma, but is not used routinely. We aimed to determine the proportion of inflammatory asthma phenotypes based on induced sputum, to find biomarkers that can discriminate between phenotypes, and to evaluate biomarkers in patients with and without biological therapy in different inflammatory asthma phenotypes.
MATERIALS AND METHODS
this cross-sectional study investigated clinical characteristics, asthma control tests, skin prick test, impulse oscillometry (IOS), spirometry, induced sputum, biomarkers (IgE, eosinophils, fractional exhaled nitric oxide (FeNO), serum periostin, IL-5, IL-6, IL-8, IL-17A, IL-33) in 80 asthmatics. A total of 17/80 patients were treated with biologics (10 with omalizumab, 7 with benralizumab).
RESULTS
a total of 31% of patients had eosinophilic asthma (EA), 30% had mixed granulocytic asthma (MGA), 24% had paucigranulocytic asthma (PGA), and 15% had neutrophilic asthma (NA). The difference was found in blood eosinophils ( = 0.002), the highest observed in EA. The cut-off ≥ 240/μL eosinophils, with 64% sensitivity and 72.7% specificity, identified EA (AUC = 0.743, = 0.001). A higher IL-8 level was associated with NA ( = 0.025). In 63 non-biologic asthma group, eosinophils were higher in EA than in NA, MGA, and PGA ( = 0.012, = 0.028, and = 0.049, respectively). A higher IL-17A was associated with EA without biologics ( = 0.004). A significantly higher IL-5 was found in EA treated with biologics, in comparison with EA without biologics ( = 0.043). The number of leucocytes and neutrophils was higher in MGA without biologics ( = 0.049, = 0.019), while IL-5, IL-6, and IL-8 levels were higher in MGA treated with biologics ( = 0.012, = 0.032, = 0.038, respectively).
CONCLUSIONS
EA and MGA were the most prevalent asthma phenotypes. Blood eosinophils can identify EA, both in patients with and without biologics. Apart from the clinical profile, a broad spectrum of biomarkers for assessing inflammatory phenotypes is necessary for an adequate therapy approach to patients with asthma.
PubMed: 38256660
DOI: 10.3390/jcm13020526 -
Physiological Reports Jan 2024Lingering breathing difficulties are common after COVID-19. However, the underlying causes remains unclear, with spirometry often being normal. We hypothesized that...
Lingering breathing difficulties are common after COVID-19. However, the underlying causes remains unclear, with spirometry often being normal. We hypothesized that small airway dysfunction (SAD) can partly explain these symptoms. We examined 48 individuals (32 women, 4 hospitalized in the acute phase) who experienced dyspnea and/or cough in the acute phase and/or aftermath of COVID-19, and 22 non-COVID-19 controls. Time since acute infection was, median (range), 65 (10-131) weeks. We assessed SAD using multiple breath washout (MBW) and impulse oscillometry (IOS) and included spirometry and diffusing-capacity test (DLCO). One-minute-sit-to-stand test estimated physical function, and breathing difficulties were defined as answering "yes" to the question "do you experience lingering breathing difficulties?" Spirometry, DLCO, and IOS were normal in almost all cases (spirometry: 90%, DLCO: 98%, IOS: 88%), while MBW identified ventilation inhomogeneity in 50%. Breathing difficulties (n = 21) was associated with increased MBW-derived S . However, physical function did not correlate with SAD. Among individuals with breathing difficulties, 25% had reduced physical function, 25% had SAD, 35% had both, and 15% had normal lung function and physical function. Despite spirometry and DLCO being normal in almost all post-COVID-19 individuals, SAD was present in a high proportion and was associated with lingering breathing difficulties.
Topics: Female; Humans; COVID-19; Dyspnea; Respiration; Spirometry; Lung
PubMed: 38253977
DOI: 10.14814/phy2.15918