scholarly journals EVALUATION OF SMALL AIRWAY REVERSIBILITY AMONG ASTHMATIC PATIENTS WITH NON-OBSTRUCTIVE PATTERNS OF SPIROMETRY

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Tarig Merghani ◽  
Azza Alawad
Keyword(s):  
Airway Disease ◽  
Forced Expiratory Volume ◽  
Small Airway ◽  
Small Airways ◽  
Asthmatic Patients ◽  
Peripheral Airways ◽  
Flow Parameters ◽  
Small Airway Disease ◽  
Forced Expiratory Flow ◽  
Airway Reversibility

Background: Although the forced expiratory flow parameters are increasingly used in the diagnosis of small airway disease (SAD), the reversibility of these indicators is rarely described. The aim of this study is to evaluate the association of small airways reversibility with the presence of SAD and bronchodilator reversibility (BDR) of the proximal airways. Methods: The forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and the indicators of SAD (FEF25%, FEF50%, FEF75%, FEF25-75%, and FEF75-85%) were measured before and 20 minutes after salbutamol administration (200 mcg by using inhaler/Spacer). Positive BDR was accepted when FEV1 or FVC was increased ? 12% and > 200 ml, indicating responsive proximal airways. Positive small airway reversibility was diagnosed when any of the small airway indicators is increased ? 30% above the baseline results. All measurements were performed with the All-flow spirometer (Clement Clarke International, Harlow, UK). Results: Evidence of SAD was found in 62.1% of all participants and in 75.2% of those who showed responsive proximal airways. The positive predictive value of the SAD in diagnosing responsive proximal airways was 67.8%. The reversibility of the small airway indicators showed insignificant association with the FEV1 or FVC BDR. The reversibility of FEF50%, FEF75% and FEF25-75% showed significant association with the diagnosis of SAD, with specificities ranging from 75.5%-81.1%. Conclusion: SAD has a significant association with positive reversibility of both the proximal and the peripheral airways. Further studies are needed to evaluate the clinical significance of positive small airway reversibility in the diagnosis and management of obstructive lung diseases. Keywords: Asthma; Small airway disease; Bronchodilator Reversibility, FEV1, FVC; FEF25-75%

Validation of Forced Expiratory Volume at 6 Seconds of Exhalation (FEV 6 ) in the Detection of Small Airway Disease

CHEST Journal ◽  
2015 ◽  
Vol 148 (4) ◽  
pp. 894A
Author(s):  
Edgardo Tiglao ◽  
Teresita DeGuia ◽  
Maria Encarnita Limpin ◽  
Aileen Guzman-Banzon
Keyword(s):  
Airway Disease ◽  
Forced Expiratory Volume ◽  
Small Airway ◽  
Small Airway Disease

scholarly journals The Diagnostic Value of Forced Expiratory Time

2011 ◽  
Vol 1 (1) ◽  
pp. 39-42
Author(s):  
Siraj O. Wali
Keyword(s):  
Tertiary Care ◽  
Airway Disease ◽  
Diagnostic Value ◽  
Forced Expiratory Volume ◽  
Small Airway ◽  
Airflow Limitation ◽  
Forced Expiration ◽  
Care Hospital ◽  
Expiratory Time ◽  
Small Airway Disease

Objective: Airway obstruction can be clinically quantified at the bedside by measuring the time taken for forced expiration. The aim of this study was to examine the accuracy of the forced expiratory time in detecting airflow limitation, and small airway disease when compared with simple spirometry as a gold standard test. Method: Simple spirometry and forced expiratory time were performed on 201 subjects (age range; 12-81 years), referred to a pulmonary function laboratory at a tertiary care hospital. The diagnostic accuracy of forced expiratory time and its correlation with spirometric parameters were tested. Forced expiratory time > 6 seconds was regarded as abnormal, and the ratio of forced expiratory volume in the first second to forced vital capacity of < 70% was considered indicative of an airflow limitation. Results: Forced expiratory time was found to correlate weakly with spirometric parameters. Forced expiratory time at a cut-off value of => 6 seconds had a sensitivity of 61% and a specificity of 79% in predicting obstructive airway disease when compared with simple spirometry. On the other hand, the sensitivity and the specificity of forced expiratory time in predicting small airway disease were 47% and 86%, respectively. Conclusion: Forced expiratory time does not correlate well with all parameters of a simple spirometry. Its sensitivity and specificity for detecting airflow limitation and small airway disease were not high enough to be used as a diagnostic test. However, it may be effective enough to be utilized to confirm the diagnosis of small airway disease.

scholarly journals The Diagnostic Value of Forced Expiratory Time

2011 ◽  
Vol 1 (1) ◽  
pp. 39-42
Author(s):  
Siraj O. Wali
Keyword(s):  
Tertiary Care ◽  
Airway Disease ◽  
Diagnostic Value ◽  
Forced Expiratory Volume ◽  
Small Airway ◽  
Airflow Limitation ◽  
Forced Expiration ◽  
Care Hospital ◽  
Expiratory Time ◽  
Small Airway Disease

Objective: Airway obstruction can be clinically quantified at the bedside by measuring the time taken for forced expiration. The aim of this study was to examine the accuracy of the forced expiratory time in detecting airflow limitation, and small airway disease when compared with simple spirometry as a gold standard test. Method: Simple spirometry and forced expiratory time were performed on 201 subjects (age range; 12-81 years), referred to a pulmonary function laboratory at a tertiary care hospital. The diagnostic accuracy of forced expiratory time and its correlation with spirometric parameters were tested. Forced expiratory time > 6 seconds was regarded as abnormal, and the ratio of forced expiratory volume in the first second to forced vital capacity of < 70% was considered indicative of an airflow limitation. Results: Forced expiratory time was found to correlate weakly with spirometric parameters. Forced expiratory time at a cut-off value of => 6 seconds had a sensitivity of 61% and a specificity of 79% in predicting obstructive airway disease when compared with simple spirometry. On the other hand, the sensitivity and the specificity of forced expiratory time in predicting small airway disease were 47% and 86%, respectively. Conclusion: Forced expiratory time does not correlate well with all parameters of a simple spirometry. Its sensitivity and specificity for detecting airflow limitation and small airway disease were not high enough to be used as a diagnostic test. However, it may be effective enough to be utilized to confirm the diagnosis of small airway disease.

scholarly journals Lung clearance index: assessment and utility in children with asthma

2019 ◽  
Vol 28 (154) ◽  
pp. 190046 ◽  
Author(s):  
Amy G. L. Nuttall ◽  
Werner Velásquez ◽  
Caroline S. Beardsmore ◽  
Erol A. Gaillard
Keyword(s):  
Early Stage ◽  
Airway Disease ◽  
Small Airway ◽  
Small Airways ◽  
Lung Clearance ◽  
Additional Information ◽  
Small Airway Disease ◽  
Lung Clearance Index ◽  
Children With Asthma ◽  
Ventilation Heterogeneity

There is increasing evidence that ventilation heterogeneity and small airway disease are significant factors in asthma, with evidence suggesting that the small airways are involved from an early stage in childhood asthma. Spirometry is commonly used to monitor lung function in asthmatics; however, it is not sensitive to small airway disease. There has been renewed interest in multibreath washout (MBW) tests, with recognition of the lung clearance index (LCI) as a global index of abnormality in gas mixing of the lungs that therefore also reflects small airway disease. This review summarises the technical and practical aspects of the MBW/LCI in children, and the differences between commercially available equipment. Children with severe asthma are more likely to have an abnormal LCI, whereas most children with mild-to-moderate asthma have an LCI within the normal range, but slightly higher than age-matched healthy controls. Monitoring children with asthma with MBW alongside standard spirometry may provide useful additional information.

scholarly journals Gene expression profiling of bronchial brushes is associated with the level of emphysema measured by computed tomography-based parametric response mapping

2020 ◽  
Vol 318 (6) ◽  
pp. L1222-L1228
Author(s):  
Senani N. H. Rathnayake ◽  
Firdaus A. A. Mohamed Hoesein ◽  
Craig J. Galban ◽  
Nick H. T. ten Hacken ◽  
Brian G. G. Oliver ◽  
...  
Keyword(s):  
Gene Expression ◽  
Computed Tomography ◽  
Airway Disease ◽  
Small Airway ◽  
Study Cohort ◽  
Small Airways ◽  
Air Trapping ◽  
Response Mapping ◽  
Small Airway Disease ◽  
Parametric Response

Parametric response mapping (PRM) is a computed tomography (CT)-based method to phenotype patients with chronic obstructive pulmonary disease (COPD). It is capable of differentiating emphysema-related air trapping with nonemphysematous air trapping (small airway disease), which helps to identify the extent and localization of the disease. Most studies evaluating the gene expression in smokers and COPD patients related this to spirometric measurements, but none have investigated the relationship with CT-based measurements of lung structure. The current study aimed to examine gene expression profiles of brushed bronchial epithelial cells in association with the PRM-defined CT-based measurements of emphysema (PRMEmph) and small airway disease (PRMfSAD). Using the Top Institute Pharma (TIP) study cohort (COPD = 12 and asymptomatic smokers = 32), we identified a gene expression signature of bronchial brushings, which was associated with PRMEmph in the lungs. One hundred thirty-three genes were identified to be associated with PRMEmph. Among the most significantly associated genes, CXCL11 is a potent chemokine involved with CD8+ T cell activation during inflammation in COPD, indicating that it may play an essential role in the development of emphysema. The PRMEmph signature was then replicated in two independent data sets. Pathway analysis showed that the PRMEmph signature is associated with proinflammatory and notch signaling pathways. Together these findings indicate that airway epithelium may play a role in the development of emphysema and/or may act as a biomarker for the presence of emphysema. In contrast, its role in relation to functional small airways disease is less clear.

scholarly journals Determining Response to Treatment for Drug-Induced Bronchocentric Granulomatosis by the Forced Oscillation Technique

Medicina ◽  
2021 ◽  
Vol 57 (12) ◽  
pp. 1315
Author(s):  
Susumu Fukahori ◽  
Yasushi Obase ◽  
Chizu Fukushima ◽  
Daisuke Takao ◽  
Jun Iriki ◽  
...  
Keyword(s):  
Forced Oscillation ◽  
Airway Disease ◽  
Small Airway ◽  
Response To Treatment ◽  
Chronic Obstructive ◽  
Forced Oscillation Technique ◽  
Small Airways ◽  
Small Airway Disease ◽  
Bronchocentric Granulomatosis ◽  
Effect Of Treatment

Anti-tumor necrosis factor alpha (TNFα) therapy is widely used to treat various inflammatory conditions. Paradoxically, there are several case reports describing the development of bronchocentric granulomatosis treated with TNFα inhibitors, and it is difficult to determine the effect of treatment using conventional spirometry because the lesions are located in small airways. However, it has been reported that the forced oscillation technique (FOT) is useful in the evaluation of small airway disease in bronchial asthma or chronic obstructive pulmonary disease. We performed the FOT to determine the effect of treatment on bronchocentric granulomatosis and found it to be useful. We report the case of a 55-year-old female with ulcerative colitis who was treated with golimumab and who developed bronchocentric granulomatosis as a sarcoid-like reaction to golimumab. She was successfully treated with prednisone, and the treatment efficacy was confirmed by the FOT. The FOT may be useful in the evaluation of small airway disease in bronchocentric granulomatosis. This case may help inform clinicians of the usefulness of the FOT to assess small airway disease in various diseases.

Small Airway Disease after Mycoplasma Pneumonia in Children: HRCT Findings and Correlation with Radiographic Findings

2003 ◽  
Vol 48 (4) ◽  
pp. 361
Author(s):  
Jung Eun Cheon ◽  
Woo Sun Kim ◽  
In One Kim ◽  
Young Yull Koh ◽  
Hoan Jong Lee ◽  
...  
Keyword(s):  
Airway Disease ◽  
Small Airway ◽  
Radiographic Findings ◽  
Small Airway Disease ◽  
Mycoplasma Pneumonia

scholarly journals Air Trapping Is Associated with Heterozygosity for Alpha-1 Antitrypsin Mutations in Patients with Asthma

Respiration ◽  
2021 ◽  
pp. 1-10
Author(s):  
Marina Aiello ◽  
Marianna Ghirardini ◽  
Laura Marchi ◽  
Annalisa Frizzelli ◽  
Roberta Pisi ◽  
...  
Keyword(s):  
Lung Function ◽  
Serum Concentration ◽  
Forced Expiratory Volume ◽  
Small Airway ◽  
University Hospital ◽  
Air Trapping ◽  
Asthmatic Patients ◽  
Alpha 1 Antitrypsin Deficiency ◽  
Alpha 1 Antitrypsin ◽  
Few Data

<b><i>Background:</i></b> Alpha-1 antitrypsin deficiency (AATD) is a hereditary disorder involving lungs, characterized by low serum concentration of the protein alpha-1 antitrypsin (AAT) also called proteinase inhibitor (PI). Asthma is common in AATD patients, but there are only few data on respiratory function in asthmatic patients with AATD. <b><i>Objectives:</i></b> The aim of the study was to evaluate lung function in asthmatic outpatients with mutation in the <i>SERPINA1</i> gene coding for AAT versus asthmatic subjects without mutation. <b><i>Methods:</i></b> We performed the quantitative analysis of the serum concentration of AAT in 600 outpatients affected by mild to moderate asthma from the University Hospital of Parma, Italy. Fifty-seven of them underwent the genetic analysis subsequently; they were subdivided into mutated and non-mutated subjects. All the mutated patients had a heterozygous genotype, except 1 (PI*SS). We assessed the lung function through a flow-sensing spirometer and the small airway parameters through an impulse oscillometry system. <b><i>Results:</i></b> The values of forced vital capacity (% predicted) and those of the residual volume to total lung capacity ratio (%) were, respectively, lower and higher in patients mutated versus patients without mutation, showing a significantly greater air trapping (<i>p =</i> 0.014 and <i>p =</i> 0.017, respectively). Moreover, patients with mutation in comparison to patients without mutation showed lower forced expiratory volume in 3 s (% predicted) and forced expiratory volume in 6 s (L) spirometric values, reflecting a smaller airways contribution. <b><i>Conclusions:</i></b> In asthmatic patients, heterozygosity for AAT with PI*MZ and PI*MS genotypes was associated with small airway dysfunction and with lung air trapping.

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