Asymptomatic subjects with airway obstruction have significant impairment at exercise

Soumagne, Thibaud; Laveneziana, Pierantonio; Veil-Picard, M.; Guillien, Alicia; Claudé, F; Puyraveau, Marc; Annesi‐Maesano, Isabella; Roche, N.; Dalphin, Jean‐Charles; Degano, Bruno

doi:10.1136/thoraxjnl-2015-207953

Cited by 42 publications

(35 citation statements)

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“…Routine spirometry, constant-volume body plethysmography and single breath lung transfer for carbon monoxide (TLCO) were performed in accordance with recommended techniques (Platinum Elite; MGC Diagnostics Corporation, Saint Paul, Minnesota, USA) as described elsewhere [25]. Lung hyperinflation was defined as a functional residual capacity above the upper 95 th percentile of the predicted values (z-score > 1.64) [26].…”

Section: Methodsmentioning

confidence: 99%

Emphysema in active farmer’s lung disease

et al. 2017

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BackgroundFarmer’s lung (FL) is a common type of hypersensitivity pneumonitis. It is often considered that fibrosis is the most frequent finding in chronic FL. Nevertheless, three cohort studies have suggested that some patients with chronic FL may develop emphysema. We aimed to evaluate the current prevalence of emphysema in active FL, to describe the radiological and functional features of emphysema in active FL, and to identify risk factors associated with emphysema in this population.MethodsPatients aged over 18 years with active FL were prospectively recruited through the SOPHIA study (CPP Est; P-2009-521), between 2007 and 2015. Each patient had complete medical history screening, clinical examination, high resolution computed tomodensitometry, bronchoalveolar lavage, pulmonary function tests and serum precipitins.ResultsAmong 33 patients with active FL, the prevalence of emphysema in this series of incident active FL cases was higher (48.5%) than that of fibrosis (12%) and was not dependent on smoking habits. Most patients with emphysema did not have lung hyperinflation. The possible risk factors for emphysema in active FL were a longer duration of exposure to organic dusts, and at a higher level.ConclusionEmphysema is found in half of patients with active FL and may be influenced by exposure patterns.

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Section: Methodsmentioning

confidence: 99%

Emphysema in active farmer’s lung disease

et al. 2017

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“…More recently, exercise capacity has been found to be diminished in smokers both with and without airflow limitation, with mild-to-moderate decrements in TLCO [2][3][4]. The mechanisms that link reduced TLCO to low exercise capacity in smokers without COPD, even in the absence of increased hypoxic drive or overtly abnormal lung mechanics remain unknown.…”

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confidence: 99%

Impaired exercise ventilatory efficiency in smokers with low transfer factor but normal spirometry

et al. 2017

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“…The second subtype (Group 3), that is, early grade smoking-induced lung disease with mildly abnormal spirometry but absence of symptoms (dyspnoea mMRC score equal to zero; absence of chronic cough and/or chronic expectoration) has been also described. 17 18 However, there is conflicting evidence about lung function and exercise performance in this group of patients. Two studies suggest that patients with mild non-dyspnoeic spirometric disease may include individuals with normal lung function and 6-min walk test performance 18 and subjects with resting lung hyperinflation, reduced diffusion capacity of the lung for carbon monoxide (DLCO) and slightly increased cycle-exercise-induced dyspnoea.…”

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confidence: 99%

The boundaries of mild chronic obstructive pulmonary disease (COPD): design of the searching clinical COPD onset (SOON) study

et al. 2017

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IntroductionClinical onset of chronic obstructive pulmonary disease (COPD) is the point at which the disease is first identifiable by physicians. It is a poorly defined stage which seems to include both mild spirometric and non-spirometric disease, and could be described as early grade COPD, for practical purposes. While dyspnoea; chronic bronchitis and CT imaging evidence of emphysema and airway disease may be present very early, the lone significance of dyspnoea, the most relevant symptom in COPD in identifying these individuals, has been scarcely assessed.The Searching Clinical COPD Onset (SOON) Study was designed primarily to detect clinical, physiological and structural differences between dyspnoeic and non-dyspnoeic individuals with early grade COPD. It is hypothesised that presence of dyspnoea in early disease may identify a subtype of individuals with reduced exercise capacity, notwithstanding of their spirometry results. In addition, dyspnoeic individuals will share worse quality of life, lower physical activity, greater lung hyperinflation greater emphysema and airway thickness and reduced peripheral muscle mass than their non-dyspnoeic counterpart.Methods and analysisSOON is a monocentric study, with a cross sectional design aimed at obtaining representative samples of current or ex-smoker-adults aged ≥45 and ≤80 years. Two hundred and forty participants will be enrolled into four strata, according to normal spirometry or mild spirometric obstruction and presence or not of dyspnoea modified Medical Research Council score ≥1. The primary outcome will be the difference between dyspnoeic and non-dyspnoeic individuals on the 6-min walk test performance, regardless of their spirometry results. To account for the confounding effect of heart failure on dyspnoea, stress echocardiography will be also performed. Secondary outcomes will include clinical (quality of life, physical activity), physiological (exercise testing) and structural characteristics (emphysema, airway disease and peripheral muscle mass by CT imaging).Ethics and disseminationThe Institutional Ethics Committee from Pontificia Universidad Católica de Chile has approved the study protocol and signed informed consent will be obtained from all participants. The findings of the trial will be disseminated through relevant peer-reviewed journals and international conference presentations.Trial registration numberNCT03026439.

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Asymptomatic subjects with airway obstruction have significant impairment at exercise

Abstract: Although they did not present with chronic activity-related dyspnoea, subjects with a postbronchodilator FEV1/FVC

Cited by 42 publications

References 41 publications

Emphysema in active farmer’s lung disease

Emphysema in active farmer’s lung disease

Impaired exercise ventilatory efficiency in smokers with low transfer factor but normal spirometry

The boundaries of mild chronic obstructive pulmonary disease (COPD): design of the searching clinical COPD onset (SOON) study

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