Changes in oscillatory impedance and nitrogen washout with combination fluticasone/salmeterol therapy in COPD

Timmins, Sophie; Diba, Chantale; Schoeffel, Robin E.; Salome, Cheryl M.; King, Gregory G.; Thamrin, Cindy

doi:10.1016/j.rmed.2013.10.004

Cited by 24 publications

(25 citation statements)

References 32 publications

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“…Our current choice for a higher cutoff (0.07 and not 0.03) takes into account 2 aspects: (1) to have a reasonable certainty of the presence of SAD, and 0.07, as previously reported [19], represents a conservative upper limit of normality for R5-R20; and (2) to have a model, similar to asthmatics [22,23], that identifies a portion of patients who have poor control of the disease and could require the use of as-needed medications, such as short-acting β-agonists. In fact, although COPD is considered not entirely reversible to airflow obstruction disease [2] that may show significant bronchodilator responsiveness [24], the assessment of SAD may be considered a functional marker useful to evaluate improvements of treatment and to identify flow and volume responders [13], and this despite an absence of a change in FEV 1 [25]. However, while in patients with asthma the role of SAD as a therapeutic target for extra-fine formulations is consolidated by an increasing peripheral airways drug deposition [26], in COPD this role is not yet fully established, although improvements in air trapping and dyspnoea perception [27] and in other patient-related outcomes [28] have been demonstrated.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Small-Airway Dysfunction among COPD Patients with Different GOLD Stages and Its Role in the Impact of Disease

et al. 2016

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Background: In chronic obstructive pulmonary disease (COPD) patients, small-airway dysfunction (SAD) is considered a functional hallmark of disease. However, the exact role of SAD in the clinical presentation of COPD is not yet completely understood; moreover, it is not known whether SAD may have a relationship with the impact of disease. Objectives: To evaluate the prevalence of SAD among COPD patients categorized by the old and the new GOLD classification and to ascertain whether there is a relationship between SAD and impact of disease measured by the COPD Assessment Test (CAT) questionnaire. Methods: We prospectively enrolled COPD outpatients from the University Hospital of Parma. Using the impulse oscillometry system (IOS), we assessed the fall in resistance from 5 to 20 Hz (R5-R20), reactance at 5 Hz (X5), and resonant frequency (F_Res) as markers of peripheral airway dysfunction. According to R5-R20 ≥0.07 or <0.07, the cohort was also categorized in patients with and without SAD, respectively. Results: We studied 202 patients. In both GOLD classifications, a progressive increasing distribution of R5-R20 and F_Res was reported with a decreasing of X5. Moreover, there was a significant correlation between R5-R20 and CAT (r = 0.527, p < 0.001). Finally, the presence of SAD (OR 11.96; 95% CI 4.53-31.58; p < 0.001) and use of ICS + LABA + LAMA (OR 5.31; 95% CI 1.88-15.02; p = 0.002) were independent predictors of higher impact (CAT score ≥10). Conclusion: In COPD patients, the presence of SAD, as assessed by IOS, progressively increases with GOLD classifications and it is closely related to the high impact of disease on health status.

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Section: Discussionmentioning

confidence: 99%

Prevalence of Small-Airway Dysfunction among COPD Patients with Different GOLD Stages and Its Role in the Impact of Disease

et al. 2016

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“…Treatment with an inhaled corticosteroid/long-acting beta-agonist combination for 3 months improved ΔX5 13. The identification of small airway disease and EFL in COPD patients using oscillometry methods may allow individualized targeting of drugs to treat these pathophysiological abnormalities.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics of COPD patients with tidal expiratory flow limitation

Dean¹,

Kolsum²,

Hitchen³

et al. 2017

COPD

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We have used impulse oscillometry to identify COPD patients with tidal expiratory flow limitation (EFL), which is a measurement related to small airway disease. We report that 37.4% of COPD patients had EFL; these patients had multiple clinical characteristics of more severe disease including lower forced expiratory volume in 1 second values, greater hyperinflation, reduced exercise performance, and increased small airway impairment. We highlight that EFL can be used to identify a subgroup of COPD patients with distinct characteristics associated with small airway disease.

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“…12 Treatment with an inhaled corticosteroid/ long-acting beta-agonist combination for 3 months improved ∆X5. 13 The identification of small airway disease and EFL in COPD patients using oscillometry methods may allow individualized targeting of drugs to treat these pathophysiological abnormalities. For example, inhalers with a greater proportion of extra-fine particles 14 could be targeted to COPD patients with EFL.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics of COPD patients with tidal expiratory flow limitation

Dean¹,

Kolsum²,

Hitchen³

et al. 2017

Clinical Respiratory Physiology, Exercise and Functional Imaging

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Changes in oscillatory impedance and nitrogen washout with combination fluticasone/salmeterol therapy in COPD

Abstract: Combination therapy is associated with improvements in small airways function in COPD, despite an absence of change in FEV1. FOT may be a clinically useful marker of small airway function in COPD that is responsive to treatment.

Cited by 24 publications

References 32 publications

Prevalence of Small-Airway Dysfunction among COPD Patients with Different GOLD Stages and Its Role in the Impact of Disease

Prevalence of Small-Airway Dysfunction among COPD Patients with Different GOLD Stages and Its Role in the Impact of Disease

Clinical characteristics of COPD patients with tidal expiratory flow limitation

Clinical characteristics of COPD patients with tidal expiratory flow limitation

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