Clinical application of inert gas Multiple Breath Washout in children and adolescents with asthma

Zwitserloot, Annelies M.; Fuchs, Susanne; Müller, Christina; Bisdorf, Kornelia; Gappa, Monika

doi:10.1016/j.rmed.2014.07.003

Cited by 36 publications

(33 citation statements)

References 19 publications

(21 reference statements)

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“…The median CV for LCI Org in our study was 3.2%, which is comparable to other studies reporting CV for LCI Org from 4 to 9% (7)(8)(9)(10). This implies that the MBW measurement itself is affected by some uncertainty, which should be taken into account when evaluating the algorithm.…”

Section: Discussionsupporting

confidence: 78%

New time-saving predictor algorithm for multiple breath washout in adolescents

et al. 2016

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Background: Multiple breath washout (MBW) is an informative but time-consuming test. This study evaluates the uncertainty of a time-saving predictor algorithm in adolescents. Methods: Adolescents were recruited from the Copenhagen Prospective Study on Asthma in Childhood (COPSAC 2000 ) birth cohort. MBW trials were performed at 13 y of age with Innocor model Inn00400 using sulfur hexafluoride (SF 6 ) as tracer gas. Measurements were analyzed using a mixed model focusing on two prediction points doubling (t5%) and quadrupling (t10%) the standard end point (t2.5%). results: One hundred and seventy-two MBW trials conducted in 78 adolescents with and without asthma from COPSAC 2000 were included. At t10%, the washout time (WoT) was reduced by 41%, and an uncertainty of 0.159 lung clearance index (LCI) units was introduced (±2 SD), ±1.27). At t5%, the WoT was reduced by 25%, with an uncertainty of 0.083 LCI units (±0.558). The optimal prediction point, which led to most saved time and least uncertainty was t5%. conclusion: The predictor algorithm is capable of shortening the MBW test time but introduces an increasing uncertainty with earlier prediction points. This first-of-a-kind prediction algorithm holds promise in shortening the MBW test in children but should be used with caution in subjects with normal LCI values.

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Section: Discussionsupporting

confidence: 78%

New time-saving predictor algorithm for multiple breath washout in adolescents

et al. 2016

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“…These findings reinforce that LCI is a more sensitive measure of airway dysfunction than spirometry, particularly in children with well controlled disease. Our finding in pre-school and school age children is consistent with other studies of older children and adults with well controlled asthma [9]. However, this study is one of the first using nitrogen (N 2 ) as an inert gas in this age group, while previous studies [9][10][11][12] used different gases such as sulfur hexafluoride (SF 6 ).…”

Section: Discussionsupporting

confidence: 90%

“…Our finding in pre-school and school age children is consistent with other studies of older children and adults with well controlled asthma [9]. However, this study is one of the first using nitrogen (N 2 ) as an inert gas in this age group, while previous studies [9][10][11][12] used different gases such as sulfur hexafluoride (SF 6 ). Given that SF 6 is difficult to obtain in the United States, a better understanding of the sensitivity of measurements of MBW using N 2 as the inert gas is important.…”

Section: Discussionsupporting

confidence: 90%

“…Among adult asthmatics, greater ventilation heterogeneity is associated with increased airway reactivity [8]. Limited studies have been conducted in children with asthma evaluating ventilation heterogeneity using differing inert gases (sulfur hexafluoride, SF 6 ; and nitrogen, N 2 ) and methodology [9][10][11][12]. No studies have specifically evaluated the association of ventilation heterogeneity with airway hyper-responsiveness in children with asthma.…”

Section: Introductionmentioning

confidence: 99%

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Ventilation Heterogeneity and Airway Hyperreactivity in Children with Well Controlled Asthma

Assaf

Clem²,

Jewett³

et al. 2016

J Pulm Respir Med

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“…Recent studies would suggest that mucus plugging, and specifically large-airway mucus plugging changes more than other aspects of CF lung disease with antibiotic therapy [12,41]. In contrast, LCI is affected by heterogeneities at all levels of the airway tree, including peripheral airway disease, and changes in bronchomotor tone do not affect the measurement as much as FEV1, as demonstrated by studying LCI before and after administration of bronchodilators [42][43][44]. Previously closed compartments contributing to the measurement could also affect LCI response.…”

Section: Discussionmentioning

confidence: 99%

Lung clearance index in cystic fibrosis subjects treated for pulmonary exacerbations

et al. 2015

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Pulmonary exacerbations are important clinical events for cystic fibrosis (CF) patients. Studies assessing the ability of the lung clearance index (LCI) to detect treatment response for pulmonary exacerbations have yielded heterogeneous results. Here, we conduct a retrospective analysis of pooled LCI data to assess treatment with intravenous antibiotics for pulmonary exacerbations and to understand factors explaining the heterogeneous response.A systematic literature search was performed to identify prospective observational studies. Factors predicting the relative change in LCI and spirometry were evaluated while adjusting for within-study clustering.Six previously reported studies and one unpublished study, which included 176 pulmonary exacerbations in both paediatric and adult patients, were included. Overall, LCI significantly decreased by 0.40 units (95% CI −0.60-−0.19, p=0.004) or 2.5% following treatment. The relative change in LCI was significantly correlated with the relative change in forced expiratory volume in 1 s (FEV1), but results were discordant in 42.5% of subjects (80 out of 188). Higher (worse) baseline LCI was associated with a greater improvement in LCI (slope: −0.9%, 95% CI −1.0-−0.4%).LCI response to therapy for pulmonary exacerbations is heterogeneous in CF patients; the overall effect size is small and results are often discordant with FEV1. @ERSpublications Lung clearance index response to therapy for pulmonary exacerbations is heterogeneous in cystic fibrosis patients http://ow.ly/Mnvtd

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Clinical application of inert gas Multiple Breath Washout in children and adolescents with asthma

Abstract: These pilot data show that clinically stable asthma patients and controls both have a LCI in the normal range. However, in patients the LCI is significantly higher indicating that MBW may have a role in assessing small airways disease in asthma.

Cited by 36 publications

References 19 publications

New time-saving predictor algorithm for multiple breath washout in adolescents

New time-saving predictor algorithm for multiple breath washout in adolescents

Ventilation Heterogeneity and Airway Hyperreactivity in Children with Well Controlled Asthma

Lung clearance index in cystic fibrosis subjects treated for pulmonary exacerbations

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