Detection of tidal expiratory flow limitation in infants with cystic fibrosis: A pilot study

Braggion, C.; Polese, Guido; Fenzi, V.; Carli, M. V.; Pradal, Ugo; Milic–Emili, J.

doi:10.1002/(sici)1099-0496(199803)25:3<213::aid-ppul12>3.0.co;2-9

Cited by 14 publications

(14 citation statements)

References 5 publications

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“…Previous studies have concluded that the prevalence of EFL is low [5][6][7]; however, the inclusion of a small number of subjects, their relatively mild disease and young age may have influenced these findings. In addition, EFL was not evaluated in the supine position [5,7] where it may manifest earlier in the disease process due to reduced functional residual capacity (FRC) with recumbency and a resulting decrease in expiratory flow reserve [8].…”

supporting

confidence: 82%

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Does expiratory flow limitation predict chronic dyspnoea in adults with cystic fibrosis?

Holland

Denehy²,

Wilson

2006

European Respiratory Journal

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Tidal expiratory flow limitation (EFL) may promote dynamic hyperinflation and contribute to chronic dyspnoea. The purpose of this study was to assess the contribution of EFL to chronic dyspnoea in adults with cystic fibrosis (CF).The presence of EFL was determined in 102 adults with stable CF (forced expiratory volume in one second (FEV1) 17.3-91.5% predicted) and 20 age-matched control subjects using the negative expiratory pressure technique. Measurements of inspiratory capacity (IC) and spirometry were performed, and chronic dyspnoea was evaluated using the modified Medical Research Council scale.EFL was present in 34 subjects (33%), with 18 subjects flow limited in the sitting position and 16 subjects flow limited only in the supine position. Flow limitation in the sitting position was associated with older age and lower FEV1 compared with flow-limited supine position and nonflow-limited subjects. A significant reduction in IC accompanied EFL in both the sitting and supine positions. Flow limitation in the sitting position was associated with significantly higher levels of chronic dyspnoea. Ordinal regression analysis indicated that EFL was the best predictor of chronic dyspnoea in a model that included FEV1 % pred.Expiratory flow limitation in cystic fibrosis is associated with reduced forced expiratory volume in one second, older age and dynamic hyperinflation. Expiratory flow limitation significantly contributes to chronic dyspnoea in cystic fibrosis.

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supporting

confidence: 82%

“…The present study expands on previous work describing the presence of dynamic hyperinflation in CF across the range of disease severity [5,6]. However, the most significant reductions in IC were seen in flow-limited subjects and only in the body position in which EFL occurred ( fig.…”

Section: Discussionmentioning

confidence: 99%

Does expiratory flow limitation predict chronic dyspnoea in adults with cystic fibrosis?

Holland

Denehy²,

Wilson

2006

European Respiratory Journal

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“…With the NEP technique, a low prevalence of FL had been previously found by BRAGGION et al [9] in 10 asymptomatic CF infants, and by PRADAL et al [10] in 12 stable CF adults (FEV1 range 19-110% pred). In contrast, in stable COPD patients there is a high prevalence of tidal FL [1][2][3].…”

Section: Discussionmentioning

confidence: 99%

“…4), 10 patients would be classified as FL (nos. 2,5,6,9,12,15,16,18,20,22). Their FEV1 and IC ranged, respectively, from 16-81 and 33-99% pred normal.…”

Section: Expiratory Flow Limitationmentioning

confidence: 99%

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Tidal expiratory flow limitation and chronic dyspnoea in patients with cystic fibrosis

Goetghebeur

Sarni²,

Grossi³

et al. 2002

European Respiratory Journal

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Cystic fibrosis (CF) eventually leads to hyperinflation linked to tidal expiratory flow limitation (FL) and ventilatory failure.Presence of FL was assessed at rest in 22 seated children and adults with CF (forced expiratory volume in one second (FEV1) range: 16-92% predicted), using both the negative expiratory pressure (NEP) technique and the "conventional" method based on comparison of tidal and maximal expiratory flow/volume curves. In addition, chronic dyspnoea was scored with the modified Medical Research Council (MRC) scale. Measurements were made before and 15 min after inhalation of salbutamol.With NEP, FL was present in only three malnourished patients, who had the lowest FEV1 values (16-27% pred) and claimed very severe dyspnoea (MRC score 5). By contrast, an additional seven patients were classified as FL with the conventional method. Six of these patients had little or no dyspnoea (MRC scores 0-1). Salbutamol administration had no effect on the extent of FL, and the concomitant decrease in functional residual capacity (FRC) was too small to play any clinically significant role.This study concluded that in seated patients with cystic fibrosis, expiratory flow limitation is absent at rest, unless the forced expiratory volume in one second is v30% predicted. If present, expiratory flow limitation is associated with severe chronic dyspnoea. The conventional method for assessing expiratory flow limitation is not reliable and bronchodilator administration has little effect on expiratory flow limitation.

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Negative expiratory pressure: A new tool for evaluating lung function in children?

Tauber¹,

Fazekas²,

Eichler³

et al. 2003

Pediatric Pulmonology

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The negative expiratory pressure technique (NEP) has been applied in adults with chronic obstructive pulmonary disease (COPD), demonstrating flow limitation in many of these patients. Because this technique does not require patient cooperation, it is of potential interest for application in the pediatric population. This study was performed to test the feasibility of NEP in children, and to further investigate it in children with asthma and cystic fibrosis (CF). We performed NEP (0.3-0.7 kPa) measurements in 14 healthy children (13.3 years, +/- 2.4), in 12 children with asthma (11.7 years, +/- 3.0), and in 17 children with CF (13.3 years, +/- 2.7). NEP-derived flow-volume loops were visually analyzed for flow limitation at tidal breathing. In addition, expiratory flow at 50% of tidal volume (TEF(50)) was measured. In healthy children, the intraclass coefficient of correlation was 77%, and intraindividual short- and long-term variability was 5.8% and 10.8%, respectively. In asthmatics, TEF(50) was lower compared with controls, and increased after inhalation of salbutamol. However, appropriate size-correction has still to be established. Measurement of TEF(50) using NEP is feasible in children. Despite good reproducibility in individual patients, the high intersubject variability may limit its usefulness as a clinical tool. In addition, the lack of flow limitation using NEP even in severely obstructed patients with CF warrants further investigation.

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Detection of tidal expiratory flow limitation in infants with cystic fibrosis: A pilot study

Cited by 14 publications

References 5 publications

Does expiratory flow limitation predict chronic dyspnoea in adults with cystic fibrosis?

Does expiratory flow limitation predict chronic dyspnoea in adults with cystic fibrosis?

Tidal expiratory flow limitation and chronic dyspnoea in patients with cystic fibrosis

Negative expiratory pressure: A new tool for evaluating lung function in children?

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