Early detection of changes in lung mechanics with oscillometry following bariatric surgery in severe obesity

Peters, Ubong; Hernández, Paul; Dechman, Gail; Ellsmere, James; Maksym, Geoffrey N.

doi:10.1139/apnm-2015-0473

Cited by 29 publications

(38 citation statements)

References 53 publications

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“…Recently, this method was successfully applied in our laboratory to diagnose the early respiratory changes in smokers [27] and in patients with sarcoidosis [28], systemic sclerosis [23], and silicosis [29]. Similar findings were also obtained by other researchers studying the initial changes in lung mechanics following bariatric surgery [30], the early detection of airway obstruction in sleep apnea [31, 32], and the detection of initial obstructive airway disease in patients with asthma [33] and primary Sjögren’s syndrome [34]. …”

Section: Introductionsupporting

confidence: 63%

Early Diagnosis of Respiratory Abnormalities in Asbestos-Exposed Workers by the Forced Oscillation Technique

et al. 2016

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BackgroundThe current reference test for the detection of respiratory abnormalities in asbestos-exposed workers is spirometry. However, spirometry has several shortcomings that greatly affect the efficacy of current asbestos control programs. The forced oscillation technique (FOT) represents the current state-of-the-art technique in the assessment of lung function. This method provides a detailed analysis of respiratory resistance and reactance at different oscillatory frequencies during tidal breathing. Here, we evaluate the FOT as an alternative method to standard spirometry for the early detection and quantification of respiratory abnormalities in asbestos-exposed workers.Methodology/Principal findingsSeventy-two subjects were analyzed. The control group was composed of 33 subjects with a normal spirometric exam who had no history of smoking or pulmonary disease. Thirty-nine subjects exposed to asbestos were also studied, including 32 volunteers in radiological category 0/0 and 7 volunteers with radiological categories of 0/1 or 1/1. FOT data were interpreted using classical parameters as well as integer (InOr) and fractional-order (FrOr) modeling. The diagnostic accuracy was evaluated by investigating the area under the receiver operating characteristic curve (AUC). Exposed workers presented increased obstruction (resistance p<0.001) and a reduced compliance (p<0.001), with a predominance of obstructive changes. The FOT parameter changes were correlated with the standard pulmonary function analysis methods (R = -0.52, p<0.001). Early respiratory abnormalities were identified with a high diagnostic accuracy (AUC = 0.987) using parameters obtained from the FrOr modeling. This accuracy was significantly better than those obtained with classical (p<0.001) and InOr (p<0.001) model parameters.ConclusionsThe FOT improved our knowledge about the biomechanical abnormalities in workers exposed to asbestos. Additionally, a high diagnostic accuracy in the diagnosis of early respiratory abnormalities in asbestos-exposed workers was obtained. This makes the FOT particularly useful as a screening tool in the context of asbestos control and elimination. Moreover, it can facilitate epidemiological research and the longitudinal follow-up of asbestos exposure and asbestos-related diseases.

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Section: Introductionsupporting

confidence: 63%

Early Diagnosis of Respiratory Abnormalities in Asbestos-Exposed Workers by the Forced Oscillation Technique

et al. 2016

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“…High BMI can affect the frequency dependence likely indicative of obesity causing peripheral airway closure and hence, heterogeneity. 75,[94][95][96] The CV 5 is 11%, less than 15%, and hence the study is of acceptable quality. The R 5 is significantly above the reference value for a normal subject's R 5 with a Z-score over 3.…”

Section: Copd With Emphysemamentioning

confidence: 96%

Applications of oscillometry in clinical research and practice

Lundblad

Siddiqui

Bossé

et al. 2019

Canadian Journal of Respiratory, Critical Care, and Sleep Medic

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Oscillometry is gaining in clinical use and while there is an increased interest in the technique, there is paucity in the understanding of its possibilities and limitations. Oscillometry has seen extensive use in research over several decades, but only recently is the technique being adopted in clinical practice; hence, there is a need to educate the novel users. The goal of the mini symposium arranged in San Diego in 2018 was to discuss the principles of oscillometry, showcase some of the recent ongoing research using this technique and to demonstrate how oscillometry may be used in clinical practice. It was concluded that oscillometry has several advantages over spirometry, most notably, with novel data being shown, its sensitivity allowing early detection of small airways disease not possible with spirometry and it can be used in subjects who have difficulties performing forced maneuvers such as preschool children, the elderly and subjects with handicaps. The site of respiratory pathology can be reflected by the various parameters generated by oscillometry and thus help with both disease diagnosis and localization. While the interpretation of oscillometry parameters and translating them into meaningful pathological correlates is still evolving, it is likely that oscillometry will soon be at the forefront of both pulmonary clinical practice and research. R ESUM EL'oscillom etrie est de plus en plus utilis ee en contexte clinique, mais malgr e l'int erêt accru pour cette technique, la compr ehension de ses possibilit es et de ses limites est encore insuffisante. Pendant plusieurs d ecennies, l'oscillom etrie a largement et e utilis ee dans la recherche, mais l'adoption de cette technique dans la pratique clinique est encore r ecente, de sorte qu'il est n ecessaire de former les nouveaux utilisateurs. Le but de ce mini symposium qui s'est tenu a San Diego en 2018 etait de discuter des principes de l'oscillom etrie, de pr esenter les plus r ecentes etudes utilisant cette technique et de d emontrer comment elle peutêtre utilis ee dans la pratique clinique. Il a et e d etermin e que l'oscillom etrie pr esentait plusieurs avantages par rapport a la spirom etrie notamment, comme le d emontrent de nouvelles donn ees, sa sensibilit e qui permet la d etection pr ecoce de la maladie des petites voies a eriennes, ce que la spirom etrie ne peut pas faire, ainsi que le fait qu'elle puisseêtre utilis ee aupr es de sujets qui eprouvent de la difficult e a effectuer des manoeuvres forc ees comme les enfants d'âge pr escolaire, les personnesâg ees et les personnes atteintes d'un handicap. L'emplacement de la pathologie respiratoire peut se refl eter dans les divers param etres produits par la spirom etrie, ce qui peut contribuer a diagnostiquer la maladie et a la localiser. Bien que l'interpr etation des param etres de l'oscillom etrie et leur traduction dans des corr elats pathologiques significatifs continue d' evoluer, l'oscillom etrie sera vraisemblablement a l'avant-plan de la pratique clinique et de la recherche pulmonair...

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“…Obesity is associated with respiratory symptoms like wheeze (37), dyspnea (40), orthopnea (10), and sleep disturbances (42). These symptoms are unresponsive to bronchodilators, but improvements have been widely reported with weight loss (33,35). Surprisingly, spirometry often shows little or no change in lung function with weight loss (1,31,33,47), which makes it challenging to explore the mechanisms that link obesity and weight loss to changes in lung function and associated pathologies.…”

Section: Introductionmentioning

confidence: 99%

“…These symptoms are unresponsive to bronchodilators, but improvements have been widely reported with weight loss (33,35). Surprisingly, spirometry often shows little or no change in lung function with weight loss (1,31,33,47), which makes it challenging to explore the mechanisms that link obesity and weight loss to changes in lung function and associated pathologies. Furthermore, lung function is typically assessed in the upright position, but the respiratory symptoms of obesity worsen in the supine position (10) and are thought to contribute to sleep disturbances (42).…”

Section: Introductionmentioning

confidence: 99%

“…Obesity-induced decrements in lung volume alters airway-parenchymal interdependence by attenuating the tethering forces and changing the pressurevolume relationship of the lung (23,46). Because bronchodilator responsiveness is affected by the reduction in tethering forces induced by the obese state (33), we also sought to track the changes in bronchodilator function with weight loss to compare with the changes in respiratory mechanics induced by weight loss per se. Some of the data obtained at baseline and 5 wk after bariatric surgery have been previously published (33).…”

Section: Introductionmentioning

confidence: 99%

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Improvement in upright and supine lung mechanics with bariatric surgery affects bronchodilator responsiveness and sleep quality

Peters

Dechman

Hernández

et al. 2018

Journal of Applied Physiology

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Obesity and weight-loss have complex effects on respiratory physiology, but these have been insufficiently studied, particularly at early time points following weight-loss surgery and in the supine position. We evaluated 15 severely obese female participants before, and 5 weeks and 6 months after bariatric surgery using the Pittsburgh Sleep Quality Index (PSQI), spirometry, plethysmography, and oscillometry to measure respiratory system mechanics. Oscillometry and spirometry were conducted in the upright and supine position, and pre- and post-bronchodilation with 200µg of salbutamol. At 5 weeks post-surgery, weight-loss was 11.9±2.7kg with no effect on spirometric outcomes and a slight effect on oscillometric outcomes. However, at 6 months, weight-loss was 21.4±7.1kg with a 14.1±6.1% and 17.8±5.4% reduction in upright and supine Rrs,6, respectively. Ers also decreased by 25.7±9.4% and 20.2±7.2% in the upright and supine positions. No changes were observed in spirometry, but sleep quality improved from PSQI of 8.4±3.5 to 4.1±2.9. Bronchodilator responsiveness was low at baseline but increased significantly post-surgery, and this response was comparable to the improvement in Rrs produced by weight-loss. Modeling the impedance spectra with a two-compartment model demonstrated that improvements in lung mechanics with weight-loss begin in the upper or central compartment of the lungs and progress to include the peripheral compartment. Respiratory mechanics are impaired in the severely obese and is associated with poor sleep quality, but these improved substantially with weight-loss. Our data provide new evidence that severely obese individuals may have poor sleep quality due to abnormal respiratory mechanics that weight-loss improves.

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Early detection of changes in lung mechanics with oscillometry following bariatric surgery in severe obesity

Cited by 29 publications

References 53 publications

Early Diagnosis of Respiratory Abnormalities in Asbestos-Exposed Workers by the Forced Oscillation Technique

Early Diagnosis of Respiratory Abnormalities in Asbestos-Exposed Workers by the Forced Oscillation Technique

Applications of oscillometry in clinical research and practice

Improvement in upright and supine lung mechanics with bariatric surgery affects bronchodilator responsiveness and sleep quality

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