Lung clearance index and moment ratios at different cut-off values in infant multiple-breath washout measurements

Egger, Barbara; Jost, Kerstin; Anagnostopoulou, Pinelopi; Yammine, Sophie; Singer, Florian; Casaulta, Carmen; Frey, Urs; Latzin, Philipp

doi:10.1002/ppul.23483

Cited by 10 publications

(12 citation statements)

References 36 publications

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“…LCI is defined as a number of times lung turn overs (as represented by FRC) have to turn over to the clear the lungs from nitrogen (N 2 ). LCI (LCI 2.5 ) reflects N 2 washout until 1/40 th of the starting N 2 end-tidal concentration (cet), i.e., 2.5% and LCI 5 reflects N 2 washout until 1/20 th of the starting N 2 concentration (Cet), i.e., 5% [49][50][51][52][53]. So, the sicker the child is, the more air it must breathe to clear its lungs from the tracer gas.…”

Section: Introductionmentioning

confidence: 99%

Is Lung Clearance Index (LCI) Affected by the Severity of Lung Disease in CF?

Avramidou¹,

Hatziagorou²,

Kampouras³

et al. 2017

J Pulm Respir Med

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Section: Introductionmentioning

confidence: 99%

Is Lung Clearance Index (LCI) Affected by the Severity of Lung Disease in CF?

Avramidou¹,

Hatziagorou²,

Kampouras³

et al. 2017

J Pulm Respir Med

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“…While potentially sufficient for the clinical setting in preschool children, monitoring early changes in infants or comparison of treatment efficacy may require longer washouts and more sensitive endpoints. Egger et al found that the diagnostic performance of MBW outcomes depends on the analysis cutoff point. In infants with mild lung disease, a longer washout is necessary to discriminate between health and disease, especially since newborn screened infants with CF have minimal ventilation inhomogeneity that is only slightly elevated compared with HC .…”

Section: Discussionmentioning

confidence: 99%

“…Egger et al found that the diagnostic performance of MBW outcomes depends on the analysis cutoff point. In infants with mild lung disease, a longer washout is necessary to discriminate between health and disease, especially since newborn screened infants with CF have minimal ventilation inhomogeneity that is only slightly elevated compared with HC . Although LCI 5 has advantages to LCI 2.5 in young children, and provides a suitable alternative for monitoring lung function in clinical practice, these data support LCI 2.5 as a quantitatively superior outcome in preschool children and may be the preferred outcome for interventional studies for which sensitivity and precision outweigh time savings and feasibility.…”

Section: Discussionmentioning

confidence: 99%

“…However, using indices measured earlier in the washout may affect sensitivity. We have previously described that the sensitivity to detect treatment effects in interventional studies is lower at cutoffs earlier than 2.5% and in infant studies, cutoffs from later in the washout were identified as more sensitive in identifying early functional changes . In the clinical setting, the MBW test will be useful in tracking disease progression over time as well as defining whether symptoms associated with clinical deterioration lead to worsening lung function.…”

Section: Introductionmentioning

confidence: 99%

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The utility of moment ratios and abbreviated endpoints of the multiple breath washout test in preschool children with cystic fibrosis

Shaw

Oppelaar

Jensen

et al. 2020

Pediatric Pulmonology

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Background The multiple breath washout (MBW) test may be most useful in tracking disease progression over time to inform treatment decisions. In the clinical setting, alternative outcomes, which can be obtained quickly and easily, may facilitate interpretation of clinically relevant changes in lung function. Methods In this secondary analysis of data from 78 cystic fibrosis (CF) and 72 healthy control (HC) subjects between the ages of 2.6 and 5.9 years, MBW was performed at enrollment, 1, 3, 6, 9, and 12 months, as well as during symptomatic visits using the Exhalyzer D (EcoMedics AG, Duernten, Switzerland). The lung clearance index, LCI2.5, was compared to moment ratios (M1/M0 and M2/M0) at the standard cutoff (1/40th of starting tracer gas concentration) as well as LCI5 and moment ratios at 1/20th of the starting concentration (M1/M0 at LCI5, and M2/M0 at LCI5). Results All outcomes were able to distinguish between health and disease. LCI5 reduced testing time by 40% and increased feasibility by more than 10%. The limits of biological reproducibility in healthy children were similar between LCI2.5 (15%), LCI5 (12%), M1/M0 at LCI2.5 (14%), and M1/M0 at LCI5 (12%), but markedly larger for M2/M0 at LCI2.5 (30%) and M2/M0 at LCI5 (25%). Each outcome deteriorated significantly with worsening pulmonary symptoms, the magnitude of deterioration was greatest for M2/M0. Conclusions In preschool children with CF, LCI5 was more feasible to obtain and track disease progression. The second moment ratio was most sensitive to pulmonary symptoms, but had the greatest variability both within and between subjects.

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“…2.5% of the starting tracer gas concentration) in SF 6 washouts for both LCI and moment ratios in infancy. They found optimal discriminative power for moment ratios and LCI to detect differences between healthy controls and infants with cystic fibrosis at 1.5% tracer gas concentration [39].…”

Section: Mbw Indices Other Than Lcimentioning

confidence: 99%

The use of multiple breath washout for assessing cystic fibrosis in infants

Davies

Aurora

2016

Expert Review of Respiratory Medicine

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Introduction: Lung Clearance Index, measured using the multiple breath washout (MBW) technique, may be a useful test in infants with Cystic Fibrosis (CF). However, the requirement for specialised equipment and a number of important technical and methodological considerations relevant to testing in infants have complicated matters, and to date prevented its widespread translatability in this age group. Areas covered:We review the current status of infant MBW testing in CF, focusing on Lung Clearance Index. This includes a review of recent developments in the field relevant to testing methodology in the infant population, use in evaluating lung disease in CF in infancy, and the associated challenges which remain. Expert commentary:The challenges of infant MBW are not limited to those associated with testing equipment, but also gaps in our understanding regarding the interpretation of MBW indices in infants. This includes their relationship to underlying physiology and pathology, and tracking over time. Recent advances in understanding and improving the infant MBW test set up (including both hardware and software) relevant to infants will greatly progress the field.

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Lung clearance index and moment ratios at different cut-off values in infant multiple-breath washout measurements

Cited by 10 publications

References 36 publications

Is Lung Clearance Index (LCI) Affected by the Severity of Lung Disease in CF?

Is Lung Clearance Index (LCI) Affected by the Severity of Lung Disease in CF?

The utility of moment ratios and abbreviated endpoints of the multiple breath washout test in preschool children with cystic fibrosis

The use of multiple breath washout for assessing cystic fibrosis in infants

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