Lung clearance index (LCI) as a predictor of exercise limitation among CF patients

Avramidou, Vasiliki; Hatziagorou, Elpis; Kampouras, Asterios; Hebestreit, Helge; Kourouki, Eleana; Kirvassilis, Fotios; Tsanakas, John

doi:10.1002/ppul.23833

Cited by 11 publications

(10 citation statements)

References 37 publications

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“…Differently, LCI 2.5 was able to predict some abnormalities (ie, high end-expiratory lung volume) appearing during a CPET in school-age children with CF and normal spirometry. 14 Another study 15 described how ventilation inhomogeneity was associated with less efficient ventilation during vigorous exercise with a negative impact on exercise capacity, measured through a standard CPET, in patients with mild to moderate CF lung disease. However, the variance explained by selected regression models was low.…”

Section: Discussionmentioning

confidence: 99%

Exercise capacity and ventilation inhomogeneity in cystic fibrosis: A cross‐sectional study

Gambazza

Guarise

Carta

et al. 2020

Pediatric Pulmonology

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Background Lung clearance index (LCI2.5) is a marker of overall lung ventilation inhomogeneity and has proven to be able to detect early peripheral damage in subjects with cystic fibrosis (CF), with greater sensitivity than conventional spirometry. Combining its sensitivity with the output of an incremental exercise testing, we hypothesized that any sign of ventilation inhomogeneity in subjects without severe airflow obstruction and with a normal exercise tolerance could be relevant for the CF team, tracking early lung disease and potential exercise limiting factors. Methods Patients with CF in clinical stable conditions were recruited between 2015 and 2017. Available spirometry, nitrogen multiple‐breath washout test and symptoms‐limited exercise testing performed as parts of patients' annual routine evaluation were considered for this cross‐sectional study. To describe the relationship between exercise intensity and ventilation inhomogeneity, a linear regression analysis was performed using backward elimination based on Akaike information criteria. Results Seventy‐seven patients (38 females) were included. Sacin and LCI2.5 were significantly higher in patients with an overall reduced exercise tolerance. Peak work developed during exercise was associated with body mass index (b = 5.25; 95% confidence interval [CI] = 1.53‐8.98), forced expiratory volume in 1 second (FEV1; b = 3.71; 95% CI = 1.96‐5.46), Pseudomonas aeruginosa chronic infection (b = −8.84; 95% CI = −15.84 to −1.84) but not with LCI2.5. Conclusion Exercise capacity and airflow obstruction are associated in this Italian CF cohort. Considering the greater discriminatory power of LCI2.5 over FEV1 and peak work, the Godfrey protocol without gas analysis cannot provide detailed information about lung function or efficiency. However, this incremental protocol without gas exchange measures can still provide the CF team with information about exercise tolerance and disability.

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Section: Discussionmentioning

confidence: 99%

Exercise capacity and ventilation inhomogeneity in cystic fibrosis: A cross‐sectional study

Gambazza

Guarise

Carta

et al. 2020

Pediatric Pulmonology

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“…The relationship between these physiological tests was explored in a study of 97 children and young adults with CF and mild to moderate lung disease (mean FEV1pp, 90.8%). LCI was strongly correlated with VO2 peak percent predicted ( r 2 = 0.185, P < .001), breathing reserve percent predicted ( r 2 = 0.072, P < .001), VE/VO2 ( r 2 = 0.027, P < .001) and VE/VCO2 ( r 2 = 0.069, P < .01) . Thus, ventilation inhomogeneity is correlated with exercise limitation.…”

Section: Physiological Assessmentmentioning

confidence: 92%

“…LCI was strongly correlated with VO2 peak percent predicted (r 2 = 0.185, P < .001), breathing reserve percent predicted (r 2 = 0.072, P < .001), VE/VO2 (r 2 = 0.027, P < .001) and VE/VCO2 (r 2 = 0.069, P < .01). 96 Thus, ventilation inhomogeneity is correlated with exercise limitation. In another study in 107 adult patients with CF, lung static hyperinflation, defined as RV/TLC > 0.30, was associated with a significant reduction in VO2 peak.…”

Section: Cardiopulmonary Exercise Testingmentioning

confidence: 99%

Cystic fibrosis year in review 2018, part 1

Savant

McColley

2019

Pediatric Pulmonology

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“…e following parameters were measured: peak oxygen uptake (VO 2 peak), peak oxygen uptake/weight (VO 2 peak/kg) ventilator equivalent ratios for oxygen and carbon dioxide at peak exercise (VE/VO 2 , VE/ VCO 2 ), anaerobic threshold (AT), breathing reserve at peak exercise (BR%), dead space to exhaled volume ratio (Vd/Vt). VO 2 peak% predicted was calculated using the Orenstein gender speci c equations [17]: en the VO 2 peak% predicted was calculated.…”

Section: Cardiopulmonary Exercise Testing (Cpet)mentioning

confidence: 99%

“…not able to perform exercise testing. Physicians with patients colonized intermittently or chronically could use this knowledge to prescribe exercise rehabilitation even in an early stage in order for daily activities to not be hassled [17].…”

Section: Pulmonary Medicinementioning

confidence: 99%

Does Pseudomonas aeruginosa Colonization Affect Exercise Capacity in CF?

et al. 2019

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Introduction. Cardio-Pulmonary Exercise Testing (CPET) has been recognized as a valuable method in assessing disease burden and exercise capacity among CF patients. Aim. To evaluate whether Pseudomonas aeruginosa colonization status affects Exercise Capacity, LCI and High-Resolution Computed Tomography (HRCT) indices among patients with CF; to check if Pseudomonas colonization can predict exercise intolerance. Subjects. Seventy-eight (78) children and adults with CF (31 males) mean (range) age 17.08 (6.75; 24.25) performed spirometry, Multiple Breath Washout (MBW) and CPET along with HRCT on the same day during their admission or follow up visit. Results. 78 CF patients (mean FEV1: 83.3% mean LCI: 10.9 and mean VO2 peak: 79.1%) were evaluated: 33 were chronically colonized with Pseudomonas aeruginosa, 24 were intermittently colonized whereas 21 were Pseudomonas free. Statistically significant differences were observed among the three groups in: peak oxygen uptake % predicted (VO2 peak% (p<0.001), LCI (p<0.001), as well as FEV1% (p<0.001) and FVC% (p<0.001). Pseudomonas colonization could predict VO2 peak% (p<0.001, r2: −0.395). Conclusion. Exercise capacity as reflected by peak oxygen uptake is reduced in Pseudomonas colonized patients and reflects lung structural damages as shown on HRCT. Pseudomonas colonization could predict exercise limitation among CF patients.

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Lung clearance index (LCI) as a predictor of exercise limitation among CF patients

Abstract: Introduction: FEV 1 is often considered the gold standard to monitor lung disease in

Cited by 11 publications

References 37 publications

Exercise capacity and ventilation inhomogeneity in cystic fibrosis: A cross‐sectional study

Exercise capacity and ventilation inhomogeneity in cystic fibrosis: A cross‐sectional study

Cystic fibrosis year in review 2018, part 1

Does Pseudomonas aeruginosa Colonization Affect Exercise Capacity in CF?

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