Lung Imaging with radioaerosols for the assessment of airway disease

Hayes, Michael; Taplin, George V.

doi:10.1016/s0001-2998(80)80004-3

Cited by 45 publications

(20 citation statements)

References 5 publications

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“…Moreover, alveoli in the base are less expanded and more compliant and have a greater change in volume during inspiration. 18 In addition, our findings corroborate a study of radio-aerosol deposition coupled with bi-level ventilation in normal subjects. 14 We found more deposition in the intermediate and peripheral regions than in the central region with all 3 configurations.…”

Section: Discussionsupporting

confidence: 87%

“…This distribution in normal subjects may be attributed mainly to the vertical difference in pleural pressure between the upper and lower lung regions. 18 According to Alderson and Line,19 other factors also influence the distribution of particles into the lungs, such as minute ventilation, inspiratory pressure, and nebulization position during inhalation. Ventilation per unit volume decreases from the base to the apex of the lung, as a result of regional differences in intrapleural pressure resulting from gravitational influences.…”

Section: Discussionmentioning

confidence: 99%

“…Ventilation per unit volume decreases from the base to the apex of the lung, as a result of regional differences in intrapleural pressure resulting from gravitational influences. 18 In the lung, the gravitational and retractable forces act in the same direction, making the subatmospheric intrapleural pressure more negative in the apex than in the lung base, where the gravitational and retractable forces act in opposite directions. As a result, alveoli in the apex become more expanded and less compliant, with a small change in volume during inspiration.…”

Section: Discussionmentioning

confidence: 99%

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Scintigraphic Assessment of Radio-Aerosol Pulmonary Deposition With the Acapella Positive Expiratory Pressure Device and Various Nebulizer Configurations

Mesquita¹,

Galindo-Filho²,

Neto³

et al. 2013

Respir Care

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BACKGROUND:The Acapella device produces high-frequency oscillations and positive expiratory pressure to promote bronchial secretion clearance. Its performance during aerosol delivery has not been described. We evaluated the effect of nebulizer and Acapella configuration on pulmonary deposition of radio-tagged aerosol in healthy subjects. METHODS: Ten healthy male subjects (mean age 24.4 ؎ 2.2 y) participated in a crossover study that compared pulmonary delivery of 4 mL of technetium-99m-labeled diethylene triamine penta-acetic acid (25 mCi) and 0.9% saline solution via jet nebulizer. We tested 3 configurations: nebulizer attached to the distal end of the Acapella; nebulizer placed between the mouthpiece and the Acapella; and nebulizer alone (control). With scintigraphy we measured radio-aerosol deposition in 6 lung regions: upper, middle, lower, central, intermediate, and peripheral. RESULTS: Deposition was similar between the right and left lungs, with no significant differences between device configurations. Lung deposition was less with the nebulizer attached to the Acapella than with nebulizer between the mouthpiece and the Acapella (P ‫؍‬ .001, for both lungs) or without the Acapella (P ‫؍‬ .003 and P ‫؍‬ .001 for the right and left lungs, respectively). There was no significant difference between the setup without Acapella and the setup with the nebulizer between the mouthpiece and the Acapella (P ‫؍‬ .001, for both lungs). On the vertical axis, deposition was lower with the nebulizer attached to the distal end of the Acapella than with the nebulizer between the mouthpiece and the Acapella (upper region P < .001, middle region P ‫؍‬ .001, lower region P ‫؍‬ .003), and lower with the nebulizer attached to the distal end of the Acapella than with the setup without Acapella (upper and middle region both P ‫؍‬ .001, lower region P ‫؍‬ .002), with up to a 3-fold difference in the middle and lower regions. On the centralperipheral axis, deposition was lower with the nebulizer attached to the distal end of the Acapella than with the nebulizer between the mouthpiece and the Acapella (central region P < .001, peripheral region P < .001), and lower with the nebulizer attached to the distal end of the Acapella than with the setup without Acapella (central and peripheral regions both P ‫؍‬ .002), with differences of 3-4-fold between the central and peripheral regions. CONCLUSIONS: Placing the nebulizer distal to the Acapella, as recommended by the manufacturer, decreased intrapulmonary deposition, compared to placing the nebulizer between the Acapella and the patient airway, or delivering aerosol without the Acapella in the circuit. (ClinicalTrials.gov NCT01102166)

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Scintigraphic Assessment of Radio-Aerosol Pulmonary Deposition With the Acapella Positive Expiratory Pressure Device and Various Nebulizer Configurations

Mesquita¹,

Galindo-Filho²,

Neto³

et al. 2013

Respir Care

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“…This regional difference could be attributed to the vertical difference between the base and apex of the lung, which are in different positions on the pressure-volume curve. 34 This should be explained by the scintigraphic images obtained from asthmatics that showed a different deposition pattern, which suggests that obstruction level can affect pulmonary segments differently.…”

Section: Discussionmentioning

confidence: 99%

Noninvasive Ventilation Coupled With Nebulization During Asthma Crises: A Randomized Controlled Trial

et al. 2013

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BACKGROUND: Despite the clinical improvements attributed to noninvasive ventilation (NIV) during asthma crises, and the well established effects of nebulization, there are few studies on the effects of these interventions together. We hypothesized that nebulization coupled to NIV should raise radio-aerosol pulmonary deposition in asthmatics. The aims of this study were to assess the effects of coupling ␤-agonist nebulization and NIV during asthma exacerbations on radio-aerosol pulmonary deposition, using scintigraphy and cardiopulmonary parameters, to correlate pulmonary function with radio-aerosol deposition index, radio-aerosol penetration index, and pulmonary clearance. METHODS: In this controlled trial, 21 adults with moderate to severe asthma attack were randomized to a control group (n ‫؍‬ 11) or experimental group (NIV ؉ nebulizer group, n ‫؍‬ 10). All subjects inhaled bronchodilators for 9 minutes, and after particles were counted with a gamma camera to analyze regions of interest and pulmonary clearance at 0, 15, 30, 45, and 60 min. RESULTS: Breathing frequency (P ‫؍‬ < .001) and minute ventilation (P ‫؍‬ .01) were reduced, and tidal volume was increased (P ‫؍‬ .01) in the NIV ؉ nebulizer group, compared with the control group. The NIV ؉ nebulizer group had improvement from baseline values, compared to the control group in the following parameters: FEV 1 46.7 ؎ 0.5% of predicted vs 29.8 ؎ 8.9% of predicted, P ‫؍‬ .02), FVC (41.2 ؎ 1.5% of predicted vs 23.2 ؎ 7.1% of predicted, P ‫؍‬ .02), peak expiratory flow (67.3 ؎ 38.3% of predicted vs 26.9 ؎ 12.1% of predicted, P ‫؍‬ .01), and inspiratory capacity (54.9 ؎ 28.8% of predicted vs 31.2 ؎ 9.1% of predicted, P ‫؍‬ .01). No differences were observed between groups regarding radio-aerosol deposition index or pulmonary clearance. Negative correlations were found between FEV 1 , forced expiratory flow during the middle half of the FVC maneuver (FEF 25-75% ), inspiratory capacity, and radio-aerosol penetration index. CONCLUSIONS: Coupling nebulization and NIV during asthma exacerbation did not improve radio-aerosol pulmonary deposition, but we observed clinical improvement of pulmonary function in these subjects. (ClinicalTrials.gov registration NCT01012050)

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“…(44) Radioactive gases present greater penetration into obstructive processes than does technetium-99m-labeled diethylenetriaminepentaacetic acid aerosol. (47) In patients with accentuated obstruction of the airways, the aerosol deposition occurs in the bronchi and central carinas, not reaching the alveolar area in sufficient quantity to allow an adequate V/Q comparison. The PISA-PED (28) study demonstrated that perfusion mapping can be sufficient for the diagnosis of PTE probability, with high positive and negative predictive values, when considered together with clinical probabilities.…”

Section: Commentsmentioning

confidence: 99%

O desafio de diagnosticar tromboembolia pulmonar aguda em pacientes com doença pulmonar obstrutiva crônica

Menna-Barreto

2005

J. bras. pneumol.

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Pulmonary thromboembolism and exacerbation of chronic obstructive pulmonary disease are common conditions. Chronic obstructive pulmonary disease is a clinical risk factor for pulmonary thromboembolism. The presentation of acute pulmonary thromboembolism and acute exacerbation of chronic obstructive pulmonary disease often mimic each other so closely that they cannot be distinguished clinically. The structural abnormalities of the lungs in chronic obstructive pulmonary disease make also difficult to interpret the results of noninvasive tests like ventilation-perfusion lung scans. Therefore, diagnosing acute pulmonary thromboembolism in patients with underlying chronic obstructive pulmonary disease is a challenging task. In order to update knowledge of the subject and offer suggestions regarding conduct, we evaluated various studies addressing this theme, including case reports and case series. In addition, we reviewed diagnostic approaches to acute pulmonary thromboembolism, and we reflect upon that topic. The clinical probability of pulmonary thromboembolism concomitant to chronic obstructive pulmonary disease is typically intermediate, as is positivity on the ventilation-perfusion lung scan. Diagnostic algorithms should take that into consideration.

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Lung Imaging with radioaerosols for the assessment of airway disease

Cited by 45 publications

References 5 publications

Scintigraphic Assessment of Radio-Aerosol Pulmonary Deposition With the Acapella Positive Expiratory Pressure Device and Various Nebulizer Configurations

Scintigraphic Assessment of Radio-Aerosol Pulmonary Deposition With the Acapella Positive Expiratory Pressure Device and Various Nebulizer Configurations

Noninvasive Ventilation Coupled With Nebulization During Asthma Crises: A Randomized Controlled Trial

O desafio de diagnosticar tromboembolia pulmonar aguda em pacientes com doença pulmonar obstrutiva crônica

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