Maximal mid-expiratory flow detects early lung disease in α<sub>1</sub>-antitrypsin deficiency

Stockley, James; Ismail, Asem; Hughes, Siân; Edgar, Ross; Stockley, Robert A.; Sapey, Elizabeth

doi:10.1183/13993003.02055-2016

Cited by 49 publications

(59 citation statements)

References 42 publications

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“…There are many subtypes of AATD but in the most common severe form of deficiency (named PiZZ) this leads to mis-folding of the protein product, retention of AAT in AAT-producing cells and the formation of protein polymers in these cells, which causes damage and low circulating levels of AAT. AATD is the only robustly established genetic risk factor for the development of COPD and emphysema, and these disease processes can occur in patients with AATD, even in the absence of cigarette smoking 62, 91, 95, 96 .…”

Section: Alpha-1 Anti-trypsin Deficiencymentioning

confidence: 99%

Understanding the role of neutrophils in chronic inflammatory airway disease

et al. 2019

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Airway neutrophilia is a common feature of many chronic inflammatory lung diseases and is associated with disease progression, often regardless of the initiating cause. Neutrophils and their products are thought to be key mediators of the inflammatory changes in the airways of patients with chronic obstructive pulmonary disease (COPD) and have been shown to cause many of the pathological features associated with disease, including emphysema and mucus hypersecretion. Patients with COPD also have high rates of bacterial colonisation and recurrent infective exacerbations, suggesting that neutrophil host defence mechanisms are impaired, a concept supported by studies showing alterations to neutrophil migration, degranulation and reactive oxygen species production in cells isolated from patients with COPD. Although the role of neutrophils is best described in COPD, many of the pathological features of this disease are not unique to COPD and also feature in other chronic inflammatory airway diseases, including asthma, cystic fibrosis, alpha-1 anti-trypsin deficiency, and bronchiectasis. There is increasing evidence for immune cell dysfunction contributing to inflammation in many of these diseases, focusing interest on the neutrophil as a key driver of pulmonary inflammation and a potential therapeutic target than spans diseases. This review discusses the evidence for neutrophilic involvement in COPD and also considers their roles in alpha-1 anti-trypsin deficiency, bronchiectasis, asthma, and cystic fibrosis. We provide an in-depth assessment of the role of the neutrophil in each of these conditions, exploring recent advances in understanding, and finally discussing the possibility of common mechanisms across diseases.

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Section: Alpha-1 Anti-trypsin Deficiencymentioning

confidence: 99%

Understanding the role of neutrophils in chronic inflammatory airway disease

et al. 2019

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“…However, despite the limitations of MMEF, it may still be useful as a stand-alone measure in certain patient cohorts as a marker of early airflow limitation before the spirometric criterion for COPD is reached. 13 , 23 Topalovic et al 23 extended this concept by analyzing the shape of the flow-volume curve and demonstrated that the angle of inflection between the two best fitting regression lines of the expiratory curve with a cutoff angle of <131° was highly specific (97%), although less sensitive (51%), for the presence of emphysema in COPD. This angle of inflection (or “spirographic kink”) reflects the dynamic airways collapse due to the loss of lung connective tissue in emphysema (notably elastin) that usually maintains airway patency during forced expiration in healthy individuals.…”

Section: Expiratory Flowsmentioning

confidence: 99%

“…In addition, abnormal tests were associated with impaired health status and predicted the subsequent rate of decline of FEV 1 . 13 …”

Section: Introductionmentioning

confidence: 99%

Small airways disease: time for a revisit?

Stockley¹,

Cooper²,

Stockley³

et al. 2017

COPD

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It is increasingly acknowledged that delays in the diagnosis of chronic inflammatory lung conditions have hampered our understanding of pathogenesis and thus our ability to design efficacious therapies. This is particularly true for COPD, where most patients are diagnosed with moderate-to-severe airflow obstruction and little is known about the inflammatory processes present in early disease. There is great interest in developing screening tests that can identify those most at risk of developing COPD before airflow obstruction has developed for the purpose of research and clinical care. Landmark pathology studies have suggested that damage to the small airways precedes the development of airflow obstruction and emphysema and, thus, presents an opportunity to identify those at risk of COPD. However, despite a number of physiological tests being available to assess small airways function, none have been adopted into routine care in COPD. The reasons that tests of small airways have not been utilized widely include variability in test results and a lack of validated reference ranges from which to compare results for some methodologies. Furthermore, population studies have not consistently demonstrated their ability to diagnose disease. However, the landscape may be changing. As the equipment that delivers tests of small airways become more widely available, reference ranges are emerging and newer methodologies specifically seek to address variability and difficulty in test performance. Moreover, there is evidence that while tests of small airways may not be helpful across the full range of established disease severity, there may be specific groups (particularly those with early disease) where they might be informative. In this review, commonly utilized tests of small airways are critically appraised to highlight why these tests may be important, how they can be used and what knowledge gaps remain for their use in COPD.

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“…ECG captures the electrical activity of the heart as a time series data with Ag/AgCl electrodes attached to exposed bare skin; this will cause restraint and produce some burdens to subjects [3]. Airflow is another popular measuring vital sign (respiratory) method with common sensors fixed at the nasal cavity or the chest [4]. Video camera methods run the gamut ranging from high-end expensive camera systems that track bright objects placed on the chest and used in CT image gating to low-cost vital signs "apps" for mobile devices that give heart rate by detecting facial flushing with each beat and respiration rate by chest movement [5].…”

Section: Introductionmentioning

confidence: 99%

Cardiopulmonary Signal Detection Based on Magnetic Induction

et al. 2017

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Cardiopulmonary signal contains vital and rich physiological information, which is very useful for clinical diagnosis and home healthcare. Convectional monitoring methods still need uncomfortable sensors or are expensive for nonprofessional common consumers. In this paper, we proposed a cardiopulmonary signal detection method based on electromagnetic induction. Based on thoracic volume variation affecting the biological impedance, which can be detected by magnetic induction, our idea is to develop a not complicated and practical measuring platform and exploit the intrinsic properties of cardiopulmonary signals with respiratory and heart rate. We have some theoretical analysis about the relationship of thoracic volume with biological impedance, sensor-head parameters, and the optimal measuring position. Then a whole measuring system has been designed and evaluated. The respiratory and heart rate obtained from the proposed method are not significantly different from the reference method (noncontact BCG).

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Maximal mid-expiratory flow detects early lung disease in α₁-antitrypsin deficiency

Cited by 49 publications

References 42 publications

Understanding the role of neutrophils in chronic inflammatory airway disease

Understanding the role of neutrophils in chronic inflammatory airway disease

Small airways disease: time for a revisit?

Cardiopulmonary Signal Detection Based on Magnetic Induction

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Maximal mid-expiratory flow detects early lung disease in α1-antitrypsin deficiency

Cited by 49 publications

References 42 publications

Understanding the role of neutrophils in chronic inflammatory airway disease

Understanding the role of neutrophils in chronic inflammatory airway disease

Small airways disease: time for a revisit?

Cardiopulmonary Signal Detection Based on Magnetic Induction

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Product

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Maximal mid-expiratory flow detects early lung disease in α₁-antitrypsin deficiency