Single-Breath Washout Tests to Assess Small Airway Disease in COPD

Boeck, Lucas; Gensmer, Anna; Nyilas, Sylvia; Stieltjes, Bram; Re, Thomas J.; Tamm, Michael; Latzin, Philipp; Stolz, Daiana

doi:10.1016/j.chest.2016.05.019

Cited by 35 publications

(44 citation statements)

References 35 publications

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“…SIII from DTG‐SBW is theorised to measure the mainly diffusion‐dependent ventilation distribution of the acinar lung region . This is supported by the fact that in different disease entities with small airway disease such as children with CF, mild asthma, primary ciliary dyskinesia, and adults with chronic obstructive pulmonary disease, SIII is elevated compared with healthy controls . However, we found no correlation between SIII and structural lung changes in our children with CF.…”

Section: Discussionsupporting

confidence: 49%

“…Systematic analysis of this in children is missing. Generally, SIII showed quite heterogeneous results within different disease groups . Through collective interpretation of different lung function tests it is possible to assign heterogeneous SIII results to different physiological and disease phenotypes.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, although fast and simple to perform, DTG‐SBW cannot replace MBW and does not meet the requirements to serve as a monitoring tool for structural lung disease as seen for LCI in preschool and school‐aged children . At the moment, SIII rather serves as a single piece among other lung function parameters to reflect pathophysiological conditions . Nyilas et al were able to identify different physiological phenotypes independently of the underlying disease entity of the children .…”

Section: Discussionmentioning

confidence: 99%

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Single‐breath washout and association with structural lung disease in children with cystic fibrosis

Yammine

Ramsey

King

et al. 2019

Pediatric Pulmonology

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Background: In children with cystic fibrosis (CF) lung clearance index (LCI) from multiple-breath washout (MBW) correlates with structural lung disease. As a shorter test, single-breath washout (SBW) represents an attractive alternative to assess the ventilation distribution, however, data for the correlation with lung imaging are lacking. Methods:We assessed correlations between phase III slope (SIII) of double-tracer gas SBW, nitrogen MBW indices (LCI and moment ratios for overall ventilation distribution, Scond, and Sacin for conductive and mainly acinar ventilation, respectively) and structural lung disease assessed by chest computed tomography (CT) in children with CF.Results: In a prospective cross-sectional study data from MBW, SBW, and chest CT were obtained in 32 children with CF with a median (range) age of 8.2 (5.2-16.3) years.Bronchiectasis was present in 24 (75%) children and air trapping was present in 29 (91%). Median (IQR) SIII of SBW was −138.4 (150.6) mg/mol. We found no association between SIII with either the MBW outcomes or CT scores (n = 23, association with bronchiectasis extent r = 0.10, P = 0.64). LCI and Scond were associated with bronchiectasis extent (n = 23, r = 0.57, P = 0.004; r = 0.60, P = 0.003, respectively).Conclusions: Acinar ventilation inhomogeneity measured by SBW was not associated with structural lung disease on CT. Double-tracer SBW added no benefit to indices measured by MBW.

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Section: Discussionsupporting

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Single‐breath washout and association with structural lung disease in children with cystic fibrosis

Yammine

Ramsey

King

et al. 2019

Pediatric Pulmonology

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“…It can identify tobacco smokers at risk of developing chronic obstructive pulmonary disease (COPD) (Macklem, 1972) and has been validated against histopathological proven structural peripheral airway abnormalities in the human lung (Cosio et al, 1978), and remains the only ventilation inhomogeneity marker to be validated in this way. The N 2 VC SBW test remains in use in many laboratories today (Mikamo et al, 2013;Boeck et al, 2016;Di Marco et al, 2017), mainly because of its time-effectiveness, yet the correlation between N 2 MBW and N 2 SBW remains largely unknown, and remains an important gap in current knowledge for clinicians interested in inert gas washout techniques. The N 2 VC SBW test remains in use in many laboratories today (Mikamo et al, 2013;Boeck et al, 2016;Di Marco et al, 2017), mainly because of its time-effectiveness, yet the correlation between N 2 MBW and N 2 SBW remains largely unknown, and remains an important gap in current knowledge for clinicians interested in inert gas washout techniques.…”

Section: Introductionmentioning

confidence: 99%

“…Specific to adult asthma, S III steepness correlates with disease severity as determined by asthma exacerbation frequency (Bourdin et al, 2006). The N 2 VC SBW test remains in use in many laboratories today (Mikamo et al, 2013;Boeck et al, 2016;Di Marco et al, 2017), mainly because of its time-effectiveness, yet the correlation between N 2 MBW and N 2 SBW remains largely unknown, and remains an important gap in current knowledge for clinicians interested in inert gas washout techniques.…”

Section: Introductionmentioning

confidence: 99%

Utility of single versus multiple breath washout in adult asthma

Kjellberg

Viklund

Robinson

et al. 2018

Clin Physio Funct Imaging

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Nitrogen multiple breath washout (N MBW) is a sensitive method to identify peripheral airway involvement in asthma, but is a time-consuming test. The N vital capacity single breath (VC SBW) test offers greater time efficiency, but concordance with N MBW is poorly understood. The prevalence of peripheral airway abnormality was determined by N MBW and N SBW tests in 194 asthmatic subjects aged 18-1 years. N MBW data were related to findings in 400 healthy controls, aged 17-71 years, while N SBW data were compared to findings in 224 healthy controls, aged 15-65 years, to derive equipment-specific reference values. Amongst asthmatic subjects, relationships between N SBW and N MBW outcomes were studied. N SBW relationship with clinical history, spirometry, blood eosinophils and fraction exhaled nitric oxide (FENO) data was also explored. The prevalence of peripheral airway involvement (i.e. abnormal ventilation distribution) determined by N SBW-derived phase III slope (N S ) was 24·7%, compared to 44% determined by N MBW-derived lung clearance index (LCI) (P<0·001). Predictors of abnormal N S were older age, smoking history and lower FEV N SBW offers lower sensitivity than N MBW to detect small airway dysfunction in adult asthma, but may be a marker of more severe disease.

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A simple method to reconstruct the molar mass signal of respiratory gas to assess small airways with a double-tracer gas single-breath washout

Port

Tao

Junger

et al. 2017

Med Biol Eng Comput

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For the assessment of small airway diseases, a noninvasive double-tracer gas single-breath washout (DTG-SBW) with sulfur hexafluoride (SF) and helium (He) as tracer components has been proposed. It is assumed that small airway diseases may produce typical ventilation inhomogeneities which can be detected within one single tidal breath, when using two tracer components. Characteristic parameters calculated from a relative molar mass (MM) signal of the airflow during the washout expiration phase are analyzed. The DTG-SBW signal is acquired by subtracting a reconstructed MM signal without tracer gas from the signal measured with an ultrasonic sensor during in- and exhalation of the double-tracer gas for one tidal breath. In this paper, a simple method to determine the reconstructed MM signal is presented. Measurements on subjects with and without obstructive lung diseases including the small airways have shown high reliability and reproducibility of this method.

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Single-Breath Washout Tests to Assess Small Airway Disease in COPD

Cited by 35 publications

References 35 publications

Single‐breath washout and association with structural lung disease in children with cystic fibrosis

Single‐breath washout and association with structural lung disease in children with cystic fibrosis

Utility of single versus multiple breath washout in adult asthma

A simple method to reconstruct the molar mass signal of respiratory gas to assess small airways with a double-tracer gas single-breath washout

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