Static hyperinflation is associated with ventilatory limitation and exercise tolerance in adult cystic fibrosis

Stevens, Daniel

doi:10.1111/crj.12763

Cited by 7 publications

(7 citation statements)

References 37 publications

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“…In COPD patients, EFL T promotes dynamic hyperinflation, with a concomitant increase in inspiratory work of breathing, impairment of inspiratory muscles function and adverse effects on hemodynamics. Also in CF patients ELF T is associated with lung hyperinflation, which in turn limits exercise . Moreover, in a recent longitudinal study conducted in adult CF patients, Vilozni, and colleagues found that the onset of EFL T predicts a decline in clinical course better than FEV1 and other spirometric indices …”

Section: Discussionmentioning

confidence: 99%

“…8,28,29 33 which in turn limits exercise. [33][34][35][36] Moreover, in a recent longitudinal study conducted in adult CF patients, Vilozni, and colleagues found that the onset of EFL T predicts a decline in clinical course better than FEV1 and other spirometric indices. 13 In conclusion, in the present study the within-breath analysis of respiratory system impedance provided interesting insights in the physiological changes associated with early CF lung disease, suggesting the occurrence of dynamic airway compression, which may eventually lead to EFL T .…”

Section: Similarly the Poor Association Between Within-breath Fot Pamentioning

confidence: 99%

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Within‐breath changes in respiratory system impedance in children with cystic fibrosis

Zannin

Nyilas

Ramsey

et al. 2019

Pediatric Pulmonology

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Background The aim of this study was to assess within‐breath respiratory system impedance by the forced oscillation technique (FOT) in children with cystic fibrosis (CF) and relate it to the underlying lung disease. Methods Thirty‐three children with CF (median [range] age 12.0 [6‐17] years) underwent FOT at 8 Hz during tidal breathing, multiple breath nitrogen washout (LCI), spirometry (FEV1), body plethysmography (RV/TLC), and magnetic resonance imaging (MRI). FOT outcomes included: mean inspiratory, expiratory, and whole breath resistance (R8INSP, R8EXP, R8TOT) and reactance (X8INSP, X8EXP, X8TOT), and the differences between X8INSP and X8EXP (ΔX8). Morphological changes were evaluated by MRI using CF‐specific morphological scores. Spearman correlation was performed to examine the correlation between FOT indices and other parameters. Results FEV1 was negatively correlated with R8EXP (r = −0.52, P = 0.002) and ΔX8 (r = −0.55, P = 0.001), and positively correlated with and X8EXP (r = 0.56, P < 0.001). RV/TLC was positively correlated with R8EXP (r = 0.43, P = 0.013), and ΔX8 (r = 0.54, P = 0.001) and negatively correlated with X8EXP (r = −0.54, P = 0.001). We found poor correlation between FOT parameters and LCI and no correlation between FOT parameters and MRI scores. Conclusion In children with CF, changes in within‐breath FOT parameters are consistent with peripheral obstruction and dynamic airway compression, while they are not associated with ventilation heterogeneities and morphological alterations.

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Section: Discussionmentioning

confidence: 99%

Section: Similarly the Poor Association Between Within-breath Fot Pamentioning

confidence: 99%

Within‐breath changes in respiratory system impedance in children with cystic fibrosis

Zannin

Nyilas

Ramsey

et al. 2019

Pediatric Pulmonology

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“…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 . Multilinear regression showed that the contribution of static inflation to exercise performance was greater than that of airway obstruction, measured by FEV1.…”

Section: Physiological Assessmentmentioning

confidence: 94%

“…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. 97 Multilinear regression showed that the contribution of static inflation to exercise performance was greater than that of airway obstruction, measured by FEV1. Evaluation of optimal markers of disease severity beyond traditional CPET outcomes, are also being investigated.…”

Section: Cardiopulmonary Exercise Testingmentioning

confidence: 99%

Cystic fibrosis year in review 2018, part 1

Savant

McColley

2019

Pediatric Pulmonology

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“…Aerobic exercise remains an integral part of the management of people with CF, and is associated with a reduction of the rate of decline in lung function and improved quality of life and bone mineralisation [3][4][5][6][7] . However, disease progression and the associated structural damage results in increased airway resistance, static and dynamic hyperinflation, hypoventilation and ventilationperfusion mismatch, all of which reduce exercise tolerance [8][9][10][11] . Patients can present with dyspnoea and fatigue during exercise, with exercise-induced hypoxaemia or desaturation occurring in 15 to 30% of cases [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Nasal high-flow therapy as an adjunct to exercise in patients with cystic fibrosis: A pilot feasibility trial

Spoletini

Watson

Lim

et al. 2021

Journal of Cystic Fibrosis

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Background: Exercise tolerance in people with CF and advanced lung disease is often reduced. While supplemental oxygen can improve oxygenation, it does not affect dyspnoea, fatigue or comfort. Nasal high-flow therapy (NHFT), thanks to its pathophysiological mechanisms, could improve exercise tolerance, saturation and dyspnoea. This study explores the feasibility of conducting a clinical trial of using NHFT in patients with CF during exercise. Methods:A pilot, open-label, randomized crossover trial was performed, enroling 23 participants with CF and severe lung disease. Participants completed two treadmill walking test (TWT) with and without NHFT at 24-48 h interval. Primary outcome was trial feasibility, and exploratory outcomes were TWT distance (TWTD), SpO 2 , transcutaneous CO 2 , dyspnoea and comfort.Results: Recruitment rate was 2.4 subjects/month with 1.3:1 screening-to-randomization ratio. No adverse events caused by NHFT were observed. Tolerability was good and data completion rate was 100%. Twenty subjects (91%) were included in the exploratory study. Mean difference in TWTD on NHFT was 19 m (95% CI [4.8 -33.1]). S p O 2 was similar, but respiratory rate and mean tcCO 2 were lower on NHFT (mean difference = -3.9 breaths/min 95% CI [-5.9 --1.9] and -0.22 kPa 95% CI [-0.4 -0.04]). NHFT reduced exercise-induced dyspnoea and discomfort. Conclusion:Trials using NHFT in patients with CF during exercise are feasible. NHFT appears to improve walking distance, control respiratory rate, CO 2 , dyspnoea and improve comfort. A larger trial with a longer intervention is feasible and warranted to confirm the impact of NHFT in training programmes for patients with CF.

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Static hyperinflation is associated with ventilatory limitation and exercise tolerance in adult cystic fibrosis

Abstract: Clinicians working with this patient group in a pulmonary rehabilitation or health care setting may wish to consider using measures of static hyperinflation as end points to determine program or treatment efficacy.

Cited by 7 publications

References 37 publications

Within‐breath changes in respiratory system impedance in children with cystic fibrosis

Within‐breath changes in respiratory system impedance in children with cystic fibrosis

Cystic fibrosis year in review 2018, part 1

Nasal high-flow therapy as an adjunct to exercise in patients with cystic fibrosis: A pilot feasibility trial

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