The reproducibility and responsiveness of the lung clearance index in bronchiectasis

Grillo, Lizzie; Irving, Samantha; Hansell, David M.; Nair, Arjun; Annan, Bertrand; Ward, Simon; Bilton, Diana; Main, Eleanor; Davies, Jane C.; Bush, Andrew; Wilson, Robert; Loebinger, Michael R.

doi:10.1183/13993003.00152-2015

Cited by 34 publications

(35 citation statements)

References 32 publications

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“…This has again challenged our hypothesis that worsened ventilation heterogeneity characterized the exacerbation. This was supported by Grillo et al 31,. who documented that LCI was unresponsive to two short-term courses of chest physiotherapy plus antibiotics therapy for exacerbation.…”

Section: Discussionsupporting

confidence: 66%

Maximal mid-expiratory flow is a surrogate marker of lung clearance index for assessment of adults with bronchiectasis

Guan¹,

Yuan²,

Gao³

et al. 2016

Sci Rep

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Little is known about the comparative diagnostic value of lung clearance index (LCI) and maximal mid-expiratory flow (MMEF) in bronchiectasis. We compared the diagnostic performance, correlation and concordance with clinical variables, and changes of LCI and MMEF% predicted during bronchiectasis exacerbations (BEs). Patients with stable bronchiectasis underwent history inquiry, chest high-resolution computed tomography (HRCT), multiple-breath nitrogen wash-out test, spirometry and sputum culture. Patients who experienced BEs underwent these measurements during onset of BEs and 1 week following antibiotics therapy. Sensitivity analyses were performed in mild, moderate and severe bronchiectasis. We recruited 110 bronchiectasis patients between March 2014 and September 2015. LCI demonstrated similar diagnostic value with MMEF% predicted in discriminating moderate-to-severe from mild bronchiectasis. LCI negatively correlated with MMEF% predicted. Both parameters had similar concordance in reflecting clinical characteristics of bronchiectasis and correlated significantly with forced expiratory flow in one second, age, HRCT score, Pseudomonas aeruginosa colonization, cystic bronchiectasis, ventilation heterogeneity and bilateral bronchiectasis. In exacerbation cohort (n = 22), changes in LCI and MMEF% predicted were equally minimal during BEs and following antibiotics therapy. In sensitivity analyses, both parameters had similar diagnostic value and correlation with clinical variables. MMEF% predicted is a surrogate of LCI for assessing bronchiectasis severity.

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Section: Discussionsupporting

confidence: 66%

Maximal mid-expiratory flow is a surrogate marker of lung clearance index for assessment of adults with bronchiectasis

Guan¹,

Yuan²,

Gao³

et al. 2016

Sci Rep

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“…More recently, the lung clearance index (LCI) has been reported to be a non-invasive, reliable and reproducible method to investigate lung ventilation inhomogeneity in patients with stable non-cystic fibrosis bronchiectasis [37]; however LCI, unlike traditional lung function parameters, was found to be less sensitive to exacerbations or external interventions [38].…”

Section: Discussionmentioning

confidence: 99%

A comprehensive approach to lung function in bronchiectasis

Radovanovic

Santus

Blasi

et al. 2018

Respiratory Medicine

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A comprehensive approach to lung function in bronchiectasis ABSTRACT Background: International guidelines recommend simple spirometry for bronchiectasis patients. However, pulmonary pathophysiology of bronchiectasis is very complex and still poorly understood. Our objective was to characterize lung function in bronchiectasis and identify specific functional sub-groups. Methods:This was a multicenter, prospective, observational study enrolling consecutive adults with bronchiectasis during stable sate. Patients underwent body-plethysmography before and after acute bronchodilation testing, diffusing lung capacity (DL CO ) with a 3-year follow up. Air trapping and hyperinflation were a residual volume (RV)>120%predicted and a total lung capacity>120%predicted. Acute reversibility was: ΔFEV 1 ≥12% and 200 ml from baseline (FEV 1rev ) and ΔRV ≥10% reduction from baseline (RV rev ). Sensitivity analyses included different reversibility cutoffs and excluded patients with concomitant asthma or chronic obstructive pulmonary disease.Results: 187 patients were enrolled (median age: 68 years; 29.4% males).Pathophysiological abnormalities often overlapped and were distributed as follows: air trapping (70.2%), impaired DL CO (55.7%), airflow obstruction (41.1%), hyperinflation (15.7%) and restriction (8.0%). 9.7% of patients had normal lung function. RV rev (17.6%) was more frequent than FEV 1rev (4.3%). Similar proportions were found after multiple sensitivity analyses. Compared with non-reversible patients, patients with RV rev had more severe obstruction (mean(SD) FEV 1 %pred: 83.0% (24.4) vs 68.9% (26.2); P=0.02) and air trapping (RV%pred, 151.9% (26.6) vs 166.2% (39.9); P=0.028). Conclusions:Spirometry alone does not encompass the variety of pathophysiological characteristics in bronchiectasis. Air trapping and diffusion impairment, not airflow obstruction, represent the most common functional abnormalities. RV rev is related to worse lung function and might be considered in bronchiectasis' workup and for patients' functional stratification. Demographics

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“…Several other factors need future multicentre, prospective, longitudinal studies to evaluate drivers of faster disease progression, including the evaluation of microorganisms other than P. aeruginosa, microbiome parameters such as species diversity and richness, local and systemic inflammatory biomarkers, and other measurements of lung function impairment. The importance of comorbidities should also be explored as they may be amenable to treatment [26].…”

Section: Identify Patients At Risk Of Poor Outcomes (Patients)mentioning

confidence: 99%

Research priorities in bronchiectasis: a consensus statement from the EMBARC Clinical Research Collaboration

et al. 2016

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Bronchiectasis is a disease of renewed interest in light of an increase in prevalence and increasing burden on international healthcare systems. There are no licensed therapies, and large gaps in knowledge in terms of epidemiology, pathophysiology and therapy. The European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) is a European Respiratory Society (ERS) Clinical Research Collaboration, funded by ERS to promote high-quality research in bronchiectasis. The objective of this consensus statement was to define research priorities in bronchiectasis. From 2014 to 2015, EMBARC used a modified Delphi process among European bronchiectasis experts to reach a consensus on 55 key research priorities in this field. During the same period, the European Lung Foundation collected 711 questionnaires from adult patients with bronchiectasis and their carers from 22 European countries reporting important research priorities from their perspective. This consensus statement reports recommendations for bronchiectasis research after integrating both physicians and patients priorities, as well as those uniquely identified by the two groups. Priorities identified in this consensus statement provide the clearest possible roadmap towards improving our understanding of the disease and the quality of care for patients with bronchiectasis. @ERSpublications EMBARC consensus statement identifies research priorities in bronchiectasis as determined by physicians and patients

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The reproducibility and responsiveness of the lung clearance index in bronchiectasis

Cited by 34 publications

References 32 publications

Maximal mid-expiratory flow is a surrogate marker of lung clearance index for assessment of adults with bronchiectasis

Maximal mid-expiratory flow is a surrogate marker of lung clearance index for assessment of adults with bronchiectasis

A comprehensive approach to lung function in bronchiectasis

Research priorities in bronchiectasis: a consensus statement from the EMBARC Clinical Research Collaboration

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