The role of the small airways in the clinical expression of asthma in adults

Farah, Claude S.; King, Gregory G.; Brown, Nathan J.; Downie, Sue; Kermode, Jessica A.; Hardaker, Kate; Peters, Matthew J.; Berend, Norbert; Salome, Cheryl M.

doi:10.1016/j.jaci.2011.11.017

Cited by 127 publications

(120 citation statements)

References 45 publications

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“…Longitudinal change of He SIII as compared with SF 6 SIII seems very sensitive for early detection of bronchiolitis obliterans in patients at risk [11,35]. Similar He, SF 6 , and N 2 MBW indices can detect increased ventilation inhomogeneity in patients with emphysema [36], primary ciliary dyskinesia [37], asthma [38,39] and chronic obstructive pulmonary disease [40,41].…”

Section: Implications For Clinics and Researchmentioning

confidence: 99%

A new double-tracer gas single-breath washout to assess early cystic fibrosis lung disease

et al. 2012

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In cystic fibrosis (CF), tests for ventilation inhomogeneity are sensitive but not established for clinical routine. We assessed feasibility of a new double-tracer gas single-breath washout (SBW) in school-aged children with CF and control subjects, and compared SBW between groups and with multiple-breath nitrogen washout (MBNW).Three SBW and MBNW were performed in 118 children (66 with CF) using a side-stream ultrasonic flowmeter setup. The double-tracer gas containing 5% sulfur hexafluoride and 26.3% helium was applied during one tidal breath. Outcomes were SBW phase III slope (SIIIDTG), MBNWderived lung clearance index (LCI), and indices of acinar (Sacin) and conductive (Scond) ventilation inhomogeneity.SBW took significantly less time to perform than MBNW. SBW and MBNW were feasible in 109 (92.4%) and 98 (83.0%) children, respectively. SIIIDTG differed between children with CF and controls, mean¡SD was -456.7¡492.8 and -88.4¡129.1 mg?mol?L -1 , respectively. Abnormal SIIIDTG was present in 36 (59%) children with CF. SIIIDTG was associated with LCI (r5 -0.58) and Sacin (r5 -0.58), but not with Scond.In CF, steeply sloping SIIIDTG potentially reflects ventilation inhomogeneity near the acinus entrance. This tidal SBW is a promising test to assess ventilation inhomogeneity in an easy and fast way.

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Section: Implications For Clinics and Researchmentioning

confidence: 99%

A new double-tracer gas single-breath washout to assess early cystic fibrosis lung disease

et al. 2012

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“…This may be partially due to the lower FEV1 values in ACOS, which affect the prevalence of AHR by geometric mechanisms [17], but this impact cannot be large with a mean FEV1 value of 85% predicted in the ACOS group. However, there is an alternative explanation: several studies have shown that small airway dysfunction at birth contributes to the development of asthma [18], a lower lung function growth in childhood [18], and a more severe AHR and less control of asthma in adulthood [19]. Thus, it could be hypothesised that if small airways were compromised at birth and/or childhood, this might lead to a higher prevalence of AHR in ACOS.…”

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confidence: 99%

The different faces of the asthma−COPD overlap syndrome

Postma

Berge

2015

Eur Respir J

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“…Ventilation distribution measured from inert-gas washouts is determined by the small airways; studies in smokers [7] and bone marrow transplant recipients [8] suggest it to be a highly sensitive test of small-airway function. Furthermore, analysis of the washout pattern over the course of the washout has allowed compartmentalisation of function into acinar and conductive small airways, which has also been shown to have separate clinical associations in airway diseases [9][10][11][12]. The lung clearance index (LCI) is a simpler and "aggregate" measure of airway function, and represents the number of breaths, adjusted for lung size, required to clear the lungs of a gas.…”

Section: @Erspublicationsmentioning

confidence: 99%

Complex lung function in severe asthma: seeing is believing

King

Thamrin

2016

Eur Respir J

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@ERSpublicationsTechniques to partition airway dysfunction could improve understanding of severe asthma http://ow.ly/N7zD301wFn6Difficult-to-treat or severe asthma remains a common problem and a challenge for healthcare providers. It affects up to 10% of asthmatic individuals, who continue to suffer high disease burden and healthcare costs [1]. This clinical problem still exists despite many advances in the understanding of the underlying basis of asthma and improved management strategies, which include targeted anti-inflammatory therapy with monoclonal antibodies. Research effort continues, with exploration of different aspects of pathophysiology such as genomics, proteomics, inflammation, airway remodelling and airway smooth muscle abnormalities. In this context, the examination of complex lung function at the whole-organ level becomes increasingly important. There have been many technical advances in functional imaging and in complex measures of lung function that can now be used to explore the pathophysiology of asthma at the whole-organ level, and which can be more directly related to clinical manifestations of disease such as symptoms and airway hyperresponsiveness.Measuring patterns of ventilation (ventilation distribution) is a way to characterise lung function that is highly relevant in obstructive lung diseases, and goes far beyond spirometry, peak flow and lung volumes. Ventilation distribution can be quantified visually using three-dimensional (tomographic) ventilation imaging techniques as well as functionally using inert-gas washout tests. Tomographic imaging methods include hyperpolarised noble gas magnetic resonance imaging (MRI) (e.g. helium-3 or xenon) [2], positron emission tomography [3], single photon emission computed tomography (CT) [4,5] and oxygen enhanced MRI [6], where the distribution of a tracer gas is imaged. Inert-gas washout tests are based on the simple principle that regions of the lung that ventilate poorly or not at all (i.e. altered distribution) delay the clearance (i.e. washout) of a marker gas from the lung during normal tidal breathing. Thus, 100% oxygen can be used to "wash out" the resident nitrogen over multiple breaths, which is the basis of the multiple-breath nitrogen washout (MBNW). Similarly, if low concentrations of inert gases such as sulfur hexafluoride or helium are introduced into the lung, then their pattern of clearance from the lung reflects ventilation distribution.Ventilation imaging and inert-gas washout tests are thus two different yet complementary methods for characterising ventilation distribution. Ventilation imaging shows where functional abnormalities occur, how extensive they are and how they are colocated. Conversely, inert-gas washout measures ventilation that has been averaged across the entire lung but probes much finer length scales than those afforded by the resolution of modern imaging techniques. Ventilation distribution measured from inert-gas washouts is determined by the small airways; studies in smokers [7] and bone marrow transplant...

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The role of the small airways in the clinical expression of asthma in adults

Cited by 127 publications

References 45 publications

A new double-tracer gas single-breath washout to assess early cystic fibrosis lung disease

A new double-tracer gas single-breath washout to assess early cystic fibrosis lung disease

The different faces of the asthma−COPD overlap syndrome

Complex lung function in severe asthma: seeing is believing

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