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Lung index clearance

Alex R Horsley, Katherine O'Neill, Damian G Downey, J Stuart Elborn, Nicholas J Bell, Jaclyn Smith, John Owers-Bradley
Multiple breath wash-out (MBW) testing requires prior wash-in of inert tracer gas. Wash-in efficiency can be enhanced by a rebreathing tracer in a closed circuit. Previous attempts to deploy this did not account for the impact of CO2 accumulation on patients and were unsuccessful. We hypothesised that an effective rebreathe wash-in could be delivered and it would not alter wash-out parameters. Computer modelling was used to assess the impact of the rebreathe method on wash-in efficiency. Clinical testing of open and closed circuit wash-in-wash-out was performed in healthy controls and adult patients with cystic fibrosis (CF) using a circuit with an effective CO2 scrubber and a refined wash-in protocol...
January 2016: ERJ Open Research
Simon B Drysdale, Mireia Alcazar, Theresa Wilson, Melvyn Smith, Mark Zuckerman, Hennie M Hodemaekers, Riny Janssen, Louis Bont, Sebastian L Johnston, Anne Greenough
: Term born infants are predisposed to human rhinovirus (HRV) lower respiratory tract infections (LRTI) by reduced neonatal lung function and genetic susceptibility. Our aim was to investigate whether prematurely born infants were similarly predisposed to HRV LRTIs or any other viral LRTIs. Infants born less than 36 weeks of gestational age were recruited. Prior to neonatal/maternity unit discharge, lung function (functional residual capacity by helium gas dilution and multiple breath washout, lung clearance index and compliance (Crs), and resistance (Rrs) of the respiratory system) was assessed and DNA samples assessed for eight single nucleotide polymorphisms (SNPs) in seven genes: ADAM33, IL10, MMP16 NFκB1A,SFTPC, VDR, and NOS2A...
October 1, 2016: European Journal of Pediatrics
Michal Gur, Karin Yaacoby-Bianu, Anat Ilivitzki, Ronen Bar-Yoseph, Vered Nir, Fahed Hakim, Yazeed Toukan, Lea Bentur
INTRODUCTION: Bronchiolitis obliterans (BO) is a chronic airway disease following an insult to the lower respiratory tract. Lung clearance index (LCI) measures ventilation inhomogeneity and has been studied in cystic fibrosis (CF). We aimed to evaluate LCI in BO and to compare it to LCI in CF patients. METHODS: LCI was measured in BO patients, compared to CF patients, and correlated with spirometry and CT findings. RESULTS: Twenty BO patients and 26 CF patients (with similar mean age and BMI) underwent evaluation...
August 31, 2016: Lung
Mirjam Stahl, Mark O Wielpütz, Simon Y Graeber, Cornelia Joachim, Olaf Sommerburg, Hans-Ulrich Kauczor, Michael Puderbach, Monika Eichinger, Marcus A Mall
RATIONALE: Early onset and progression of lung disease in children with cystic fibrosis (CF) indicates that sensitive noninvasive outcome measures are needed for diagnostic monitoring and early intervention clinical trials. The lung clearance index (LCI) and chest magnetic resonance imaging (MRI) were shown to detect early lung disease in CF, however, the relationship between the two measures remains unknown. OBJECTIVES: To correlate the LCI with abnormalities detected by MRI and compare the sensitivity of the two techniques to detect responses to therapy for pulmonary exacerbations in children with CF...
August 30, 2016: American Journal of Respiratory and Critical Care Medicine
Diane M Gray, Lidija Turkovic, Lauren Willemse, Ane Visagie, Aneesa Vanker, Dan J Stein, Peter D Sly, Graham L Hall, Heather J Zar
Rationale Lower respiratory tract illness is a major cause of childhood morbidity and mortality. It is unknown whether infants are predisposed to illness due to impaired lung function or whether respiratory illness reduces lung function. We aimed to investigate the impact of early life exposures, including lower respiratory tract illness on lung function during infancy. Methods Infants enrolled in the Drakenstein child health study had lung function at six weeks and one year. Testing, during quiet natural sleep, included tidal breathing, exhaled nitric oxide and multiple breath washout measures...
August 10, 2016: American Journal of Respiratory and Critical Care Medicine
S Kjellberg, B K Houltz, O Zetterström, P D Robinson, Per M Gustafsson
Suboptimal asthma control is common despite modern asthma therapy. The degree of peripheral airway involvement remains unclear and poor medication delivery to these regions might be a contributing reason for this failure in obtaining adequate symptom control. A cohort of 196 adults (median (range) age 44 (18-61) years, 109 females, 54 ex-smokers, six current smokers) with physician-diagnosed asthma were recruited from primary care. Subjects were characterized clinically by interviews, questionnaires, skin prick tests (SPT) and blood eosinophil counts...
August 2016: Respiratory Medicine
Helene E Kobbernagel, Frederik F Buchvald, Eric G Haarman, Carmen Casaulta, Samuel A Collins, Claire Hogg, Claudia E Kuehni, Jane S Lucas, Heymut Omran, Alexandra L Quittner, Claudius Werner, Kim G Nielsen
BACKGROUND: Clinical management of primary ciliary dyskinesia (PCD) respiratory disease is currently based on improving mucociliary clearance and controlling respiratory infections, through the administration of antibiotics. Treatment practices in PCD are largely extrapolated from more common chronic respiratory disorders, particularly cystic fibrosis, but no randomized controlled trials (RCT) have ever evaluated efficacy and safety of any pharmacotherapeutics used in the treatment of PCD...
2016: BMC Pulmonary Medicine
Katherine O'Neill, Michael M Tunney, Elinor Johnston, Stephen Rowan, Damian G Downey, Jacqueline Rendall, Alastair Reid, Ian Bradbury, J Stuart Elborn, Judy M Bradley
BACKGROUND: Lung clearance index (LCI) has good clinimetric properties and an acceptable feasibility profile as a surrogate endpoint in Cystic Fibrosis (CF). Although most studies to date have been in children, increasing numbers of adults with CF also have normal spirometry. Further study of LCI as an endpoint in CF adults is required. Therefore, the purpose of this study was to determine the clinimetric properties of LCI over the complete age range of people with CF. METHODS: Clinically stable adults and children with CF and age matched healthy controls were recruited...
July 6, 2016: Chest
Zhengtu Li, Runfeng Li, Jing Li, Hui Xie, Yanbing Hao, Qiuling Du, Tingting Chen, Yimin Li, Rongchang Chen, Zifeng Yang, Nanshan Zhong
BACKGROUND: China-made Peramivir, an anti-influenza neuraminidase inhibitor drug, is manufactured and widely used in China. Although effective if initiated within 48 h of the onset of symptoms, yet we observed that this drug shows an inconclusive efficacy if treatment is delayed in clinical. Thus we evaluated the efficacy of delayed treatment of China-made Peramivir in a mouse model. METHODS: The mouse model of influenza infection was made and Peramivir was administered intravenously for 5 days following infection, and weight loss, lung index, viral shedding and survival rates were monitored...
2016: BMC Infectious Diseases
Barrett Downing, Samantha Irving, Yvonne Bingham, Louise Fleming, Andrew Bush, Sejal Saglani
Lung function testing in pre-school children in the clinical setting is challenging. Most cannot perform spirometry and many infant lung function tests require sedation. Lung clearance index (LCI) derived from the multiple-breath washout (MBW) test has been shown to be sensitive to early disease changes but may be time consuming and so a shortened test (LCI0.5) may be more feasible in young children. We sought to establish feasibility of MBW in unsedated pre-school children in a clinic setting and hypothesised use of LCI0...
July 7, 2016: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
Wei-Jie Guan, Jing-Jing Yuan, Yong-Hua Gao, Hui-Min Li, Jin-Ping Zheng, Rong-Chang Chen, Nan-Shan Zhong
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...
2016: Scientific Reports
Rebecca J Theilmann, Chantal Darquenne, Ann R Elliott, Barbara A Bailey, Douglas J Conrad
Translational investigations in cystic fibrosis (CF) have a need for improved quantitative and longitudinal measures of disease status. To establish a non-invasive quantitative MRI technique to monitor lung health in patients with CF and correlate MR metrics with airway physiology as measured by multiple breath washout (MBW). Data were collected in 12 CF patients and 12 healthy controls. Regional (central and peripheral lung) measures of fractional lung water density (FLD: air to 100% fluid) were acquired both at FRC and TLC on a 1...
2016: PloS One
Susanne I Fuchs, Nicolaus Schwerk, Klaus Pittschieler, Frank Ahrens, Winfried Baden, Robert Bals, Sebastian Fähndrich, Wolfgang Gleiber, Matthias Griese, Georg Hülskamp, Thomas Köhnlein, Ludmilla Reckling, Ernst Rietschel, Doris Staab, Monika Gappa
Patients with alpha-1-antitrypsin deficiency (AATD) and a PI-ZZ genotype are at high risk to develop severe emphysema during adulthood. However, little is known about early stages of emphysema and disease manifestation in other PI-types. Spirometry is commonly used for monitoring although early manifestation of emphysema is suspected within the peripheral airways that are not accessible by forced expiratory manoeuvres. We hypothesized that the Lung Clearance Index (LCI) derived from multiple breath nitrogen-washout (N2-washout) is useful to bridge this diagnostic gap...
July 2016: Respiratory Medicine
Aaron R Casha, Alexander Manché, Liberato Camilleri, Ruben Gatt, Krzysztof Dudek, Michael Pace-Bardon, Marilyn Gauci, Joseph N Grima
OBJECTIVE: A hypothesis is presented suggesting that the pathogenesis of apical lung disease is due to progression of subclinical congenital apical bullae in people with low Body Mass Index (BMI), a combination present in 15% of the population, due to high pleural stress levels present in the antero-posteriorly flattened chests of these individuals. DESIGN: The hypothesis was tested for validity in two apical lung pathologies with widespread epidemiological literature, namely tuberculosis (TB) and primary spontaneous pneumothorax (PSP), assessing whether the hypothesis could identify high-risk populations, explain exceptional cases like apical lower lobe disease and confirm predictions...
July 2016: Medical Hypotheses
Sylvia Nyilas, Florian Singer, Nitin Kumar, Sophie Yammine, Delphine Meier-Girard, Cordula Koerner-Rettberg, Carmen Casaulta, Urs Frey, Philipp Latzin
Inert tracer gas washout (IGW) measurements detect increased ventilation inhomogeneity (VI) in chronic lung diseases. Their suitability for different diseases, such as cystic fibrosis (CF) and primary ciliary dyskinesia (PCD), has already been shown. However, it is still unclear if physiological phenotypes based on different IGW variables can be defined independently of underlying disease. Eighty school-age children, 20 with CF, 20 with PCD, 20 former preterm children, and 20 healthy children, performed nitrogen multiple-breath washout, double-tracer gas (DTG) single-breath washout, and spirometry...
July 1, 2016: Journal of Applied Physiology
Steven Caskey, Aisling Gough, Stephen Rowan, Scott Gillespie, Jim Clarke, Marshall Riley, Jacqui Megarry, Paul Nicholls, Chris Patterson, Henry L Halliday, Michael D Shields, Lorcan McGarvey
RATIONALE: As more preterm infants recover from severe bronchopulmonary dysplasia (BPD), it is critical to understand the clinical consequences of this condition on the lung health of adult survivors. OBJECTIVES: To assess structural and functional lung parameters in young adult BPD survivors and preterm and term control subjects. METHODS: Young adult survivors of BPD (mean age, 24 yr) underwent spirometry, lung volume assessment, transfer factor, lung clearance index, and fractional exhaled nitric oxide measurements, together with high-resolution chest computed tomography and cardiopulmonary exercise testing...
August 2016: Annals of the American Thoracic Society
Barbara Egger, Kerstin Jost, Pinelopi Anagnostopoulou, Sophie Yammine, Florian Singer, Carmen Casaulta, Urs Frey, Philipp Latzin
BACKGROUND: Multiple-breath washout (MBW) is increasingly used for infant lung function testing. Current guidelines recommend calculating lung clearance index (LCI) and functional residual capacity (FRC) at 2.5% of normalized tracer gas concentration, without clear recommendation for moment ratios (MR). Whether the 2.5% cut-off has the highest discriminative power to detect ventilation inhomogeneity in infants with lung diseases is unknown. METHODS: We used sulfur-hexafluoride MBW measurements from 32 infants with cystic fibrosis, 32 preterm infants, and 32 healthy controls at postmenstrual age of 41-54 weeks...
May 23, 2016: Pediatric Pulmonology
Sarah Svenningsen, Parameswaran Nair, Fumin Guo, David G McCormack, Grace Parraga
In asthma patients, magnetic resonance imaging (MRI) and the lung clearance index (LCI) have revealed persistent ventilation heterogeneity, although its relationship to asthma control is not well understood. Therefore, our goal was to explore the relationship of MRI ventilation defects and the LCI with asthma control and quality of life in patients with severe, poorly controlled asthma.18 patients with severe, poorly controlled asthma (mean±sd 46±12 years, six males/12 females) provided written informed consent to an ethics board approved protocol, and underwent spirometry, LCI and (3)He MRI during a single 2-h visit...
August 2016: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
Sophie Yammine, Sylvia Nyilas, Carmen Casaulta, Susanne Schibli, Philipp Latzin, Christiane Sokollik
BACKGROUND: Extraintestinal manifestations are common among patients with inflammatory bowel disease (IBD), whereas pulmonary involvement is considered rare. However, chronic lung diseases begin with subclinical changes of the small airways and often originate in childhood. Pulmonary involvement, particularly of the small airways, can be assessed using novel inert gas washout tests. METHODS: In this prospective, single-center study, 30 children and adolescents (mean age, 14 years; SD, ±2...
August 2016: Inflammatory Bowel Diseases
Jeremy P Wrobel, Matthew J Ellis, Kirk Kee, Christopher R Stuart-Andrews, Bruce R Thompson
The effect of exercise on ventilation heterogeneity has not been investigated. We hypothesized that a maximal exercise bout would increase ventilation heterogeneity. We also hypothesized that increased ventilation heterogeneity would be associated with exercise-induced arterial hypoxemia (EIAH). Healthy trained adult males were prospectively assessed for ventilation heterogeneity using lung clearance index (LCI), Scond, and Sacinat baseline, postexercise and at recovery, using the multiple breath nitrogen washout technique...
April 2016: Physiological Reports
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