Abstract:
BACKGROUND:Current functional assessments do not allow a reliable assessment of small airways, which are a major site of disease in COPD. Single-breath washout (SBW) tests are feasible and reproducible methods for evaluating small airway disease. Their relevance in COPD remains unknown. METHODS:We performed a cross-sectional study in 65 patients with moderate to severe COPD. Phase III slope of nitrogen (SIIIN2) and double tracer gas (SIIIDTG) SBW tests were used as a measure of ventilation inhomogeneity. The association of both markers with established physiological and clinical features of COPD was assessed. RESULTS:Ventilation inhomogeneity as measured by SIIIN2 and SIIIDTG was increased in patients with COPD compared with healthy subjects (P < .001 and P < .001, respectively). SIIIN2 was associated with FEV1 predicted, residual volume (RV)/total lung capacity (TLC) and diffusing capacity of the lung for carbon monoxide (Dlco) (all P < .001). Furthermore, SIIIN2 was related to dyspnea, exercise-induced desaturation, and exercise capacity (P = .001, P < .001, and P = .047, respectively). SIIIDTG was associated with TLC, Dlco, and cough (P < .001, P = .001, and P = .009, respectively). In multivariate regression models, we demonstrated that these associations are largely independent of FEV1 and mostly stronger than associations with FEV1. In contrast, FEV1 was superior in predicting emphysema severity. CONCLUSIONS:SIIIN2 and SIIIDTG, two fast and clinically applicable measures of small airway disease, reflect different physiological and clinical aspects of COPD, largely independent of spirometry. TRIAL REGISTRY:ISRCTN99586989, Ethics committee Beider Basel (approval number 295/07).
journal_name
Chestjournal_title
Chestauthors
Boeck L,Gensmer A,Nyilas S,Stieltjes B,Re TJ,Tamm M,Latzin P,Stolz Ddoi
10.1016/j.chest.2016.05.019subject
Has Abstractpub_date
2016-11-01 00:00:00pages
1091-1100issue
5eissn
0012-3692issn
1931-3543pii
S0012-3692(16)49106-3journal_volume
150pub_type
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