Dejan Radovanovic1, Pierachille Santus2, Francesco Blasi3, Giovanni Sotgiu4, Francesca D'Arcangelo5, Edoardo Simonetta6, Martina Contarini7, Elisa Franceschi8, Pieter C Goeminne9, James D Chalmers10, Stefano Aliberti11. 1. Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenfratelli-Sacco, Milan, Italy. Electronic address: danko86@hotmail.com. 2. Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenfratelli-Sacco, Milan, Italy. Electronic address: pierachille.santus@unimi.it. 3. Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy. Electronic address: francesco.blasi@unimi.it. 4. Clinical Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari, Sassari, Italy. Electronic address: gsotgiu@uniss.it. 5. School of Medicine, University of Milan Bicocca, Respiratory Unit, AO San Gerardo, Monza, Italy. Electronic address: francescadarcangelo@yahoo.it. 6. School of Medicine, University of Milan Bicocca, Respiratory Unit, AO San Gerardo, Monza, Italy. Electronic address: edo.simonetta@gmail.com. 7. Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy. Electronic address: martina.contarini@unimi.it. 8. Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy. Electronic address: elisa.franceschi.93@gmail.com. 9. Department of Respiratory Disease, AZ Nikolaas, Sint-Niklaas, Belgium; Department of Respiratory Disease, UZ Leuven, Leuven, Belgium. Electronic address: pieter.goeminne@aznikolaas.be. 10. Scottish Centre for Respiratory Research, University of Dundee, Dundee, DD1 9SY, UK. Electronic address: j.chalmers@dundee.ac.uk. 11. Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy; School of Medicine, University of Milan Bicocca, Respiratory Unit, AO San Gerardo, Monza, Italy. Electronic address: stefano.aliberti@unimi.it.
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 (DLCO) 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: ΔFEV1 ≥12% and 200 mL from baseline (FEV1rev) and ΔRV ≥10% reduction from baseline (RVrev). 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 DLCO (55.7%), airflow obstruction (41.1%), hyperinflation (15.7%) and restriction (8.0%). 9.7% of patients had normal lung function. RVrev (17.6%) was more frequent than FEV1rev (4.3%). Similar proportions were found after multiple sensitivity analyses. Compared with non-reversible patients, patients with RVrev had more severe obstruction (mean(SD) FEV1%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. RVrev is related to worse lung function and might be considered in bronchiectasis' workup and for patients' functional stratification.
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 (DLCO) 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: ΔFEV1 ≥12% and 200 mL from baseline (FEV1rev) and ΔRV ≥10% reduction from baseline (RVrev). 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 DLCO (55.7%), airflow obstruction (41.1%), hyperinflation (15.7%) and restriction (8.0%). 9.7% of patients had normal lung function. RVrev (17.6%) was more frequent than FEV1rev (4.3%). Similar proportions were found after multiple sensitivity analyses. Compared with non-reversible patients, patients with RVrev had more severe obstruction (mean(SD) FEV1%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. RVrev is related to worse lung function and might be considered in bronchiectasis' workup and for patients' functional stratification.
Authors: Katherine O'Neill; Gokul R Lakshmipathy; Curtis Neely; Denise Cosgrove; Kathryn Ferguson; Rebecca McLeese; Adam T Hill; Michael R Loebinger; Mary Carroll; James D Chalmers; Timothy Gatheral; Chris Johnson; Anthony De Soyza; John R Hurst; Ian Bradbury; Joseph S Elborn; Judy M Bradley Journal: Ann Am Thorac Soc Date: 2022-09
Authors: Sotirios Kakavas; Ourania S Kotsiou; Fotis Perlikos; Maria Mermiri; Georgios Mavrovounis; Konstantinos Gourgoulianis; Ioannis Pantazopoulos Journal: NPJ Prim Care Respir Med Date: 2021-05-07 Impact factor: 2.871
Authors: Maria Cecília Nieves Maiorano de Nucci; Frederico Leon Arrabal Fernandes; João Marcos Salge; Rafael Stelmach; Alberto Cukier; Rodrigo Athanazio Journal: J Bras Pneumol Date: 2020-06-15 Impact factor: 2.624
Authors: Letizia Traversi; Marc Miravitlles; Miguel Angel Martinez-Garcia; Michal Shteinberg; Apostolos Bossios; Katerina Dimakou; Joseph Jacob; John R Hurst; Pier Luigi Paggiaro; Sebastian Ferri; Georgios Hillas; Jens Vogel-Claussen; Sabine Dettmer; Stefano Aliberti; James D Chalmers; Eva Polverino Journal: ERJ Open Res Date: 2021-11-22