Martina Bonifazi1,2, Nicola Sverzellati3, Eva Negri4, Giovanni Pomponio5, Valeria Seletti3, Matteo Bonini6,7, Paolo Fraticelli5, Luca Paolini2, Massimo Mattioli5, Matteo Franchi8, Irene Tramacere9, Venerino Poletti10,11, Carlo La Vecchia12, Stefano Gasparini1,2, Armando Gabrielli5. 1. Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, Italy. 2. Unità Operativa di Pneumologia, Azienda Ospedaliero Universitaria "Ospedali Riuniti" - Ancona, Ancona, Italy. 3. Dipartimento di Medicina e Chirurgia, Università di Parma, Radiologia, Italy. 4. Dipartimento di Scienze Biomediche e Cliniche, "Luigi Sacco", Università degli Studi di Milano, Milano, Italy. 5. Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy. 6. National Heart and Lung Institute (NHLI), Imperial College London, London, UK. 7. Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy. 8. Dipartimento di Statistica e Metodi Quantitativi, Divisione di Biostatistica, Epidemiologia e Salute Pubblica, Università di Milano-Bicocca, Milano, Italy. 9. Dipartimento Gestionale di Ricerca e Sviluppo Clinico, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy. 10. Dipartimento Toracico, Ospedale GB Morgagni, Forlì, Italy. 11. Department of Respiratory Diseases and Allergology, Aarhus University Hospital, Aarhus, Denmark. 12. Dipartimento di Scienze Cliniche e Salute Pubblica, Università degli Studi di Milano, Milano, Italy.
Abstract
OBJECTIVES: The prevalence and clinical implications of small airways involvement in SSc are still to be fully elucidated. The goal of the present work is to assess the prevalence of small airways dysfunction by impulse oscillometry and to determine whether it correlates with selected disease-related features and respiratory-related quality of life. METHODS: Ninety-four SSc patients and 93 healthy controls were studied by impulse oscillometry measurements. Small airways dysfunction was defined as the difference between resistance at low frequency, i.e. 5 Hz, and resistance at high frequency, i.e. 20 Hz, termed 'R5-R20', ⩾0.07 kPa/l/s. The St George's Respiratory Questionnaire was used to measure health impairment in SSc patients. Radiological features of small airways disease and parenchymal abnormalities on high resolution CT chest scans were jointly assessed by two thoracic radiologists. RESULTS: Small airways dysfunction was present in 21.5% of the SSc patient cohort, with a prevalence almost 5-fold higher compared with controls, and it was significantly associated with worse respiratory-related quality of life. Radiological features consistent with small airways abnormalities were detected in 25% of SSc patients, mostly in the absence of interstitial lung changes. Combining functional and radiological evaluations, one-third of the SSc cohort showed at least one feature of small airways involvement, which was associated with the lcSSc phenotype and with longer disease duration. CONCLUSION: The current study strengthens the hypothesis that small airway dysfunction might be a feature of SSc-related lung involvement, providing the first data on its significant impact on respiratory-related quality of life. A full assessment of lung function in SSc patients should include impulse oscillometry as a complementary technique, due to potential clinical and therapeutic implications.
OBJECTIVES: The prevalence and clinical implications of small airways involvement in SSc are still to be fully elucidated. The goal of the present work is to assess the prevalence of small airways dysfunction by impulse oscillometry and to determine whether it correlates with selected disease-related features and respiratory-related quality of life. METHODS: Ninety-four SSc patients and 93 healthy controls were studied by impulse oscillometry measurements. Small airways dysfunction was defined as the difference between resistance at low frequency, i.e. 5 Hz, and resistance at high frequency, i.e. 20 Hz, termed 'R5-R20', ⩾0.07 kPa/l/s. The St George's Respiratory Questionnaire was used to measure health impairment in SSc patients. Radiological features of small airways disease and parenchymal abnormalities on high resolution CT chest scans were jointly assessed by two thoracic radiologists. RESULTS: Small airways dysfunction was present in 21.5% of the SSc patient cohort, with a prevalence almost 5-fold higher compared with controls, and it was significantly associated with worse respiratory-related quality of life. Radiological features consistent with small airways abnormalities were detected in 25% of SSc patients, mostly in the absence of interstitial lung changes. Combining functional and radiological evaluations, one-third of the SSc cohort showed at least one feature of small airways involvement, which was associated with the lcSSc phenotype and with longer disease duration. CONCLUSION: The current study strengthens the hypothesis that small airway dysfunction might be a feature of SSc-related lung involvement, providing the first data on its significant impact on respiratory-related quality of life. A full assessment of lung function in SSc patients should include impulse oscillometry as a complementary technique, due to potential clinical and therapeutic implications.
Authors: Xiaolin Liang; Jinping Zheng; Yi Gao; Zhe Zhang; Wen Han; Jing Du; Yong Lu; Li Chen; Tao Wang; Jinming Liu; Gang Huang; Bingrong Zhao; Guihua Zhao; Xuhua Zhang; Yi Peng; Xin Chen; Ning Zhou Journal: ERJ Open Res Date: 2022-10-17