A comprehensive approach to lung function in bronchiectasis

Dejan Radovanovic, Pierachille Santus, Francesco Blasi, Giovanni Sotgiu, Francesca D'Arcangelo, Edoardo Simonetta, Martina Contarini, Elisa Franceschi, Pieter C. Goeminne, James D. Chalmers, Stefano Aliberti (Lead / Corresponding author)

Research output: Contribution to journalArticle

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.

LanguageEnglish
Pages120-129
Number of pages10
JournalRespiratory Medicine
Volume145
Early online date2 Nov 2018
DOIs
Publication statusPublished - Dec 2018

Fingerprint

Bronchiectasis
Lung
Air
Residual Volume
Spirometry
Lung Volume Measurements
Total Lung Capacity
Plethysmography
Chronic Obstructive Pulmonary Disease
Observational Studies
Asthma
Prospective Studies
Guidelines

Keywords

  • Bronchiectasis
  • Exacerbation
  • Plethysmography
  • Residual volume
  • Reversibility
  • Spirometry

Cite this

Radovanovic, D., Santus, P., Blasi, F., Sotgiu, G., D'Arcangelo, F., Simonetta, E., ... Aliberti, S. (2018). A comprehensive approach to lung function in bronchiectasis. Respiratory Medicine, 145, 120-129. https://doi.org/10.1016/j.rmed.2018.10.031
Radovanovic, Dejan ; Santus, Pierachille ; Blasi, Francesco ; Sotgiu, Giovanni ; D'Arcangelo, Francesca ; Simonetta, Edoardo ; Contarini, Martina ; Franceschi, Elisa ; Goeminne, Pieter C. ; Chalmers, James D. ; Aliberti, Stefano. / A comprehensive approach to lung function in bronchiectasis. In: Respiratory Medicine. 2018 ; Vol. 145. pp. 120-129.
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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.",
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author = "Dejan Radovanovic and Pierachille Santus and Francesco Blasi and Giovanni Sotgiu and Francesca D'Arcangelo and Edoardo Simonetta and Martina Contarini and Elisa Franceschi and Goeminne, {Pieter C.} and Chalmers, {James D.} and Stefano Aliberti",
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Radovanovic, D, Santus, P, Blasi, F, Sotgiu, G, D'Arcangelo, F, Simonetta, E, Contarini, M, Franceschi, E, Goeminne, PC, Chalmers, JD & Aliberti, S 2018, 'A comprehensive approach to lung function in bronchiectasis' Respiratory Medicine, vol. 145, pp. 120-129. https://doi.org/10.1016/j.rmed.2018.10.031

A comprehensive approach to lung function in bronchiectasis. / Radovanovic, Dejan; Santus, Pierachille; Blasi, Francesco; Sotgiu, Giovanni; D'Arcangelo, Francesca; Simonetta, Edoardo; Contarini, Martina; Franceschi, Elisa; Goeminne, Pieter C.; Chalmers, James D.; Aliberti, Stefano (Lead / Corresponding author).

In: Respiratory Medicine, Vol. 145, 12.2018, p. 120-129.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A comprehensive approach to lung function in bronchiectasis

AU - Radovanovic, Dejan

AU - Santus, Pierachille

AU - Blasi, Francesco

AU - Sotgiu, Giovanni

AU - D'Arcangelo, Francesca

AU - Simonetta, Edoardo

AU - Contarini, Martina

AU - Franceschi, Elisa

AU - Goeminne, Pieter C.

AU - Chalmers, James D.

AU - Aliberti, Stefano

PY - 2018/12

Y1 - 2018/12

N2 - 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.

AB - 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.

KW - Bronchiectasis

KW - Exacerbation

KW - Plethysmography

KW - Residual volume

KW - Reversibility

KW - Spirometry

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Radovanovic D, Santus P, Blasi F, Sotgiu G, D'Arcangelo F, Simonetta E et al. A comprehensive approach to lung function in bronchiectasis. Respiratory Medicine. 2018 Dec;145:120-129. https://doi.org/10.1016/j.rmed.2018.10.031