Multiple Breath Washout Outcome Measures in Adults with Bronchiectasis

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

doi:10.1513/AnnalsATS.202006-584OC

Multiple Breath Washout Outcome Measures in Adults with Bronchiectasis

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

Research output: Contribution to journal › Article › peer-review

5 Citations (Scopus)

Abstract

Rationale: Lung clearance index (LCI) has good intravisit repeatability with better sensitivity in detecting lung disease on computed tomography scan compared with forced expiratory volume in 1 second (FEV ₁) in adults with bronchiectasis. Alternative multiple-breath washout parameters have not been systematically studied in bronchiectasis. Objectives: To determine the validity, repeatability, sensitivity, specificity, and feasibility of standard LCI (LCI ^2.5), shortened LCI (LCI ^5.0), ventilation heterogeneity arising within proximal conducting airways (S _condVT), and ventilation heterogeneity arising within the acinar airways (S _acinVT) in a cross-sectional observational cohort of adults with bronchiectasis. Methods: Cross-sectional multiple-breath nitrogen washout data (Exhalyzer D; Eco Medics AG) from 132 patients with bronchiectasis across five United Kingdom centers (BronchUK Clinimetrics study) and 88 healthy control subjects were analyzed. Results: Within-test repeatability (mean coefficient of variation) was,5% for both LCI ^2.5 and LCI ^5.0 in patients with bronchiectasis, and there was no difference in mean coefficient of variation for LCI ^2.5 and LCI ^5.0 in patients with bronchiectasis compared with healthy volunteers. Moderate-strength correlations were seen between FEV ₁ and LCI ^2.5 (r = 20.54), LCI ^5.0 (r = 20.53), S _condVT (r = 20.35), and S _acinVT (r = 20.38) z-scores. The proportion of subjects with abnormal multiple-breath washout (z-score . 2) but in normal FEV ₁ (z-score, 22) was 42% (LCI ^2.5) and 36% (LCI ^5.0). Overall results from the receiver operating characteristic curve analysis indicated that LCI ^2.5 had the greatest combined sensitivity and specificity to discriminate between bronchiectasis and control subjects, followed by LCI ^5.0, FEV ₁, and S _condVT z-scores. There was a 57% time saving with LCI ^5.0. Conclusions: LCI ^2.5 and LCI ^5.0 had good within-test repeatability and superior sensitivity compared with spirometry measures in differentiating between health and bronchiectasis disease. LCI ^5.0 is quicker and more feasible than LCI ^2.5

Original language	English
Pages (from-to)	1489-1497
Number of pages	9
Journal	Annals of the American Thoracic Society
Volume	19
Issue number	9
Early online date	22 Apr 2022
DOIs	https://doi.org/10.1513/AnnalsATS.202006-584OC
Publication status	Published - Sept 2022

Keywords

bronchiectasis
lung function
multiple breath washout

ASJC Scopus subject areas

Pulmonary and Respiratory Medicine

Access to Document

10.1513/AnnalsATS.202006-584OC

Cite this

O'Neill, K., Lakshmipathy, G. R., Neely, C., Cosgrove, D., Ferguson, K., McLeese, R., Hill, A. T., Loebinger, M. R., Carroll, M., Chalmers, J. D., Gatheral, T., Johnson, C., De Soyza, A., Hurst, J. R., Bradbury, I., Elborn, J. S., & Bradley, J. M. (2022). Multiple Breath Washout Outcome Measures in Adults with Bronchiectasis. Annals of the American Thoracic Society, 19(9), 1489-1497. https://doi.org/10.1513/AnnalsATS.202006-584OC

@article{8b64a4ab0ea544218b6c64105b334f1d,

title = "Multiple Breath Washout Outcome Measures in Adults with Bronchiectasis",

abstract = "Rationale: Lung clearance index (LCI) has good intravisit repeatability with better sensitivity in detecting lung disease on computed tomography scan compared with forced expiratory volume in 1 second (FEV 1) in adults with bronchiectasis. Alternative multiple-breath washout parameters have not been systematically studied in bronchiectasis. Objectives: To determine the validity, repeatability, sensitivity, specificity, and feasibility of standard LCI (LCI 2.5), shortened LCI (LCI 5.0), ventilation heterogeneity arising within proximal conducting airways (S condVT), and ventilation heterogeneity arising within the acinar airways (S acinVT) in a cross-sectional observational cohort of adults with bronchiectasis. Methods: Cross-sectional multiple-breath nitrogen washout data (Exhalyzer D; Eco Medics AG) from 132 patients with bronchiectasis across five United Kingdom centers (BronchUK Clinimetrics study) and 88 healthy control subjects were analyzed. Results: Within-test repeatability (mean coefficient of variation) was,5% for both LCI 2.5 and LCI 5.0 in patients with bronchiectasis, and there was no difference in mean coefficient of variation for LCI 2.5 and LCI 5.0 in patients with bronchiectasis compared with healthy volunteers. Moderate-strength correlations were seen between FEV 1 and LCI 2.5 (r = 20.54), LCI 5.0 (r = 20.53), S condVT (r = 20.35), and S acinVT (r = 20.38) z-scores. The proportion of subjects with abnormal multiple-breath washout (z-score . 2) but in normal FEV 1 (z-score, 22) was 42% (LCI 2.5) and 36% (LCI 5.0). Overall results from the receiver operating characteristic curve analysis indicated that LCI 2.5 had the greatest combined sensitivity and specificity to discriminate between bronchiectasis and control subjects, followed by LCI 5.0, FEV 1, and S condVT z-scores. There was a 57% time saving with LCI 5.0. Conclusions: LCI 2.5 and LCI 5.0 had good within-test repeatability and superior sensitivity compared with spirometry measures in differentiating between health and bronchiectasis disease. LCI 5.0 is quicker and more feasible than LCI 2.5",

keywords = "bronchiectasis, lung function, multiple breath washout",

author = "Katherine O'Neill and Lakshmipathy, {Gokul R.} and Curtis Neely and Denise Cosgrove and Kathryn Ferguson and Rebecca McLeese and Hill, {Adam T.} and Loebinger, {Michael R.} and Mary Carroll and Chalmers, {James D.} and Timothy Gatheral and Chris Johnson and {De Soyza}, Anthony and Hurst, {John R.} and Ian Bradbury and Elborn, {Joseph S.} and Bradley, {Judy M.}",

note = "Funding Information: Supported by Medical Research Council funding grant MR/L011263/1 for the BronchUK Collaborative. The wider collaborative includes multiple sites across the United Kingdom, and we acknowledge the input to the consortium and primary grant from the collaborators (www.bronch.ac.uk). We acknowledge the support received from European Union/European Federation of Pharmaceutical Industries and Associations Innovative Medicines Initiative Joint Undertaking iABC grant 115721, which provided some of the multiple-breath washout equipment. Publisher Copyright: Copyright {\textcopyright} 2022 by the American Thoracic Society.",

year = "2022",

month = sep,

doi = "10.1513/AnnalsATS.202006-584OC",

language = "English",

volume = "19",

pages = "1489--1497",

journal = "Annals of the American Thoracic Society",

issn = "2325-6621",

publisher = "American Thoracic Society",

number = "9",

}

O'Neill, K, Lakshmipathy, GR, Neely, C, Cosgrove, D, Ferguson, K, McLeese, R, Hill, AT, Loebinger, MR, Carroll, M, Chalmers, JD, Gatheral, T, Johnson, C, De Soyza, A, Hurst, JR, Bradbury, I, Elborn, JS & Bradley, JM 2022, 'Multiple Breath Washout Outcome Measures in Adults with Bronchiectasis', Annals of the American Thoracic Society, vol. 19, no. 9, pp. 1489-1497. https://doi.org/10.1513/AnnalsATS.202006-584OC

TY - JOUR

T1 - Multiple Breath Washout Outcome Measures in Adults with Bronchiectasis

AU - O'Neill, Katherine

AU - Lakshmipathy, Gokul R.

AU - Neely, Curtis

AU - Cosgrove, Denise

AU - Ferguson, Kathryn

AU - McLeese, Rebecca

AU - Hill, Adam T.

AU - Loebinger, Michael R.

AU - Carroll, Mary

AU - Chalmers, James D.

AU - Gatheral, Timothy

AU - Johnson, Chris

AU - De Soyza, Anthony

AU - Hurst, John R.

AU - Bradbury, Ian

AU - Elborn, Joseph S.

AU - Bradley, Judy M.

N1 - Funding Information: Supported by Medical Research Council funding grant MR/L011263/1 for the BronchUK Collaborative. The wider collaborative includes multiple sites across the United Kingdom, and we acknowledge the input to the consortium and primary grant from the collaborators (www.bronch.ac.uk). We acknowledge the support received from European Union/European Federation of Pharmaceutical Industries and Associations Innovative Medicines Initiative Joint Undertaking iABC grant 115721, which provided some of the multiple-breath washout equipment. Publisher Copyright: Copyright © 2022 by the American Thoracic Society.

PY - 2022/9

Y1 - 2022/9

N2 - Rationale: Lung clearance index (LCI) has good intravisit repeatability with better sensitivity in detecting lung disease on computed tomography scan compared with forced expiratory volume in 1 second (FEV 1) in adults with bronchiectasis. Alternative multiple-breath washout parameters have not been systematically studied in bronchiectasis. Objectives: To determine the validity, repeatability, sensitivity, specificity, and feasibility of standard LCI (LCI 2.5), shortened LCI (LCI 5.0), ventilation heterogeneity arising within proximal conducting airways (S condVT), and ventilation heterogeneity arising within the acinar airways (S acinVT) in a cross-sectional observational cohort of adults with bronchiectasis. Methods: Cross-sectional multiple-breath nitrogen washout data (Exhalyzer D; Eco Medics AG) from 132 patients with bronchiectasis across five United Kingdom centers (BronchUK Clinimetrics study) and 88 healthy control subjects were analyzed. Results: Within-test repeatability (mean coefficient of variation) was,5% for both LCI 2.5 and LCI 5.0 in patients with bronchiectasis, and there was no difference in mean coefficient of variation for LCI 2.5 and LCI 5.0 in patients with bronchiectasis compared with healthy volunteers. Moderate-strength correlations were seen between FEV 1 and LCI 2.5 (r = 20.54), LCI 5.0 (r = 20.53), S condVT (r = 20.35), and S acinVT (r = 20.38) z-scores. The proportion of subjects with abnormal multiple-breath washout (z-score . 2) but in normal FEV 1 (z-score, 22) was 42% (LCI 2.5) and 36% (LCI 5.0). Overall results from the receiver operating characteristic curve analysis indicated that LCI 2.5 had the greatest combined sensitivity and specificity to discriminate between bronchiectasis and control subjects, followed by LCI 5.0, FEV 1, and S condVT z-scores. There was a 57% time saving with LCI 5.0. Conclusions: LCI 2.5 and LCI 5.0 had good within-test repeatability and superior sensitivity compared with spirometry measures in differentiating between health and bronchiectasis disease. LCI 5.0 is quicker and more feasible than LCI 2.5

AB - Rationale: Lung clearance index (LCI) has good intravisit repeatability with better sensitivity in detecting lung disease on computed tomography scan compared with forced expiratory volume in 1 second (FEV 1) in adults with bronchiectasis. Alternative multiple-breath washout parameters have not been systematically studied in bronchiectasis. Objectives: To determine the validity, repeatability, sensitivity, specificity, and feasibility of standard LCI (LCI 2.5), shortened LCI (LCI 5.0), ventilation heterogeneity arising within proximal conducting airways (S condVT), and ventilation heterogeneity arising within the acinar airways (S acinVT) in a cross-sectional observational cohort of adults with bronchiectasis. Methods: Cross-sectional multiple-breath nitrogen washout data (Exhalyzer D; Eco Medics AG) from 132 patients with bronchiectasis across five United Kingdom centers (BronchUK Clinimetrics study) and 88 healthy control subjects were analyzed. Results: Within-test repeatability (mean coefficient of variation) was,5% for both LCI 2.5 and LCI 5.0 in patients with bronchiectasis, and there was no difference in mean coefficient of variation for LCI 2.5 and LCI 5.0 in patients with bronchiectasis compared with healthy volunteers. Moderate-strength correlations were seen between FEV 1 and LCI 2.5 (r = 20.54), LCI 5.0 (r = 20.53), S condVT (r = 20.35), and S acinVT (r = 20.38) z-scores. The proportion of subjects with abnormal multiple-breath washout (z-score . 2) but in normal FEV 1 (z-score, 22) was 42% (LCI 2.5) and 36% (LCI 5.0). Overall results from the receiver operating characteristic curve analysis indicated that LCI 2.5 had the greatest combined sensitivity and specificity to discriminate between bronchiectasis and control subjects, followed by LCI 5.0, FEV 1, and S condVT z-scores. There was a 57% time saving with LCI 5.0. Conclusions: LCI 2.5 and LCI 5.0 had good within-test repeatability and superior sensitivity compared with spirometry measures in differentiating between health and bronchiectasis disease. LCI 5.0 is quicker and more feasible than LCI 2.5

KW - bronchiectasis

KW - lung function

KW - multiple breath washout

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U2 - 10.1513/AnnalsATS.202006-584OC

DO - 10.1513/AnnalsATS.202006-584OC

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SN - 2325-6621

VL - 19

SP - 1489

EP - 1497

JO - Annals of the American Thoracic Society

JF - Annals of the American Thoracic Society

IS - 9

ER -

Multiple Breath Washout Outcome Measures in Adults with Bronchiectasis

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Keywords

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Inhaled Antibiotics in Bronchiectasis and Cystic Fibrosis (iABC) (Joint with 19 Partners)

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Multiple Breath Washout Outcome Measures in Adults with Bronchiectasis

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ASJC Scopus subject areas

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Inhaled Antibiotics in Bronchiectasis and Cystic Fibrosis (iABC) (Joint with 19 Partners)

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