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Significances of spirometry and impulse oscillometry for detecting small airway disorders assessed with endobronchial optical coherence tomography in COPD.
Int J Chron Obstruct Pulmon Dis 2018; 13:3031-3044IJ

Abstract

Background

Spirometry confers limited value for identifying small-airway disorders (SADs) in early-stage COPD, which can be detected with impulse oscillometry (IOS) and endobronchial optical coherence tomography (EB-OCT). Whether IOS is useful for reflecting small-airway morphological abnormalities in COPD remains unclear.

Objectives

To compare the diagnostic value of spirometry and IOS for identifying SADs in heavy-smokers and COPD based on the objective assessment with EB-OCT.

Methods

We recruited 59 COPD patients (stage I, n=17; stage II, n=18; stage III-IV, n=24), 26 heavy-smokers and 21 never-smokers. Assessments of clinical characteristics, spirometry, IOS and EB-OCT were performed. Receiver operation characteristic curve was employed to demonstrate the diagnostic value of IOS and spirometric parameters.

Results

More advanced staging of COPD was associated with greater abnormality of IOS and spirometric parameters. Resonant frequency (Fres) and peripheral airway resistance (R5-R20) conferred greater diagnostic values than forced expiratory volume in one second (FEV1%) and maximal (mid-)expiratory flow (MMEF%) predicted in discriminating SADs in never-smokers from heavy-smokers (area under curve [AUC]: 0.771 and 0.753 vs 0.570 and 0.558, respectively), and heavy-smokers from patients with stage I COPD (AUC: 0.726 and 0.633 vs 0.548 and 0.567, respectively). The combination of IOS (Fres and R5-R20) and spirometric parameters (FEV1% and MMEF% predicted) contributed to a further increase in the diagnostic value for identifying SADs in early-stage COPD. Small airway wall area percentage (Aw% 7-9), an EB-OCT parameter, correlated significantly with Fres and R5-R20 in COPD and heavy-smokers, whereas EB-OCT parameters correlated with FEV1% and MMEF% in advanced, rather than early-stage, COPD.

Conclusions

IOS parameters correlated with the degree of morphologic abnormalities of small airways assessed with EB-OCT in COPD and heavy-smokers. Fres and R5-R20 might be sensitive parameters that reliably reflect SADs in heavy-smokers and early-stage COPD.

Authors+Show Affiliations

State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China, nanshan@vip.163.com.State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China, nanshan@vip.163.com.State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China, nanshan@vip.163.com.Department of Respiratory Medicine, The Affiliated Zhongda Hospital of Southeast University, Medical School of Southeast University, Nanjing, People's Republic of China.State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China, nanshan@vip.163.com.State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China, nanshan@vip.163.com.State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China, nanshan@vip.163.com.State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China, nanshan@vip.163.com.State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China, nanshan@vip.163.com.State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China, nanshan@vip.163.com.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

30319251

Citation

Su, Zhu-Quan, et al. "Significances of Spirometry and Impulse Oscillometry for Detecting Small Airway Disorders Assessed With Endobronchial Optical Coherence Tomography in COPD." International Journal of Chronic Obstructive Pulmonary Disease, vol. 13, 2018, pp. 3031-3044.
Su ZQ, Guan WJ, Li SY, et al. Significances of spirometry and impulse oscillometry for detecting small airway disorders assessed with endobronchial optical coherence tomography in COPD. Int J Chron Obstruct Pulmon Dis. 2018;13:3031-3044.
Su, Z. Q., Guan, W. J., Li, S. Y., Ding, M., Chen, Y., Jiang, M., ... Zhong, N. S. (2018). Significances of spirometry and impulse oscillometry for detecting small airway disorders assessed with endobronchial optical coherence tomography in COPD. International Journal of Chronic Obstructive Pulmonary Disease, 13, pp. 3031-3044. doi:10.2147/COPD.S172639.
Su ZQ, et al. Significances of Spirometry and Impulse Oscillometry for Detecting Small Airway Disorders Assessed With Endobronchial Optical Coherence Tomography in COPD. Int J Chron Obstruct Pulmon Dis. 2018;13:3031-3044. PubMed PMID: 30319251.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Significances of spirometry and impulse oscillometry for detecting small airway disorders assessed with endobronchial optical coherence tomography in COPD. AU - Su,Zhu-Quan, AU - Guan,Wei-Jie, AU - Li,Shi-Yue, AU - Ding,Ming, AU - Chen,Yu, AU - Jiang,Mei, AU - Chen,Xiao-Bo, AU - Zhong,Chang-Hao, AU - Tang,Chun-Li, AU - Zhong,Nan-Shan, Y1 - 2018/10/01/ PY - 2018/10/16/entrez PY - 2018/10/16/pubmed PY - 2019/3/9/medline KW - chronic obstructive pulmonary disease KW - diagnostic value KW - impulse oscillometry KW - optical coherence tomography KW - small airway disorder SP - 3031 EP - 3044 JF - International journal of chronic obstructive pulmonary disease JO - Int J Chron Obstruct Pulmon Dis VL - 13 N2 - Background: Spirometry confers limited value for identifying small-airway disorders (SADs) in early-stage COPD, which can be detected with impulse oscillometry (IOS) and endobronchial optical coherence tomography (EB-OCT). Whether IOS is useful for reflecting small-airway morphological abnormalities in COPD remains unclear. Objectives: To compare the diagnostic value of spirometry and IOS for identifying SADs in heavy-smokers and COPD based on the objective assessment with EB-OCT. Methods: We recruited 59 COPD patients (stage I, n=17; stage II, n=18; stage III-IV, n=24), 26 heavy-smokers and 21 never-smokers. Assessments of clinical characteristics, spirometry, IOS and EB-OCT were performed. Receiver operation characteristic curve was employed to demonstrate the diagnostic value of IOS and spirometric parameters. Results: More advanced staging of COPD was associated with greater abnormality of IOS and spirometric parameters. Resonant frequency (Fres) and peripheral airway resistance (R5-R20) conferred greater diagnostic values than forced expiratory volume in one second (FEV1%) and maximal (mid-)expiratory flow (MMEF%) predicted in discriminating SADs in never-smokers from heavy-smokers (area under curve [AUC]: 0.771 and 0.753 vs 0.570 and 0.558, respectively), and heavy-smokers from patients with stage I COPD (AUC: 0.726 and 0.633 vs 0.548 and 0.567, respectively). The combination of IOS (Fres and R5-R20) and spirometric parameters (FEV1% and MMEF% predicted) contributed to a further increase in the diagnostic value for identifying SADs in early-stage COPD. Small airway wall area percentage (Aw% 7-9), an EB-OCT parameter, correlated significantly with Fres and R5-R20 in COPD and heavy-smokers, whereas EB-OCT parameters correlated with FEV1% and MMEF% in advanced, rather than early-stage, COPD. Conclusions: IOS parameters correlated with the degree of morphologic abnormalities of small airways assessed with EB-OCT in COPD and heavy-smokers. Fres and R5-R20 might be sensitive parameters that reliably reflect SADs in heavy-smokers and early-stage COPD. SN - 1178-2005 UR - https://www.unboundmedicine.com/medline/citation/30319251/Significances_of_spirometry_and_impulse_oscillometry_for_detecting_small_airway_disorders_assessed_with_endobronchial_optical_coherence_tomography_in_COPD_ L2 - https://dx.doi.org/10.2147/COPD.S172639 DB - PRIME DP - Unbound Medicine ER -