Preview

Bulletin Physiology and Pathology of Respiration

Advanced search

Methods for diagnosing dysfunction of small airways and uniformity of lung ventilation: their use after a novel coronavirus infection

https://doi.org/10.36604/1998-5029-2022-84-137-143

Abstract

In this lecture, we discussed methods and approaches to the diagnosis of small airways dysfunction, such as multiple breath nitrogen washout test, impulse oscillometry, as well as the calculation of poorly communicating fraction (PCF) as the ratio of total lung capacity to alveolar volume. The detection of the small airways dysfunction with the help of the diagnostic tools listed above makes it possible to establish functional disorders of the respiratory system in the early stages of bronchopulmonary diseases, when the results of traditional pulmonary functional tests remain within normal values. Thus, a well-standardized and the most accessible method for detecting the peripheral airways dysfunction is body plethysmography, which is used to diagnose the presence of “air trappings”. However, in the early stages of bronchopulmonary diseases, the possibilities of this method are limited. The lecture focuses primarily on the results of our own researches which were performed on patients who have suffered from a novel coronavirus infection complicated by viral pneumonia. Spirometry, body plethysmography, diffusion test, impulse oscillometry, multiple breath nitrogen washout test were conducted, and PCF index was calculated in all patients included in this analysis. The description of the PCF index, the method of its calculation, the range of normal values, as well as the possibilities of application in clinical practice are given for the first time in the Russian literature. The approaches to assessing the dysfunction of the small airways described in the lecture are not widely used at present, however, we hope that the knowledge that is currently being applied in scientific laboratories will gradually be introduced into routine clinical practice.

About the Authors

O. I. Savushkina
Pulmonology Scientific Research Institute of Federal Medical and Biological Agency; Acad. N.N.Burdenko Main Military Clinical Hospital of Russian Federation Ministry of Defence
Russian Federation

Olʹga I. Savushkina, PhD (Biol.), Senior Staff Scientist of the Laboratory of Functional and Ultrasonic Research Methods; Head of the Department of Lung Function Testing, Center of Functional Diagnostic Investigations

28 Orekhovuy Boulevard, Moscow, 115682, Russian Federation

3 Gospitalʹnaya Sq., Moscow, 105094, Russian Federation



A. V. Cherniak
Pulmonology Scientific Research Institute of Federal Medical and Biological Agency
Russian Federation

Alexander V. Cherniak, MD, PhD (Med.), Head of the Laboratory of Functional and Ultrasonic Research Methods

28 Orekhovuy Boulevard, Moscow, 115682, Russian Federation



References

1. Weibel E.R. Principles and methods for the morphometric study of the lung and other organs. Lab. Invest. 1963; 12:131–155.

2. McNulty W., Usmani O.S. Techniques of assessing small airways dysfunction. Eur. Clin. Respir. J. 2014; 1:25898. https://doi.org/10.3402/ecrj.v1.25898

3. Usemann J., Yammine S., Singer F., Latzin P. Inert gas washout: background and application in various lung diseases. Swiss. Med. Wkly 2017; 147:w14483. https://doi.org/10.4414/smw.2017.14483

4. Verbanck S., Thompson B.R., Schuermans D., Kalsi H., Biddiscombe M., Stuart-Andrews C., Hanon S., Van Muylem A., Paiva M., Vincken W., Usmani O. Ventilation heterogeneity in the acinar and conductive zones of the normal ageing lung. Thorax 2012; 67(9):789–795. https://doi.org/10.1136/thoraxjnl-2011-201484

5. Robinson P.D., Latzin Ph., Verbanck S., Hall G.L., Horsley A., Gappa M., Thamrin C., Arets H.G.M., Aurora P., Fuchs S.I., King G.G., Lum S., Macleod K., Paiva M., Pillow J.J., Ranganathan S., Ratjen F., Singer F., Sonnappa S., Stocks J., Subbarao P., Thompson B.R., Gustafsson P.M. Consensus statement for inert gas washout measurement using multiple- and single breath tests. Eur. Respir. J. 2013; 41(3):507–522. https://doi.org/10.1183/09031936.00069712

6. Mustafina M.H., Chernjak A.V. [Methods of washing out inert gases: significance in the diagnosis of respiratory diseases]. Prakticheskaya pul'monologiya 2014; (1):39–44 (in Russian).

7. Robinson P.D., Goldman M.D., Gustafsson P.M. Inert Gas Washout: Theoretical Background and Clinical Utility in Respiratory Disease. Respiration 2009; 78(3):339–355. https://doi.org/10.1159/000225373

8. Wielpütz M.O., Weinheimer O., Eichinger M., Wiebel M., Biederer J., Kauczor H.U., Heußel C.P., Mall M.A., Puderbach M. Pulmonary emphysema in cystic fibrosis detected by densitometry on chest multidetector computed tomography. PLoS One 2013; 8(8):e73142. https://doi.org/10.1371/journal.pone.0073142

9. Chernyak A.V., Neklyudova G.V., Krasovskiy S.A., Mikhaylichenko K.Yu., Naumenko Z.K., Polivanov G.E. [Nitrogen leaching in multiple breathing and structural changes in the bronchopulmonary system in adult patients with cystic fibrosis]. Pulmonologiya 2020; 30(2):193–203 (in Russian). https://doi.org/10.18093/0869-0189-2020-30-2-193-203

10. Savushkina O.I., Cherniak A.V., Zaitsev A.F., Kryukov E.V. Ventilation heterogeneity after COVID-19. Eur. Respir. J. 2021; 58(Suppl.65):OA2681 https://doi.org/10.1183/13993003.congress-2021.OA2681

11. Kryukov E.V., Savushkina O.I., Chernyak A.V., Kulagina I.C. [Diagnosing ventilation inhomogeneity after COVID- 19 by multiple-breath nitrogen washout test]. Pulmonologiya 2021; 31(1):30–36 (in Russian). https://doi.org/10.18093/0869-0189-2021-31-1-30-36

12. Galant S.P., Komarow H.D., Shin H.-W., Siddiqui S., Lipworth B.J. The case for impulse oscillometry in the management of asthma in children and adults. Ann. Allergy Asthma Immunol. 2017; 118(6):664–671. https://doi.org/10.1016/j.anai.2017.04.009

13. Brashier B., Salvi S. Measuring lung function using sound waves: role of the forced oscillation technique and impulse oscillometry system. Breathe 2015; 11(1):57–65. https://doi.org/10.1183/20734735.020514

14. Kameneva M.Yu., Savushkina O.I., Chernyak A.V. [Impulse oscillometry. In: Savushkina O.I., Chernyak A.V., editors. Pulmonary functional tests: from theory to practice. A guide for doctors]. Moscow: Firm Strom; 2017:121–148 (in Russian).

15. Neder A., O’Donnell C.D.J., Cory J., Langer D., Ciavaglia C.E., Ling Y., Webb K.A., O’Donnell D.E. Ventilation Distribution Heterogeneity at Rest as a Marker of Exercise Impairment in Mild-to-Advanced COPD. COPD 2015; 12(3):249–256. https://doi.org/10.3109/15412555.2014.948997

16. Pisi R., Aiello M., Luigino C., Frizzelli A., Alfieri V., Bertorelli G., Pisi G., Chetta A. Ventilation Heterogeneity in Asthma and COPD: The Value of the Poorly Communicating Fraction as the Ratio of Total Lung Capacity to Alveolar Volume. Respiration 2021; 100(5):404–410. https://doi.org/10.1159/000513954

17. Frantz S., Nihlén U., Dencker M., Engström G., Löfdahl C.G., Wollmer P. Impulse oscillometry may be of value in detecting early manifestations of COPD. Respir. Med. 2012; 106(8):1116–1123. https://doi.org/10.1016/j.rmed.2012.04.010

18. Savushkina O.I., Cherniak A.V., Kryukov E.V. [Possibilities of pulse oscillometry in the diagnosis of small airway dysfunction in patients with bronchial asthma]. Medical Alliance 2020; 8(2):72–78. https://doi.org/10.36422/23076348-2020-8-2-72-78 (in Russian).


Review

For citations:


Savushkina O.I., Cherniak A.V. Methods for diagnosing dysfunction of small airways and uniformity of lung ventilation: their use after a novel coronavirus infection. Bulletin Physiology and Pathology of Respiration. 2022;(84):137-143. (In Russ.) https://doi.org/10.36604/1998-5029-2022-84-137-143

Views: 297


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1998-5029 (Print)