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Utility of single versus multiple breath washout in adult asthma

Journal article
Authors Sanna Kjellberg
Emilia Viklund
P. D. Robinson
O. Zetterstrom
Anna-Carin Olin
Per Magnus Gustafsson
Published in Clinical Physiology and Functional Imaging
Volume 38
Issue 6
Pages 936-943
ISSN 1475-0961
Publication year 2018
Published at Institute of Medicine, School of Public Health and Community Medicine
Institute of Medicine, Department of Public Health and Community Medicine, Section of Occupational and environmental medicine
Institute of Clinical Sciences, Department of Pediatrics
Institute of Clinical Sciences
Pages 936-943
Language en
Links dx.doi.org/10.1111/cpf.12503
Keywords blood eosinophils, lung function, small airways, tobacco smoking, ventilation distribution, pulmonary-function tests, lung-function tests, small airways, reference, values, ventilation maldistribution, regression equations, smoking, variables, nitrogen test, obstruction, spirometry, Physiology, wler ws, 1949, journal of applied physiology, v2, p283, namara jj, 1987, journal of applied physiology, v63, p1648
Subject categories Respiratory Medicine and Allergy

Abstract

Nitrogen multiple breath washout (N-2 MBW) is a sensitive method to identify peripheral airway involvement in asthma, but is a time-consuming test. The N-2 vital capacity single breath (VC SBW) test offers greater time efficiency, but concordance with N-2 MBW is poorly understood. The prevalence of peripheral airway abnormality was determined by N-2 MBW and N-2 SBW tests in 194 asthmatic subjects aged 18-1years. N-2 MBW data were related to findings in 400 healthy controls, aged 17-71years, while N-2 SBW data were compared to findings in 224 healthy controls, aged 15-65years, to derive equipment-specific reference values. Amongst asthmatic subjects, relationships between N-2 SBW and N-2 MBW outcomes were studied. N-2 SBW relationship with clinical history, spirometry, blood eosinophils and fraction exhaled nitric oxide (FENO) data was also explored. The prevalence of peripheral airway involvement (i.e. abnormal ventilation distribution) determined by N-2 SBW-derived phase III slope (N-2 S-III) was 247%, compared to 44% determined by N-2 MBW-derived lung clearance index (LCI) (P<0001). Predictors of abnormal N-2 S-III were older age, smoking history and lower FEV1. N-2 SBW offers lower sensitivity than N-2 MBW to detect small airway dysfunction in adult asthma, but may be a marker of more severe disease.

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