Zobraziť v EDS

Standard pulmonary function tests and respiratory oscillometry patterns in hypersensitivity pneumonitis and idiopathic pulmonary fibrosis.

Uložené v:
Podrobná bibliografia
Názov: Standard pulmonary function tests and respiratory oscillometry patterns in hypersensitivity pneumonitis and idiopathic pulmonary fibrosis.
Autori: Wu JKY; Toronto General-Pulmonary Function Laboratory, University Health Network, Toronto, Ontario, Canada.; Division of Respirology, University of Toronto, Toronto, Ontario, Canada., Xu JJ; Division of Respirology, University of Toronto, Toronto, Ontario, Canada., Numakura T; Division of Respirology, University of Toronto, Toronto, Ontario, Canada., Ryan CM; Toronto General-Pulmonary Function Laboratory, University Health Network, Toronto, Ontario, Canada.; Division of Respirology, University of Toronto, Toronto, Ontario, Canada., McInnis MC; University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada., Binnie M; Division of Respirology, University of Toronto, Toronto, Ontario, Canada.; Interstitial Lung Disease Program, University Health Network, Toronto, Ontario, Canada.; Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada., Shapera S; Division of Respirology, University of Toronto, Toronto, Ontario, Canada.; Interstitial Lung Disease Program, University Health Network, Toronto, Ontario, Canada., Fisher JH; Division of Respirology, University of Toronto, Toronto, Ontario, Canada.; Interstitial Lung Disease Program, University Health Network, Toronto, Ontario, Canada., Hantos Z; Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary.; Department of Technical Informatics, University of Szeged, Szeged, Hungary., Chow CW; Division of Respirology, University of Toronto, Toronto, Ontario, Canada Chung-Wai.Chow@uhn.ca.; Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada.
Zdroj: BMJ open respiratory research [BMJ Open Respir Res] 2025 Nov 30; Vol. 12 (1). Date of Electronic Publication: 2025 Nov 30.
Spôsob vydávania: Journal Article
Jazyk: English
Informácie o časopise: Publisher: BMJ Publishing Group Ltd & British Thoracic Society Country of Publication: England NLM ID: 101638061 Publication Model: Electronic Cited Medium: Internet ISSN: 2052-4439 (Electronic) Linking ISSN: 20524439 NLM ISO Abbreviation: BMJ Open Respir Res Subsets: MEDLINE
Imprint Name(s): Original Publication: London : BMJ Publishing Group Ltd & British Thoracic Society, [2013]-
Výrazy zo slovníka MeSH: Alveolitis, Extrinsic Allergic*/physiopathology , Alveolitis, Extrinsic Allergic*/diagnosis , Idiopathic Pulmonary Fibrosis*/physiopathology , Idiopathic Pulmonary Fibrosis*/diagnosis , Oscillometry*/methods , Respiratory Function Tests*/methods, Humans ; Female ; Male ; Aged ; Middle Aged
Abstrakt: Competing Interests: Competing interests: None declared.
Background: Hypersensitivity pneumonitis (HP) is an interstitial lung disease (ILD) caused by repeated exposure to inhaled antigens, leading to small airway and parenchymal inflammation. Diagnosis is based on a detailed clinical history, chest imaging and invasive tests such as bronchoalveolar lavage. Distinguishing HP from other ILDs is challenging. Respiratory oscillometry, a novel pulmonary function test (PFT), is highly sensitive to small airway abnormalities. Oscillometry measurement of reactance is strongly correlated with gender-age-physiology score, a prognostic tool used to predict mortality and disease severity in idiopathic pulmonary fibrosis (IPF).
Objective: To determine if oscillometry and standard PFT patterns are different in HP and IPF.
Methods: 39 HP (79.5% with fibrotic HP) were enrolled from October 2022 to December 2023 for oscillometry before clinically-indicated standard PFTs and compared with 39 age-matched and sex-matched patients with IPF who also had same day oscillometry and standard PFTs. The main oscillometry metrics of interest were R5-19 (the difference in resistance from 5 to 19 Hz, a metric of small airway function and ventilatory inhomogeneity that increases with worsening respiratory mechanics), X5 (reactance at 5 Hz) which primarily reflects respiratory elastance and AX (area of reactance), a summative measure of the respiratory system stiffness across a range of frequencies, that behaves similarly but in opposite direction to X5.
Results: Patients with HP exhibited higher residual volume/total lung capacity (RV/TLC), lower per cent predicted (%) forced expiratory volume in 1 s (FEV 1 ) and % predicted forced vital capacity (FVC) than IPF (p<0.05) while FEV 1 /FVC and %TLC were similar. Oscillometry showed higher R5-19 in HP. RV/TLC ratio correlated with AX (r 2 =0.72), X5 (r 2 =0.66) and R5-19 (r 2 =0.64).
Conclusion: Gas trapping (RV/TLC>0.40) is a feature of HP not observed in IPF. The strong correlations of RV/TLC with AX, X5 and R5-19 suggest that oscillometry can provide non-invasive markers of small airway obstruction in HP that can differentiate it from IPF.
(© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)
Contributed Indexing: Keywords: Idiopathic Pulmonary Fibrosis; Interstitial Fibrosis; Respiratory Function Test
Entry Date(s): Date Created: 20251201 Date Completed: 20251201 Latest Revision: 20251201
Update Code: 20251202
DOI: 10.1136/bmjresp-2025-003600
PMID: 41326053
Databáza: MEDLINE
Popis
Abstrakt:Competing Interests: Competing interests: None declared.<br />Background: Hypersensitivity pneumonitis (HP) is an interstitial lung disease (ILD) caused by repeated exposure to inhaled antigens, leading to small airway and parenchymal inflammation. Diagnosis is based on a detailed clinical history, chest imaging and invasive tests such as bronchoalveolar lavage. Distinguishing HP from other ILDs is challenging. Respiratory oscillometry, a novel pulmonary function test (PFT), is highly sensitive to small airway abnormalities. Oscillometry measurement of reactance is strongly correlated with gender-age-physiology score, a prognostic tool used to predict mortality and disease severity in idiopathic pulmonary fibrosis (IPF).<br />Objective: To determine if oscillometry and standard PFT patterns are different in HP and IPF.<br />Methods: 39 HP (79.5% with fibrotic HP) were enrolled from October 2022 to December 2023 for oscillometry before clinically-indicated standard PFTs and compared with 39 age-matched and sex-matched patients with IPF who also had same day oscillometry and standard PFTs. The main oscillometry metrics of interest were R5-19 (the difference in resistance from 5 to 19 Hz, a metric of small airway function and ventilatory inhomogeneity that increases with worsening respiratory mechanics), X5 (reactance at 5 Hz) which primarily reflects respiratory elastance and AX (area of reactance), a summative measure of the respiratory system stiffness across a range of frequencies, that behaves similarly but in opposite direction to X5.<br />Results: Patients with HP exhibited higher residual volume/total lung capacity (RV/TLC), lower per cent predicted (%) forced expiratory volume in 1 s (FEV <subscript>1</subscript> ) and % predicted forced vital capacity (FVC) than IPF (p&lt;0.05) while FEV <subscript>1</subscript> /FVC and %TLC were similar. Oscillometry showed higher R5-19 in HP. RV/TLC ratio correlated with AX (r <sup>2</sup> =0.72), X5 (r <sup>2</sup> =0.66) and R5-19 (r <sup>2</sup> =0.64).<br />Conclusion: Gas trapping (RV/TLC&gt;0.40) is a feature of HP not observed in IPF. The strong correlations of RV/TLC with AX, X5 and R5-19 suggest that oscillometry can provide non-invasive markers of small airway obstruction in HP that can differentiate it from IPF.<br /> (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)
ISSN:2052-4439
DOI:10.1136/bmjresp-2025-003600