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Comparison of two methods of determining lung de-recruitment, using the forced oscillation technique

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Abstract

Airway closure has proved to be important in a number of respiratory diseases and may be the primary functional defect in asthma. A surrogate measure of closing volume can be identified using the forced oscillation technique (FOT), by performing a deflation maneuver and examining the resultant reactance (Xrs) lung volume relationship. This study aims to determine if a slow vital capacity maneuver can be used instead of this deflation maneuver and compare it to existing more complex techniques. Three subject groups were included in the study; healthy (n = 29), asthmatic (n = 18), and COPD (n = 10) for a total of 57 subjects. Reactance lung volume curves were generated via FOT recordings during two different breathing manoeuvres (both pre and post bronchodilator). The correlation and agreement between surrogate closing volume (Volcrit) and reactance (Xrscrit) at this volume was analysed. The changes in Volcrit and Xrscrit pre and post bronchodilator were also analysed. Across all three subject groups, the two different measures of Volcrit were shown to be statistically equivalent (p > 0.05) and demonstrated a strong fit to the data (R2 = 0.49, 0.78, 0.59, for asthmatic, COPD and healthy subject groups, respectively). A bias was evident between the two measurements of Xrscrit with statistically different means (p < 0.05). However, the two measurements of Xrscrit displayed the same trends. In conclusion, we have developed an alternative technique for measuring airway closure from FOT recordings. The technique delivers equivalent and possibly more sensitive results to previous methods while being simple and easily performed by the patient.

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Abbreviations

ACQ6:

Asthma control questionnaire-6

COPD:

Chronic obstructive pulmonary disease

FEV1 :

Forced expiratory volume in 1 s

FOT:

Forced oscillation technique

FVC:

Forced vital capacity

RV:

Residual volume

SVC:

Slow vital capacity

TLC:

Total lung capacity

Volcrit :

Critical volume

Xrs:

Reactance

Xrscrit :

Critical reactance

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Funding

The Gerald Kerkut Charitable Trust for part funding co author’s (KG) studentship. We would like to acknowledge Prof Peter Howarth for funding Southampton’s Tremoflo equipment.

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Authors and Affiliations

  1. Central Clinical School Monash University, Melbourne, Australia

    K. Nilsen, F. Thien & B. R. Thompson

  2. Lung Function Laboratory, Department of Respiratory Medicine, The Alfred Hospital, Commercial Rd, Melbourne, VIC, 3004, Australia

    K. Nilsen & B. R. Thompson

  3. Department of Respiratory Medicine, Eastern Health, Melbourne, Australia

    F. Thien

  4. Faculty of Medicine, University of Southampton, Southampton, UK

    K. Gove & T. Wilkinson

  5. NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK

    K. Gove & T. Wilkinson

Authors
  1. K. Nilsen
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  2. K. Gove
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  3. F. Thien
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  4. T. Wilkinson
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  5. B. R. Thompson
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Contributions

KN: Study design, data collection, analysis of results, writing of manuscript. KG: Study design, data collection, analysis of results, writing of manuscript. FT: Study design, and writing of manuscript. TW: Study design, and writing of manuscript. BRT: Study design, analysis of results, writing of manuscript.

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Correspondence to K. Nilsen.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Communicated by Susan Hopkins.

This study demonstrates a new and improved technique for identifying closing volume via FOT measurements. The technique delivers equivalent and possibly more sensitive results to previous methods while being simple and easy to perform for the patient.

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Nilsen, K., Gove, K., Thien, F. et al. Comparison of two methods of determining lung de-recruitment, using the forced oscillation technique. Eur J Appl Physiol 118, 2213–2224 (2018). https://doi.org/10.1007/s00421-018-3949-1

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