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Multiple-Breath Washout Outcome Measures in Adults with Bronchiectasis

Lookup NU author(s): Professor Anthony De SoyzaORCiD


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Copyright © 2022 by the American Thoracic Society.Rationale: Lung clearance index (LCI) has good intravisit repeatability with better sensitivity in detecting lung disease on computed tomography scan compared with forced expiratory volume in 1 second (FEV1) in adults with bronchiectasis. Alternative multiple-breath washout parameters have not been systematically studied in bronchiectasis. Objectives: To determine the validity, repeatability, sensitivity, specificity, and feasibility of standard LCI (LCI2.5), shortened LCI (LCI5.0), ventilation heterogeneity arising within proximal conducting airways (ScondVT), and ventilation heterogeneity arising within the acinar airways (SacinVT) in a cross-sectional observational cohort of adults with bronchiectasis. Methods: Cross-sectional multiple-breath nitrogen washout data (Exhalyzer D; Eco Medics AG) from 132 patients with bronchiectasis across five United Kingdom centers (BronchUK Clinimetrics study) and 88 healthy control subjects were analyzed. Results: Within-test repeatability (mean coefficient of variation) was,5% for both LCI2.5 and LCI5.0 in patients with bronchiectasis, and there was no difference in mean coefficient of variation for LCI2.5 and LCI5.0 in patients with bronchiectasis compared with healthy volunteers. Moderate-strength correlations were seen between FEV1 and LCI2.5 (r = 20.54), LCI5.0 (r = 20.53), ScondVT (r = 20.35), and SacinVT (r = 20.38) z-scores. The proportion of subjects with abnormal multiple-breath washout (z-score . 2) but in normal FEV1 (z-score, 22) was 42% (LCI2.5) and 36% (LCI5.0). Overall results from the receiver operating characteristic curve analysis indicated that LCI2.5 had the greatest combined sensitivity and specificity to discriminate between bronchiectasis and control subjects, followed by LCI5.0, FEV1, and ScondVT z-scores. There was a 57% time saving with LCI5.0. Conclusions: LCI2.5 and LCI5.0 had good within-test repeatability and superior sensitivity compared with spirometry measures in differentiating between health and bronchiectasis disease. LCI5.0 is quicker and more feasible than LCI2.5

Publication metadata

Author(s): O'Neill K, Lakshmipathy GR, Neely C, Cosgrove D, Ferguson K, McLeese R, Hill AT, Loebinger MR, Carroll M, Chalmers JD, Gatheral T, Johnson C, De Soyza A, Hurst JR, Bradbury I, Elborn JS, Bradley JM

Publication type: Article

Publication status: Published

Journal: Annals of the American Thoracic Society

Year: 2022

Volume: 19

Issue: 9

Pages: 1489-1497

Online publication date: 01/09/2022

Acceptance date: 22/04/2022

ISSN (print): 2329-6933

ISSN (electronic): 2325-6621

Publisher: American Thoracic Society


DOI: 10.1513/AnnalsATS.202006-584OC

PubMed id: 35451922


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