Diagnosis of small airway dysfunction in patients with chronic obstructive pulmonary disease

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Abstract

Background: Small airway dysfunction (SAD) is a functional hallmark of chronic obstructive pulmonary disease (COPD). However, SAD prevalence and its role in COPD pathophysiology are not yet sufficiently studied.

Background: Small airway dysfunction (SAD) is a functional hallmark of chronic obstructive pulmonary disease (COPD). However, SAD prevalence and its role in COPD pathophysiology are not yet sufficiently studied.

Aim: To assess the prevalence of SAD in COPD patients by various functional diagnostic methods, such as spirometry, body plethysmography, and impulse oscillometry (IOS).

Materials and methods: This was an cross-sectional study. Spirometry, body plethysmography and IOS were used in 132 COPD patients in remission under standard anti-COPD treatments. The presence of SAD was confirmed by at least one of the following criteria or their combination: 1) by spirometry: the difference between vital capacity (VC) and forced vital capacity (FVC) > 10%; 2) the presence of air trapping by body plethysmography; 3) identification of the frequency dependence of the resistive resistance at 5 to 20 Hz (R5 - R20 > 0.07 kPa x s/l), as assessed by IOS.

Results: Mean forced expiratory volume in 1 s (FEV1) was 42.9% of predicted. Depending on the severity of the obstruction, the patients were divided into 4 groups: 7 patients (group 1) had the obstruction corresponding to GOLD 1 stage, 37 (group 2) to GOLD 2, 49 (group 3) to GOLD 3, and 39 (group 4) to GOLD 4. SAD was found in 96% of COPD patients, whereas in those with severe obstruction (GOLD 3-4), it was present in 100% of the cases. By spirometry, SAD was identified only in 67% of COPD patients, by body plethysmography in 75% of COPD patients (in those with severe obstruction (GOLD 3 and 4) in 88 and 97%, respectively). With IOS, it was possible to identify SAD in 94% of patients and in 100% of those with severe obstruction (GOLD 3-4).

Conclusion: With deterioration of obstructive pulmonary ventilation abnormalities in COPD patients, there is a progressive increase in small airway dysfunction. Impulse oscillometry seems to be the most effective method for diagnosis of small airway dysfunction, as it helped to identify SAD in 94% of COPD patients and in 100% of those with severe and very severe obstruction.

About the authors

A. V. Cherniak

Pulmonology Scientific Research Institute, Federal Medical and Biological Agency of Russian Federation

Author for correspondence.
Email: achi2000@mail.ru
ORCID iD: 0000-0002-2001-5504

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

28 Orekhovyy bul’var, Moscow, 115682, Tel.: +7 (917) 550 06 34

Russian Federation

O. I. Savushkina

N.N. Burdenko Main Military Clinical Hospital

Email: olga-savushkina@yandex.ru
ORCID iD: 0000-0002-7486-4990

Olga I. Savushkina - PhD (in Biol.), Head of Department of Lung Function Testing, Center of Functional Diagnostic Investigations.

3 Gospital’naya ploshchad’, Moscow, 105094

Russian Federation

T. L. Pashkova

Pulmonology Scientific Research Institute, Federal Medical and Biological Agency of Russian Federation

Email: tanya.pashkova.33@mail.ru

Tatyana L. Pashkova - MD, PhD, Senior Research Fellow, Laboratory of Functional and Ultrasonic Research Methods.

28 Orekhovyy bul'var, Moscow, 115682

Russian Federation

E. V. Kryukov

N.N. Burdenko Main Military Clinical Hospital

Email: evgeniy.md@mail.ru
ORCID iD: 0000-0002-8396-1936

Evgeniy V. Kryukov - MD, PhD, Professor, Corresponding Member of Russian Academy of Sciences, Head.

3 Gospital’naya ploshchad’, Moscow, 105094

Russian Federation

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Copyright (c) 2020 Cherniak A.V., Savushkina O.I., Pashkova T.L., Kryukov E.V.

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