A comprehensive approach to lung function in bronchiectasis

Dejan Radovanovic; Pierachille Santus; Francesco Blasi; Giovanni Sotgiu; Francesca D'Arcangelo; Edoardo Simonetta; Martina Contarini; Elisa Franceschi; Pieter C Goeminne; James D Chalmers; Stefano Aliberti

doi:10.1016/j.rmed.2018.10.031

A comprehensive approach to lung function in bronchiectasis

Respir Med. 2018 Dec:145:120-129. doi: 10.1016/j.rmed.2018.10.031. Epub 2018 Nov 2.

Affiliations

¹ Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenfratelli-Sacco, Milan, Italy. Electronic address: danko86@hotmail.com.
² Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenfratelli-Sacco, Milan, Italy. Electronic address: pierachille.santus@unimi.it.
³ Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy. Electronic address: francesco.blasi@unimi.it.
⁴ Clinical Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari, Sassari, Italy. Electronic address: gsotgiu@uniss.it.
⁵ School of Medicine, University of Milan Bicocca, Respiratory Unit, AO San Gerardo, Monza, Italy. Electronic address: francescadarcangelo@yahoo.it.
⁶ School of Medicine, University of Milan Bicocca, Respiratory Unit, AO San Gerardo, Monza, Italy. Electronic address: edo.simonetta@gmail.com.
⁷ Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy. Electronic address: martina.contarini@unimi.it.
⁸ Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy. Electronic address: elisa.franceschi.93@gmail.com.
⁹ Department of Respiratory Disease, AZ Nikolaas, Sint-Niklaas, Belgium; Department of Respiratory Disease, UZ Leuven, Leuven, Belgium. Electronic address: pieter.goeminne@aznikolaas.be.
¹⁰ Scottish Centre for Respiratory Research, University of Dundee, Dundee, DD1 9SY, UK. Electronic address: j.chalmers@dundee.ac.uk.
¹¹ Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy; School of Medicine, University of Milan Bicocca, Respiratory Unit, AO San Gerardo, Monza, Italy. Electronic address: stefano.aliberti@unimi.it.

PMID: 30509700
DOI: 10.1016/j.rmed.2018.10.031

Abstract

Background: International guidelines recommend simple spirometry for bronchiectasis patients. However, pulmonary pathophysiology of bronchiectasis is very complex and still poorly understood. Our objective was to characterize lung function in bronchiectasis and identify specific functional sub-groups.

Methods: This was a multicenter, prospective, observational study enrolling consecutive adults with bronchiectasis during stable sate. Patients underwent body-plethysmography before and after acute bronchodilation testing, diffusing lung capacity (DLCO) with a 3-year follow up. Air trapping and hyperinflation were a residual volume (RV) > 120%predicted and a total lung capacity>120%predicted. Acute reversibility was: ΔFEV1 ≥12% and 200 mL from baseline (FEV1rev) and ΔRV ≥10% reduction from baseline (RVrev). Sensitivity analyses included different reversibility cutoffs and excluded patients with concomitant asthma or chronic obstructive pulmonary disease.

Results: 187 patients were enrolled (median age: 68 years; 29.4% males). Pathophysiological abnormalities often overlapped and were distributed as follows: air trapping (70.2%), impaired DLCO (55.7%), airflow obstruction (41.1%), hyperinflation (15.7%) and restriction (8.0%). 9.7% of patients had normal lung function. RVrev (17.6%) was more frequent than FEV1rev (4.3%). Similar proportions were found after multiple sensitivity analyses. Compared with non-reversible patients, patients with RVrev had more severe obstruction (mean(SD) FEV1%pred: 83.0% (24.4) vs 68.9% (26.2); P = 0.02) and air trapping (RV%pred, 151.9% (26.6) vs 166.2% (39.9); P = 0.028).

Conclusions: Spirometry alone does not encompass the variety of pathophysiological characteristics in bronchiectasis. Air trapping and diffusion impairment, not airflow obstruction, represent the most common functional abnormalities. RVrev is related to worse lung function and might be considered in bronchiectasis' workup and for patients' functional stratification.

Keywords: Bronchiectasis; Exacerbation; Plethysmography; Residual volume; Reversibility; Spirometry.

Publication types

Multicenter Study
Observational Study

MeSH terms

Aged
Bronchiectasis / diagnosis*
Bronchiectasis / physiopathology*
Female
Follow-Up Studies
Humans
Lung Volume Measurements
Male
Middle Aged
Prospective Studies
Pulmonary Ventilation
Residual Volume*
Respiratory Function Tests
Severity of Illness Index
Spirometry
Time Factors