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2 de mayo de 2022 / en Scientific Article

Resumen

BACKGROUND

Airwave oscillometry (AO) can detect small airway dysfunction and measure treatment response to inhaled corticosteroids and bronchodilators.1 We compared spirometry and AO changes in severe eosinophilic asthma (SEA) patients treated with mepolizumab to identify the preferred method for assessing mepolizumab efficacy.

Methods

SEA patients from two UK specialist asthma centres, due to start mepolizumab at clinic, were recruited prior to receiving the first treatment dose. Spirometry (Vitalograph alpha, Vitalograph Ltd., Buckingham, UK), AO (Tremoflo, Thorasys, Montreal), exhaled nitric oxide (FeNO), blood eosinophils, induced sputum eosinophils, symptom and quality of life questionnaire scores were measured before and after ≥12 weeks of mepolizumab.

Results

Thirteen patients completed assessments at both timepoints, of which 54% were female, 92% were Caucasian and mean (SD) age at study entry was 53 (15). 23% of patients were ex-smokers and none were current smokers.

At baseline, mean (SD) R5-20 was 0.31 (0.44) cmH2O.s/L, AX was 9.83 (9.62) cmH2O/L and X5 was -0.15 (1.12) cmH2O.s/L. Mean FEV1% predicted was 74%, FEV1/FVC was 69% and FEF25–75% predicted was 51%.

After 12 weeks, mean FEV1 and% predicted improved by 230 ml (p<0.01) and 9.4% (p<0.01), respectively. FEF25–75% predicted increased by 10.2% (p<0.05). There were no significant changes in FeNO or AO parameters. ACQ-5 score improved by 1.23 (MCID 0.5, p=0.02) and SGRQ improved by 16 points (MCID 4.0, p<0.01).

Change in ACQ-5 score correlated with FEV1 (r=-0.57, p=0.04), but not with change in R5-20 (r=-0.09, p=0.78). Change in sputum eosinophils was significantly associated with change in FEV1 (r=-0.94, p<0.001), but not AO indices. A relationship between changes in R5-20 and FEV1 or FEF25–75 was not observed.

Conclusion

Spirometry detected improvements in lung function after 12 weeks of mepolizumab in the absence of airwave oscillometry changes. There was a strong association between change in FEV1 and sputum eosinophil response to mepolizumab.


Fuente

Yang J, Pavord I, Heaney L, Brightling C, Borg K, Busby J, et al. P102 Spirometry versus airwave oscillometry for assessment of mepolizumab efficacy in severe eosinophilic asthma. In: Thorax [Internet]. BMJ Publishing Group Ltd; 2021 [cited 2021 Aug 3]. p. A142.2-A143

Other resources of interest

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9 de junio de 2022
Longitudinal monitoring of asthma in the clinic using respiratory oscillometry
Asthma guidelines emphasize the importance of assessing lung function and symptoms. The forced oscillation technique (FOT) and its longitudinal relationship with spirometry and symptoms are unresolved. We examined concordance between longitudinal spirometry, FOT and symptom control, and determined FOT limits of agreement in stable asthma.
9 de junio de 2022
Criteria for Airway Oscillometry Reversibility in Asthma
We read with interest the article in the June 2020 issue of CHEST from Cottee et al,1 examining 52 patients with asthma, which concluded that bronchodilator response to albuterol 400 mg using forced oscillation technique (airway oscillometry [AO]) with Thorasys Tremoflo was more sensitive than spirometry at identifying poor disease control with the asthma control test.1 This pattern was observed for reactance area (AX) and reactance at 5Hz but not for resistance at 5Hz (R5).
2 de mayo de 2022
Effects of Renewable Diesel Exhaust on Lung Function and Self-rated Symptoms for Healthy Volunteers in a Human Chamber Exposure Study
Diesel engine exhaust causes adverse health effects. Meanwhile, the impact of renewable diesel exhaust on human health is less known. In this study, nasal patency, pulmonary function, and self-rated symptoms were assessed in 19 healthy volunteers after two separate 3-hour exposures to renewable diesel (hydrotreated vegetable oil [HVO]) exhaust, and exposure to filtered air (FA) for comparison.
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