Distinct Mechanical Properties of the Respiratory System Evaluated by Forced Oscillation Technique in Acute Exacerbation of COPD and Acute Decompensated Heart Failure

Silvia Terraneo,Giuseppe Francesco Sferrazza Papa,Fabiano Di Marco,Rocco Francesco Rinaldo,Emiliano Gatti,Laura Maugeri,Fulvia Ribolla,Carlo Gulotta,Stefano Centanni

doi:10.3390/diagnostics11030554

Abstract

Discriminating between cardiac and pulmonary dyspnea is essential for patients’ management. We investigated the feasibility and ability of forced oscillation techniques (FOT) in distinguishing between acute exacerbation of COPD (AECOPD), and acute decompensated heart failure (ADHF) in a clinical emergency setting. We enrolled 49 patients admitted to the emergency department (ED) for dyspnea and acute respiratory failure for AECOPD, or ADHF, and 11 healthy subjects. All patients were able to perform bedside FOT measurement. Patients with AECOPD showed a significantly higher inspiratory resistance at 5 Hz, Xrs5 (179% of predicted, interquartile range, IQR 94–224 vs. 100 IQR 67–149; p = 0.019), and a higher inspiratory reactance at 5 Hz (151%, IQR 74–231 vs. 57 IQR 49–99; p = 0.005) than patients with ADHF. Moreover, AECOPD showed higher heterogeneity of ventilation (respiratory system resistance difference at 5 and 19 Hz, Rrs5-19: 1.49 cmH2O/(L/s), IQR 1.03–2.16 vs. 0.44 IQR 0.22–0.76; p = 0.030), and a higher percentage of flow limited breaths compared to ADHF (10%, IQR 0–100 vs. 0 IQR 0–12; p = 0.030). FOT, which resulted in a suitable tool to be used in the ED setting, has the ability to identify distinct mechanical properties of the respiratory system in AECOPD and ADHF.

Highlights

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and acute decompensated heart failure (ADHF) are two of the most frequent clinical conditions that occur in patients presenting to the emergency department (ED) with dyspnea and respiratory failure [1,2]
The aims of the present study were to investigate whether forced oscillation techniques (FOT) is a feasible tool in an emergency setting, and whether this could be an aid to distinguish the mechanical properties of the respiratory systems in patients presenting with AECOPD or ADHF
Patients with AECOPD had a severe functional impairment, assessed from spirometric values obtained in the previous year and collected through their medical record, and the median value of FEV1 in patients with COPD was 20% of predicted value (IQR: 25–47), and the median value of FVC was 53% of predicted value (IQR: 45–77)

Summary

Introduction

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and acute decompensated heart failure (ADHF) are two of the most frequent clinical conditions that occur in patients presenting to the emergency department (ED) with dyspnea and respiratory failure [1,2]. Because of the high prevalence of their underlying chronic disease such as chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF), the epidemiological burden of such conditions is remarkable. Different procedures have been proposed so far to aid in differentiating cardiac or pulmonary dyspnea in ED (e.g., point of care thoracic ultrasound, pro-brain-type natriuretic peptide) since the clinical presentation of both AECOPD and ADHF is characterized by such symptom. Differential diagnosis remains a notable clinical challenge in some cases [2], the evaluation of other tools useful in this context is of great medical interest

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