Airflow Obstruction In Adults Research Articles

Effects of elexacaftor-tezacaftor-ivacaftor on daily treatment burden and airflow obstruction in adults with cystic fibrosis

BackgroundThe drug combination elexacaftor-tezacaftor-ivacaftor (ETI) proved highly effective in the improvement of the respiratory symptoms, the percentage of predicted forced expiratory volume in 1 s (FEV1), and to reduce rates of pulmonary exacerbations in people with cystic fibrosis (CF) with at least one F508del mutation.The objectives of the study were to evaluate the impact of ETI on the daily treatment burden due to patient decision and the evolution of lung function parameters at 6 months of treatment in real life. MethodsA single-center observational study was realized including adult patients starting ETI therapy from March 10, 2020 to April 5, 2022. Clinical characteristics were collected at initiation (T0) and at 6 months (T6) of treatment. Outcome measures included names and number of chronic daily medications, respectively lung function parameters: FEV1, forced vital capacity (FVC), FEV1/FVC ratio, peak expiratory flow (PEF), forced expiratory flow at 25–75% of FVC (FEF25-75), β‐angle and FEF50/PEF ratio. ResultsSixty-five patients were included with a mean age of 29.4 ± 8.5 years old, 48% of them F508del homozygous previously treated by lumacaftor-ivacaftor. At T6, the median number of daily medications decreased from 13 [2-24] to 9 [1-19] (p < 0.001). All the studied functional respiratory parameters were improved: FEV1 +18%, FVC +14%, FEF25-75% + 18% (all p < 0.001), as well the airflow obstruction: FEV1/FVC +6%, FEF50/PEF by 0.1 ± 0.1 and β‐angle by 10° ± 13° (all p ≤ 0.007). ConclusionETI therapy can reduce the daily treatment burden in real-life at 6 months of treatment, increase a large number of lung function parameters and improve airflow obstruction.

Airflow Obstruction in Adults with Williams Syndrome and Mice with Elastin Insufficiency.

Williams–Beuren syndrome (WS) results from the deletion of 25–27 coding genes, including elastin (ELN), on human chromosome 7q11.23. Elastin provides recoil to tissues; emphysema and chronic obstructive pulmonary disease have been linked to its destruction. Consequently, we hypothesized that elastin insufficiency would predispose to obstructive features. Twenty-two adults with WS (aged 18–55) and controls underwent pulmonary function testing, 6 min walk, and chest computed tomography (CT). Lung and airspace dimensions were assessed in Eln+/− and control mice via microCT and histology. The forced expiratory volume in 1 s (FEV1) and the ratio of FEV1 to forced vital capacity (FVC) were lower in adults with WS (p < 0.0001 and p < 0.05, respectively). The FEV1/FVC ratio was more frequently below the lower limit of normal in cases (p < 0.01). The ratio of residual volume to total lung capacity (RV/TLC, percent predicted) was higher in cases (p < 0.01), suggesting air trapping. People with WS showed reduced exercise capacity (p < 0.0001). In Eln+/− mice, ex vivo lung volumes were increased (p < 0.0001), with larger airspaces (p < 0.001). Together these data show that elastin insufficiency impacts lung physiology in the form of increased air trapping and obstruction, suggesting a role for lung function monitoring in adults with WS.

Diagnostic accuracy of respiratory impedance parameters to detect airflow obstruction in adults

OBJECTIVE: The present study was aimed to evaluate the diagnostic accuracy of impedance parameters to detect airflow obstruction and the severity of airflow obstruction in adults. METHODS: The spirometry parameters (forced expiratory volume in 1 s [FEV1], forced vital capacity [FVC], FEV1/FVC, FVC3/FVC, and FEF25-75) and respiratory impedance parameters (R5, R19, R5-19, and X5) measured by forced oscillation technique of consecutive 299 adults (male: 186) were included in the present analysis. The Spearman correlation coefficient (ρ) was used to assess the correlations of impedance parameters with spirometry indices. The area under the curve (AUC) was used to assess respiratory impedance parameters' diagnostic accuracy. RESULTS: The mean age of the study population was 54.1 ± 12.3 years, and 99 individuals (33%) had airflow obstruction (FEV1/FVC &lt; 0.70) in spirometry. All spirometry indices (% of predicted) showed a weak negative correlation with R5, R19, R5-19, and weak positive correlation with X5. The R5 &gt;142% predicted and X5 &gt;136% predicted had the maximum AUC (0.75) with a sensitivity of up to 56% and specificity up to 86% to identify airflow obstruction. The impedance parameters showed low concordance with the severity of airflow obstruction. CONCLUSION: Respiratory impedance parameters had insufficient sensitivity to diagnose airflow obstruction and the severity of obstruction in adults. Thus, impedance parameters cannot a substitute for spirometry in diagnosing obstructive lung function.

Hypersegmented airway neutrophils and its association with reduced lung function in adults with obstructive airway disease: an exploratory study

ObjectivesThe significance of neutrophilic inflammation in obstructive airway disease remains controversial. Recent studies have demonstrated presence of an active neutrophil population in systemic circulation, featuring hypersegmented morphology, with high oxidative...

Clinical and functional differences between early-onset and late-onset adult asthma: a population-based Tasmanian Longitudinal Health Study

BackgroundDifferences between early-onset and late-onset adult asthma have not been comprehensively described using prospective data.AimsTo characterise the differences between early-onset and late-onset asthma in a longitudinal cohort study.MethodsThe Tasmanian Longitudinal...

Tiotropium/Olodaterol: A Review in COPD.

Tiotropium/olodaterol (Stiolto™ Respimat®, Spiolto™ Respimat®) is a fixed-dose combination of the long-acting antimuscarinic agent tiotropium bromide (hereafter referred to as tiotropium) and the long-acting β2-adrenoreceptor agonist olodaterol delivered via the Respimat® Soft Mist™ inhaler. It is indicated for the maintenance treatment of airflow obstruction in adults with COPD. Several randomized, phase III studies of 6-52 weeks' duration evaluated the efficacy of once-daily tiotropium/olodaterol in patients with GOLD stage 2-3 or 2-4 COPD. Tiotropium/olodaterol maintenance therapy improved lung function to a greater extent than the individual components or placebo and provided clinically meaningful improvements in health-related quality of life and dyspnoea in 12- and 52-week studies. Tiotropium/olodaterol consistently improved 24-h lung function in 6-week studies, providing greater benefits than the monotherapies, placebo or twice-daily fixed-dose fluticasone propionate/salmeterol. Inspiratory capacity and exercise endurance were also improved with tiotropium/olodaterol following 6 or 12 weeks' treatment. The tolerability profile of tiotropium/olodaterol in the phase III studies was generally similar to that of the component monotherapies. The most common adverse events and serious adverse events during 52 weeks' therapy were respiratory in nature, with COPD exacerbation, unsurprisingly, reported most frequently with tiotropium/olodaterol and component monotherapies. Although additional data assessing the effect of tiotropium/olodaterol on exacerbations and comparative studies with other recommended therapies are needed to definitively position tiotropium/olodaterol, current evidence indicates that tiotropium/olodaterol is a useful treatment option for patients with COPD.

Area specific differences in lung function indices and prevalence of airflow obstruction in adults: findings from people in 10 areas in China

To describe the area specific differences in lung function indices and prevalence of airflow obstruction (AFO) in adults found by China Kadoorie Biobank (CKB) study, involving 512 495 adults, in 10 areas in China. The detailed information on lung function indices (FEV, and FVC) and prevalence of AFO (diagnosed according to GOLD and LLN criteria) of subjects aged 30-79 years were analyzed, those with abnormal lung function indices at baseline survey were excluded. The FEV1 and FVC among males (2.66 L, 3.16 L) were higher than those among females (1.99 L, 2.35 L). The FEV1 and FVC were highest in Henan and Harbin. The prevalence of AFO diaonosed according to GOLD criteria was 5.13% in males, higher than that in females (3.75%). The prevalence of AFO was higher in rural area than in urban area (males: 6.32% vs. 3.47%; females: 4.26% vs. 2.97%). The prevalence of AFO was highest in Sichuan (13.34% in males, 10.70% in females), followed by that in Suzhou, Henan and Hunan. The prevalence of AFO diagnosed according to LLN criteria (6.93% in males, 6.29% in females) was higher than that diagnosed according to GOLD criteria, but the area specific difference was similar. The lung function indices and the prevalence of AFO in adults varied greatly among the 10 areas covered by CKB study.

PP60 Probable Airflow Obstruction in Adults: Data from the Health Survey for England 2010

BackgroundIn the UK, chronic obstructive pulmonary disease (COPD) causes approximately 25,000 deaths annually. Around three million people are estimated to have COPD, of whom fewer than one-third have been diagnosed....

Indacaterol

Indacaterol inhalation powder (Onbrez® Breezhaler®) is a long-acting, selective β(2)-adrenoceptor agonist that is indicated for the maintenance bronchodilator treatment of airflow obstruction in adults with chronic obstructive pulmonary disease (COPD). This article reviews the clinical efficacy and tolerability of indacaterol 150 and 300 μg once daily in adults with moderate to severe COPD, as well as reviewing indacaterol's pharmacological properties and results of a cost-utility analysis. Indacaterol has a fast onset of action after the first dose and is effective over 24 hours, allowing for once-daily administration. In short-term trials (≤21 days) in patients with COPD, once-daily indacaterol 150 or 300 μg significantly improved lung function, exercise endurance and lung hyperinflation relative to placebo. In large, longer-term clinical studies (12 weeks to 1 year) in patients with moderate to severe COPD, once-daily indacaterol 150 or 300 μg improved lung function (primary endpoint) significantly more than placebo, and improvements were significantly greater than twice-daily formoterol 12 μg or salmeterol 50 μg, and noninferior to once-daily tiotropium bromide 18 μg (all agents were administered via inhalation). Overall, indacaterol improved dyspnoea, use of rescue medication and general health status significantly more than placebo, salmeterol or tiotropium bromide, and the degree of improvement in these endpoints was similar to or greater than that achieved with formoterol. Improvements were sustained over the long term (1 year), with no evidence of tolerance. Combination therapy with indacaterol plus tiotropium bromide improved lung function, dyspnoea, rescue medication use and general health status significantly more than tiotropium bromide alone in patients with moderate to severe COPD. Indacaterol is generally well tolerated when used alone or in combination with tiotropium bromide in patients with COPD and has not been associated with any safety issues. The most common adverse event in clinical trials was COPD worsening, which occurred more commonly with placebo than indacaterol. Indacaterol was not associated with an increased risk of cardiovascular adverse events. In a cost-utility analysis from a German healthcare payer perspective, once-daily indacaterol 150 μg was dominant (i.e. more effective with lower total costs) to once-daily tiotropium bromide 18 μg and twice-daily salmeterol 50 μg in the treatment of patients with COPD. In conclusion, indacaterol provides a valuable option for the maintenance treatment of adults with COPD.

Review: β-agonists plus ipratropium bromide improve airflow obstruction in adults with acute asthma

Source Citation Stoodley RG, Aaron SD, Dales RE. The role of ipratropium bromide in the emergency management of acute asthma exacerbation: a metaanalysis of randomized clinical trials. Ann Emerg Me...

Review: β-agonists plus ipratropium bromide improve airflow obstruction in adults with acute asthma

Review: β-agonists plus ipratropium bromide improve airflow obstruction in adults with acute asthma

Analysis of expiratory tidal flow patterns as a diagnostic tool in airflow obstruction.

An index obtained from tidal expiration, the ratio of time to peak tidal expiratory flow (tPTEF) to expiratory time (tE), discriminates between groups with and without airflow obstruction in infants and children and correlates with other measurements of airflow obstruction in adults. The aim of this study was to determine whether the diagnosis of airflow obstruction could be made from an analysis of the later part of the expiratory tidal flow time curve, i.e beyond the maximum flow. One hundred and eighteen patients attending the lung function laboratory with a putative diagnosis of airflow obstruction were studied. From uncoached tidal breathing, measurements were made of the average time constant of the respiratory system (Trs) and extrapolated volume (EV). Forced expiratory spirometry and whole-body plethysmography were performed. In this cross-sectional study, Trs correlated with inspiratory airways resistance and forced expiratory volume in one second (FEV1), according to the linear regression equations, airway resistance (Raw)=3.03 Trs+1.2, r=0.65, p<0.001, and FEV1% predicted = 87.8-23.7 Trs, r=058, p<0.001. EV correlated positively with overinflation, functional residual capacity (FRC) % pred = 152 EV+103, r=0.68, p<0.001. This study shows that there is a relationship between these measurements made from analysis of tidal breathing and recognized measurements of airflow obstruction and overinflation.