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Plethysmography-derived gas trapping lacks utility in predicting response to bronchial thermoplasty

Ashwin Rajan, Kim Bennetts, David Langton
ERJ Open Research 2022 8: 00690-2021; DOI: 10.1183/23120541.00690-2021
Ashwin Rajan
1Dept of Thoracic Medicine, Frankston Hospital, Peninsula Health, Frankston, Australia
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Kim Bennetts
1Dept of Thoracic Medicine, Frankston Hospital, Peninsula Health, Frankston, Australia
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David Langton
1Dept of Thoracic Medicine, Frankston Hospital, Peninsula Health, Frankston, Australia
2Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
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  • For correspondence: davidlangton@phcn.vic.gov.au
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    FIGURE 1

    Baseline gas trapping versus change in Asthma Control Questionnaire (ΔACQ). RV: residual volume; TLC: total lung capacity.

Tables

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  • TABLE 1

    Baseline characteristics of participants

    Participants43
    Age (years)57.6±13.3
    Female (%)48.8
    BMI (kg·m−2)31.3±7.3
    Smoking (pack-years)6.8±11.6
    SABA (puffs·day−1)10 (14)
    LABA (%)100
    LAMA (%)100
    Inhaled steroid (beclomethasone µg·day−1)1730±941
    Daily oral steroid (%)62.7
    Prednisolone dose (mg·day−1)7 (15)
    Monoclonal antibodies (%)67.4
    Exacerbations (per annum)4 (8)
    ACQ3.3±1.0
    Pre-bronchodilator FEV1 (% predicted)49.1±15.8
    Forced expiratory ratio (%)50.4±11.3
    Bronchodilator response FEV1 (%)15.1±14.5
    RV (% predicted)150.3±40.8
    TLC (% predicted)104.7±17.4
    RV/TLC (%)51.3±10.5
    KCO (% predicted)94.0±23.3
    Blood eosinophil count (cells·µL−1)190±210
    Serum IgE (IU·mL−1)588±2324

    Data are presented as n, mean±sd or median (interquartile range), unless otherwise stated. BMI: body mass index; SABA: short-acting β-agonist; LABA: long-acting β-agonist; LAMA: long-acting muscarinic antagonist; ACQ: Asthma Control Questionnaire; FEV1: forced expiratory volume in 1 s; RV: residual volume; TLC: total lung capacity; KCO: diffusing capacity of the lung for carbon monoxide corrected for alveolar volume.

    • TABLE 2

      Response to bronchial thermoplasty at 12 months post procedure

      Baseline12 months post bronchial thermoplastyp-value
      Symptom score (ACQ)3.3±1.02.0±1.30.001
      SABA (puffs·day−1)10 (14)2 (6)0.001
      Prednisolone dose (mg·day−1)7 (15)0 (10)0.001
      Exacerbations (per annum)4 (8)1 (3)0.001
      FEV1 (L)1.43±0.631.51±0.700.140
      FEV1 (% pred)49.1±15.852.7±18.10.035
      Vital capacity (L)2.91±0.943.01±1.000.078
      TLC (L)6.01±1.435.95±1.420.338
      TLC (% pred)104.7±17.4103.9±20.60.567
      RV (L)3.09±0.952.93±0.940.026
      RV (% pred)150.3±40.8141.8±46.00.023
      RV/TLC (%)51.3±10.549.3±10.80.009

      Data are presented as mean±sd or median (interquartile range), unless otherwise stated. Bold type represents statistical significance. n=43. ACQ: Asthma Control Questionnaire; SABA: short-acting β-agonist; FEV1: forced expiratory volume in 1 s; TLC: total lung capacity; RV: residual volume.

      • TABLE 3

        Correlation between baseline gas trapping and bronchial thermoplasty outcome (12 months)

        Pearson correlation coefficient
        RV (%)p-valueRV/TLCp-value
        ΔACQ−0.180.240.090.55
        ΔSABA (puffs·day−1)−0.050.730.140.37
        ΔPrednisolone dose (mg·day−1)0.0060.970.040.79
        ΔExacerbations (per annum)0.090.560.140.39

        n=43. RV: residual volume; TLC: total lung capacity; Δ: change; ACQ: Asthma Control Questionnaire score; SABA: short-acting β-agonist.

        • TABLE 4

          Baseline comparisons: nonresponders versus responders using change in Asthma Control Questionnaire score (ΔACQ)

          Nonresponders (ΔACQ <0.5)Responders (ΔACQ ≥0.5)p-value
          Patients1627
          ΔACQ at 12 months−0.03±0.5−2.2±0.9
          Baseline characteristics
           Age (years)56.4±13.257.3±13.60.872
           Male/female8/814/130.910
           BMI (kg·m−2)30.2±7.532.4±7.50.22
           Smoking history (pack-years)0 (0)1 (14)0.040
           ACQ3.1±0.83.5±1.00.199
           SABA (puffs·day−1)8.5 (14)10 (13)0.604
           Prednisolone dose (mg·day−1)8.8 (15)5 (15)0.476
           Exacerbations (per annum)4 (7)4 (7)0.395
           FEV1 (% pred)47.2±10.950.3±18.10.534
           TLC (% pred)100±13107±200.200
           RV (% pred)146±33153±450.601
           RV/TLC (%)53±1051±110.571

          Data are presented as n, mean±sd or median (interquartile range), unless otherwise stated. BMI: body mass index; SABA: short-acting β-agonist; FEV1: forced expiratory volume in 1 s; TLC: total lung capacity; RV: residual volume.

          • TABLE 5

            Baseline comparisons: nonresponders versus responders using change (Δ) in annual exacerbation frequency

            Nonresponders (ΔExacerbations <50%)Responders (ΔExacerbations ≥50%)p-value
            Patients1030
            ΔExacerbations at 12 months−1 (2)−4 (5)
            Baseline characteristics
             Age (years)51.2±16.459.0±12.20.120
             Male/female3/716/140.200
             BMI (kg·m−2)30.9±8.431.7±7.40.778
             Smoking history (pack-years)0 (4)0 (10)0.406
             ACQ3.6±0.93.4±1.00.499
             SABA (puffs·day−1)10.5 (16.5)9 (14)0.288
             Prednisolone dose (mg·day−1)17.5 (25)5 (10)0.143
             Exacerbations (per annum)5 (8)4 (6)0.623
             FEV1 (% pred)52.9±10.848.3±17.70.440
             TLC (% pred)98.7±15.2105±180.331
             RV (% pred)135±35152±430.261
             RV/TLC (%)48±1052±110.230

            Data are presented as n, mean±sd or median (interquartile range), unless otherwise stated. BMI: body mass index; ACQ: Asthma Control Questionnaire; SABA: short-acting β-agonist; FEV1: forced expiratory volume in 1 s; TLC: total lung capacity; RV: residual volume.

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            Plethysmography-derived gas trapping lacks utility in predicting response to bronchial thermoplasty
            Ashwin Rajan, Kim Bennetts, David Langton
            ERJ Open Research Apr 2022, 8 (2) 00690-2021; DOI: 10.1183/23120541.00690-2021

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            Plethysmography-derived gas trapping lacks utility in predicting response to bronchial thermoplasty
            Ashwin Rajan, Kim Bennetts, David Langton
            ERJ Open Research Apr 2022, 8 (2) 00690-2021; DOI: 10.1183/23120541.00690-2021
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