Usemann Jakob, Yammine Sophie, Singer Florian, Latzin Philipp
University Children's Hospital Basel (UKBB), Basel, Switzerland; Division of Respiratory Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland.
Division of Respiratory Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland.
Swiss Med Wkly. 2017 Aug 16;147:w14483. doi: 10.4414/smw.2017.14483. eCollection 2017.
Multiple breath inert gas washout (MBW) is a lung function technique to measure ventilation inhomogeneity. The technique was developed more than 60 years ago, but not much used for many decades. Technical improvements, easy protocols and higher sensitivity compared with standard lung function tests in some disease groups have led to a recent renaissance of MBW. The lung clearance index (LCI) is a common measure derived from MBW tests, and offers information on lung pathology complementary to that from conventional lung function tests such as spirometry. The LCI measures the overall degree of pulmonary ventilation inhomogeneity. There are other MBW-derived parameters, which describe more regional airway ventilation and enable specific information on conductive or acinar ventilation inhomogeneity. How this specific ventilation distribution is exactly related to different disease processes has not entirely been examined yet. MBW measurements are performed during tidal breathing, making this technique attractive for children, even young children and infants. These benefits and the additional physiological information on ventilation inhomogeneity early in the course of lung diseases have led to increasing research activities and clinical application of MBW, especially in paediatric lung diseases such as cystic fibrosis (CF). In these patients, LCI detects early airway damage and enables monitoring of disease progression and treatment response. Guidelines for the standardisation of the MBW technique were recently published. These guidelines will, hopefully, increase comparability of LCI data obtained in different centres or intervention trials in children and adults. In this non-systematic review article, we provide an overview of recent developments in MBW, with a special focus on children. We first explain the physiological and technical background to this technique with a short explanation of several methodological aspects that are important for understanding the principle behind the technique and enable high quality measurements. We then provide examples of MBW application in different lung diseases of children and adults, with regards to both clinical application and research activities. Lastly, we report on ongoing clinical trials using MBW as outcome and give an outlook on possible future developments.
多次呼吸惰性气体冲洗法（MBW）是一种用于测量通气不均匀性的肺功能检测技术。该技术在60多年前就已开发出来，但几十年来使用并不广泛。技术的改进、简便的操作流程以及与某些疾病组的标准肺功能测试相比更高的灵敏度，使得MBW最近得以复兴。肺清除指数（LCI）是从MBW测试中得出的一项常用指标，可提供与传统肺功能测试（如肺活量测定）互补的肺部病理信息。LCI测量肺通气不均匀性的总体程度。还有其他源自MBW的参数，可描述更多局部气道通气情况，并能提供关于传导性或腺泡性通气不均匀性的具体信息。这种特定的通气分布与不同疾病进程的确切关系尚未完全研究清楚。MBW测量是在潮气呼吸过程中进行的，这使得该技术对儿童，甚至是幼儿和婴儿都具有吸引力。这些优势以及在肺部疾病早期阶段提供的关于通气不均匀性的额外生理信息，促使MBW的研究活动和临床应用不断增加，尤其是在诸如囊性纤维化（CF）等儿科肺部疾病中。在这些患者中，LCI可检测早期气道损伤，并能监测疾病进展和治疗反应。MBW技术标准化指南最近已发布。希望这些指南能提高在不同中心或儿童及成人干预试验中获得的LCI数据的可比性。在这篇非系统性综述文章中，我们概述了MBW的最新进展，特别关注儿童。我们首先解释该技术的生理和技术背景，并简要说明几个对理解该技术背后原理及进行高质量测量很重要的方法学方面。然后我们给出MBW在儿童和成人不同肺部疾病中的应用实例，涉及临床应用和研究活动两方面。最后，我们报告正在进行的以MBW为结果指标的临床试验，并展望未来可能的发展。
