Hajian Bita, De Backer Jan, Vos Wim, van Geffen Wouter H, De Winter Paul, Usmani Omar, Cahn Tony, Kerstjens Huib Am, Pistolesi Massimo, De Backer Wilfried
Department of Respiratory Medicine, University Hospital Antwerp, Edegem, Belgium.
FLUIDDA nv, Kontich, Belgium.
Int J Chron Obstruct Pulmon Dis. 2018 Mar 6;13:833-842. doi: 10.2147/COPD.S153295. eCollection 2018.
Severe exacerbations associated with chronic obstructive pulmonary disease (COPD) that require hospitalization significantly contribute to morbidity and mortality. Definitions for exacerbations are very broad, and it is unclear whether there is one predominant underlying mechanism that leads to them. Functional respiratory imaging (FRI) with modeling provides detailed information about airway resistance, hyperinflation, and ventilation-perfusion (V/Q) mismatch during and following an acute exacerbation.
Forty-two patients with COPD participating in a multicenter study were assessed by FRI, pulmonary function tests, and self-reported outcome measures during an acute exacerbation and following resolution. Arterial blood gasses and lung function parameters were measured.
A significant correlation was found between alveolar-arterial gradient and image-based V/Q (iV/Q), suggesting that iV/Q represents V/Q mismatch during an exacerbation (<0.05).
Recovery of an exacerbation is due to decreased (mainly distal) airway resistance (<0.05). Improvement in patient-reported outcomes were also associated with decreased distal airway resistance (<0.05), but not with forced expiratory volume. FRI is, therefore, a sensitive tool to describe changes in airway caliber, ventilation, and perfusion during and after exacerbation. On the basis of the fact that FRI increased distal airway resistance seems to be the main cause of an exacerbation, therapy should mainly focus on decreasing it during and after the acute event.
与慢性阻塞性肺疾病（COPD）相关的严重加重发作需要住院治疗，这对发病率和死亡率有显著影响。加重发作的定义非常宽泛，目前尚不清楚是否存在一种主要的潜在机制导致这些发作。功能呼吸成像（FRI）结合模型可提供有关急性加重发作期间及之后气道阻力、肺过度充气和通气-灌注（V/Q）不匹配的详细信息。
42例参与多中心研究的COPD患者在急性加重发作期间及缓解后通过FRI、肺功能测试和自我报告的结局指标进行评估。测量动脉血气和肺功能参数。
发现肺泡-动脉氧分压差与基于图像的V/Q（iV/Q）之间存在显著相关性，表明iV/Q代表加重发作期间的V/Q不匹配（<0.05）。
加重发作的恢复归因于气道阻力降低（主要是远端气道）（<0.05）。患者报告结局的改善也与远端气道阻力降低相关（<0.05），但与用力呼气量无关。因此，FRI是描述加重发作期间及之后气道管径、通气和灌注变化的敏感工具。基于FRI增加远端气道阻力似乎是加重发作的主要原因这一事实，治疗应主要集中在急性事件期间及之后降低远端气道阻力。
