Center of Pneumology, Hirslanden Salem-Spital, Bern, Switzerland
School of Biomedical and Precision Engineering, University of Bern, Bern, Switzerland.
BMJ Open Respir Res. 2024 Mar 9;11(1):e002142. doi: 10.1136/bmjresp-2023-002142.
The plethysmographic shift volume-flow loop (sR-loop) measured during tidal breathing allows the determination of several lung function parameters such as the effective specific airway resistance (sR), calculated from the ratio of the integral of the resistive aerodynamic specific work of breathing (sWOB) and the integral of the corresponding flow-volume loop. However, computing the inspiratory and expiratory areas of the sR-loop separately permits the determination of further parameters of airway dynamics. Therefore, we aimed to define the discriminating diagnostic power of the inspiratory and expiratory sWOB (sWOB, sWOB), as well as of the inspiratory and expiratory sR (sR and sR ), for discriminating different functional phenotypes of chronic obstructive lung diseases.
Reference equations were obtained from measurement of different databases, incorporating 194 healthy subjects (35 children and 159 adults), and applied to a collective of 294 patients with chronic lung diseases (16 children with asthma, aged 6-16 years, and 278 adults, aged 17-92 years). For all measurements, the same type of plethysmograph was used (Jaeger Würzburg, Germany).
By multilinear modelling, reference equations of sWOB, sWOB, sR and sR were derived. Apart from anthropometric indices, additional parameters such as tidal volume (V), the respiratory drive (P), measured by means of a mouth occlusion pressure measurement 100 ms after inspiration and the mean inspiratory flow (V/T) were found to be informative. The statistical approach to define reference equations for parameters of airway dynamics reveals the interrelationship between covariants of the actual breathing pattern and the control of breathing.
We discovered that sWOB, sWOB, sR and sR are new discriminating target parameters, that differentiate much better between chronic obstructive diseases and their subtypes, especially between chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap (ACO), thus strengthening the concept of precision medicine.
在潮式呼吸过程中测量的体积描记移位容积-流量环（sR-环）允许确定几个肺功能参数，例如有效比气道阻力（sR），它是通过呼吸阻力比气道阻力工作（sWOB）积分与相应的流量-容积环积分的比值计算得出。然而，分别计算吸气和呼气 sR-环的面积允许确定气道动力学的进一步参数。因此，我们旨在定义吸气和呼气 sWOB（sWOB、sWOB）以及吸气和呼气 sR（sR 和 sR）的鉴别诊断能力，以区分慢性阻塞性肺疾病的不同功能表型。
从不同数据库的测量中获得参考方程，纳入 194 名健康受试者（35 名儿童和 159 名成人），并应用于 294 名慢性肺部疾病患者（16 名患有哮喘的儿童，年龄 6-16 岁，和 278 名年龄为 17-92 岁的成人）。对于所有测量，均使用相同类型的体积描记仪（德国耶格-维尔茨堡）。
通过多元线性建模，得出了 sWOB、sWOB、sR 和 sR 的参考方程。除了人体测量学指标外，还发现了其他参数，如潮气量（V）、呼吸驱动（P），通过在吸气后 100ms 进行口腔闭塞压力测量来测量，以及平均吸气流量（V/T），这些参数具有信息性。用于气道动力学参数的参考方程的统计学方法揭示了实际呼吸模式和呼吸控制的协变量之间的相互关系。
我们发现 sWOB、sWOB、sR 和 sR 是新的鉴别目标参数，它们可以更好地区分慢性阻塞性疾病及其亚型，特别是慢性阻塞性肺疾病（COPD）和哮喘-COPD 重叠（ACO），从而加强精准医学的概念。
