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Lung clearance index (LCI) as a predictor of exercise limitation among CF patients
Author(s) -
Avramidou Vasiliki,
Hatziagorou Elpis,
Kampouras Asterios,
Hebestreit Helge,
Kourouki Eleana,
Kirvassilis Fotis,
Tsanakas John
Publication year - 2018
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.23833
Subject(s) - medicine , ventilation (architecture) , spirometry , cardiology , respiratory minute volume , vo2 max , respiratory system , heart rate , mechanical engineering , asthma , blood pressure , engineering
FEV 1 is often considered the gold standard to monitor lung disease in cystic fibrosis (CF). Recently, there has been increasing interest in multiple breath washout (MBW) and cardiopulmonary exercise testing (CPET) as alternative or even more sensitive techniques. However, limited data exist on associations among the above methods. Aim To evaluate the correlations between outcome measures of MBW and CPET and to examine if ventilation inhomogeneity can predict exercise intolerance. Subjects and methods Ninety‐seven children and adults with CF (47 males, mean [range] age 14.9 (6.6; 26.7) years, mean FEV 1 : 90.8% predicted, mean lung clearance index [LCI]: 11.4, and mean peak oxygen uptake [VO 2 peak]: 82.4% predicted) performed spirometry, MBW, and CPET on the same day during their admission or outpatient visit. Results LCI, m 1 /m 0 , and m 2 /m 0 ( P < 0.001) as well as VO 2 peak%, breathing reserve (BR), minute ventilation (VE)/VO 2 ( P < 0.001), and VE/carbon dioxide release (VCO 2 ) ( P = 0.006) correlated significantly with FEV 1 %. LCI, m 1 /m 0 , and m 2 /m 0 correlated with VO 2 peak ( P ≤ 0.001), VE (L/min) ( P < 0.05), BR ( P < 0.01), VE/VO 2 ( P < 0.001), and VE/VCO 2 ( P < 0.01). Multiple regression analysis showed that LCI could predict BR% ( P < 0.001, r 2 :0.272) and VE/VO 2 ( P < 0.001, r 2 : 0.207) while LCI and FRC could predict VO 2 peak% P < 0.001, r 2 : 0.216) and VE/VCO 2 ( P < 0.001, r 2 : 0.226). Conclusion Ventilation inhomogeneity as indicated by increased LCI is associated with less efficient ventilation during strenuous exercise and negatively impacts exercise capacity in CF.