None listed
Conditions
Brief summary
Background. Chronic lung allograft dysfunction (CLAD), and especially bronchiolitis obliterans syndrome (BOS), remain dominant causes of morbidity and mortality after lung transplantation. Interest is growing in the forced oscillation technique, of which impulse oscillometry (IOS) is a form, as a tool to improve our understanding of these disorders. However, data remain limited and no longitudinal studies have been published, meaning there is no information regarding any capacity IOS may have for the early detection of CLAD. Methods. We conducted a prospective longitudinal study enrolling a consecutive sample of adult bilateral lung transplant recipients with healthy lung allografts or CLAD and performed ongoing paired IOS and spirometry tests on a clinically determined basis. We assessed for correlations between IOS and spirometry and examined any predictive value either modality may hold for the early detection of BOS. Results. We enrolled 91 patients and conducted testing for 43 mo, collecting 558 analyzable paired IOS and spirometry tests, with a median of 9 tests per subject (interquartile range, 5–12) and a median testing interval of 92 d (interquartile range, 62–161). Statistically significant moderate-to-strong correlations were demonstrated between all IOS parameters and spirometry, except resistance at 20 Hz, which is a proximal airway measure. No predictive value for the early detection of BOS was found for IOS or spirometry. Conclusions. This study presents the first longitudinal data from IOS after lung transplantation and adds considerably to the growing literature, showing unequivocal correlations with spirometry but failing to demonstrate a predictive value for BOS.
Interventions
This prospective diagnostic study seeks to determine whether impulse oscillometry may provide a more sensitive diagnostic tool for the diagnosis of chronic lung allograft dysfunction (both bronchiolitis obliterans and restrictive allograft syndrome subtypes) and, separately, chronic graft-versus-host disease of the lung in allogeneic haematopoietic stem cell transplant recipients (bronchiolitis obliterans).
Participants will perform impulse oscillometry (IOS) prior to performing spirometry as o
This prospective diagnostic study seeks to determine whether impulse oscillometry may provide a more sensitive diagnostic tool for the diagnosis of chronic lung allograft dysfunction (both bronchiolitis obliterans and restrictive allograft syndrome subtypes) and, separately, chronic graft-versus-host disease of the lung in allogeneic haematopoietic stem cell transplant recipients (bronchiolitis obliterans). Participants will perform impulse oscillometry (IOS) prior to performing spirometry as ordered by their treating clinicians as surveillance for chronic lung allograft dysfunction or bronchiolitis obliterans in the case of allogeneic haematopoietic stem cell transplant patients. Patients typically undergo spirometry at least three-monthly. Patients will be observed for a minimum of 12 months and a maximum of 60 months. IOS is a simple test with no risks to the patient which involves minimal to no discomfort. It involves the subject placing their mouth over a mouthpiece and forming a seal. The subject then breathes normally and while this is occurring the machine delivers a range of impulses into the respiratory system at different frequencies. The entire procedure takes only around 2 minutes.
Sponsors
Dr Thomas Crowhurst
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
- Bilateral Lung transplant recipient - 18 years old or more OR: - Allogeneic haematopoietic stem cell transplant recipient - 18 years old or more
Exclusion criteria
In lung transplant recipients, allograft dysfunction from causes other than BOS or RAS, including: - BOS / RAS overlap - Active non-BOS alloinflammatory processes (e.g. acute cellular rejection, lymphocytic bronchiolitis and antibody-mediated rejection) - Active allograft infection - Mechanical impediment: - Known upper / large airway obstructive pathology (e.g. anastomotic stricture or stricture to level of segmental bronchus) - Pleural complications such as pneumothorax, infection or pleural effusion - Neuromuscular deficits (e.g. diaphragmatic paralysis) - Uncontrolled cardiac failure of any cause - Recurrent of primary disease in allograft In allogeneic haematopoietic stem cell transplant recipients, lung dysfunction from causes other than bronchiolitis obliterans including: - Active pulmonary infection - Mechanical impediment: - Known upper / large airway obstructive pathology - Pleural complications such as pneumothorax, infection or pleural effusion - Neuromuscular deficits (e.g. diaphragmatic paralysis) - Uncontrolled cardiac failure of any cause - Pre-existing lung disease that is more than mild in severity (either obstructive or restrictive)
Outcome results
None listed