Asthma, Copd, COVID-19, Small Airways Disease
Conditions
Brief summary
The purpose of this research project is to study small airways physiological function in patients with chronic obstructive lung disease or COVID-19 and explore the relationship with in-vivo microanatomical small airway structure as measured by OCT. Correlating endobronchial assessment with multiple breath nitrogen washout and impulse oscillometry will allow the characterisation of the relationship between small airway structural findings and these validated investigations. A small volume lung wash, endobronchial brushings and the collection of a limited number of endobronchial cryobiopsy samples will be performed to better understand the endobronchial environment of the small airways through inflammatory studies. Following the completion of any such work, residual samples will be stored in a bio-bank to enable the completion of future work. Understanding the relationship with symptom-based quality of life scoring questionnaires and a functional assessment of exercise capacity will help elucidate the clinical impact of in-vivo small airways findings.
Interventions
None listed
Sponsors
Imperial College London
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
16 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Age 16 or over 2. Scheduled for bronchoscopy as part of clinical care or research protocol 3. No bleeding diathesis or therapeutic anticoagulation 4. COPD: * FEV1/FVC ratio \<70% or Asthma: * Diagnosed by standard clinical methods * Post-bronchodilator FEV1 ≥60% predicted or COVID-19 infection or previous COVID-19 infection (confirmed as per local guidelines)
Exclusion criteria
1. Unable to provide informed consent 2. Exacerbation of obstructive airways disease or respiratory infection requiring systemic antibiotics or corticosteroids in the 6 weeks prior to enrolment unless suffering from COVID-19 infection and bronchoscopy is required for clinical reasons 3. Contra-indications to performing lung function testing * Aortic aneurysm \>6cm * Unstable cardiovascular disease (unstable angina, myocardial infarction or pulmonary embolism \<4 weeks prior) * Severe aortic stenosis * Pneumothorax * Cerebral aneurysm * Thoracic or abdominal surgery \<4 weeks prior 4. Contra-indications to passing oesophageal balloons * Oesophageal ulceration or varices * Sinusitis, recent nasal surgery or epistaxis
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Respiratory resistance at 5Hz - 20Hz (R5-R20) (kPa/l/s) related to airtrapping as determined by quantitative CT (Expiratory phase low attenuation area <856 HU (%LAA <856 HU) | Baseline, pre-procedure | Impulse Oscillometry |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Functional residual capacity by MBNW: FRCgas (L) | Baseline, pre-procedure | Multiple Breath Nitrogen Washout |
| Lung clearance index: LCI | Baseline, pre-procedure | Multiple Breath Nitrogen Washout |
| Respiratory reactance at 5Hz: X5 (kPa/l/s) | Baseline, pre-procedure | Impulse Oscillometry |
| Ventilation heterogeneity conducting airways: Scond (L/s) | Baseline, pre-procedure | Multiple Breath Nitrogen Washout |
| Ventilation heterogeneity acinar airways: Sacin (L/s) | Baseline, pre-procedure | Multiple Breath Nitrogen Washout |
| Forced expiratory volume in 1 second: FEV1 (L) | Baseline, pre-procedure | Spirometry |
| Forced vital capacity: FVC (L) | Baseline, pre-procedure | Spirometry |
| Total lung capacity: TLC (L) | Baseline, pre-procedure | Plethysmography |
| Residual volume: RV (L) | Baseline, pre-procedure | Plethysmography |
| Reactance area: Ax (kPa/l/s) | Baseline, pre-procedure | Impulse Oscillometry |
| Airway mean luminal diameter (Dmean) | Baseline, during the procedure | Optical Coherence Tomography |
| Airway inner lumen area (Ai) | Baseline, during the procedure | Optical Coherence Tomography |
| Airway wall area (Aw), airway wall percentage (Aw%) as determined by [Aw/(Ai + Aw) × 100%] | Baseline, during the procedure | Optical Coherence Tomography |
| Air trapping - expiratory phase low attenuation area <856 HU (%LAA <856 HU) | Baseline, pre-procedure | Quantitative CT |
| Modified MRC dyspnoea score | Baseline, pre-procedure | Patient reported outcome measure |
| St George's Respiratory Questionnaire Score | Baseline, pre-procedure | Patient reported outcome measure |
| Asthma-related Quality of Life Questionnaire (AQLQ) (if asthmatic) | Baseline, pre-procedure | Patient reported outcome measure |
| Asthma Control Questionnaire (ACQ) (if asthmatic) | Baseline, pre-procedure | Patient reported outcome measure |
| 6-minute walk distance (m) | Baseline, pre-procedure | 6-minute walk distance (m) |
| Functional residual capacity by plethysmography: FRCpleth (L) | Baseline, pre-procedure | plethysmography |
Other
| Measure | Time frame | Description |
|---|---|---|
| Exploratory: Inflammatory and pathological studies of airways brush, wash and cryobiopsy samples | Baseline, during the procedure | Laboratory based scientific studies |
Countries
United Kingdom
Contacts
Primary ContactChristopher M Orton, MBBS
Outcome results
None listed