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Small Airway Function Improvement after Smoking Cessation in Smokers without Airway Obstruction

Small Airway Function Improvement after Smoking Cessation in Smokers without Airway Obstruction,Sylvia Verbanck,Daniel Schuermans,Manuel Paiva,Marc Me

Small Airway Function Improvement after Smoking Cessation in Smokers without Airway Obstruction   (Citations: 13)
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Objective: Studying smokers with normal spirometry requires moni- toring tools of the peripheral lung. A validated multiple breath washouttechniquewas used toassesspossible recoveryofsmoking- induced small airway malfunction in acinar and conductive lung zones. Methods: Eighty-seven smokers with a smoking history of at least 10 pack-years but absence of spirometric airflow obstruction were invited for assessment of lung function and small airway function at baseline and after 1 wk, 3 mo, 6 mo, and 12 mo of smoking cessation. A control group of 16 persistent smokers was studied at the same time intervals. Measurements and Main Results: Of the 87 smokers, 66, 32, 28, and 21% successfully ceased smoking for 1 wk, 3 mo, 6 mo, and 12 mo, respectively. Lung function parameters remained essentially unaf- fected by smoking cessation. Ventilation heterogeneity showed transient improvements after 1 wk in the acinar lung compartment with a return to baseline afterwards. By contrast, there were persis- tent improvements in the conductive airway compartment; for ex- ample, smokers who successfully quit smoking for 12 mo (n 18) showed a 30 and 42% reduction of conductive airways abnormality after 1 wk and 1 yr, respectively.
Published in 2006.
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    • ... and the multiple breath washout test [...

    Tomoshi Takedaet al. Relationship between Small Airway Function and Health Status, Dyspnea ...

    • ...have since demonstrated with MBW, by comparing adult smokers with differing pack-year histories (10–40 pack years), that abnormalities in Scond and Sacin are detectable despite normal FEV1 throughout the cohort, with abnormalities detectable as early as 10–20 pack years. In addition, as pack-year history increased, a disproportionate increase in Sacin was seen in relation to Scond. Smoking cessation maintained over a 12-month period, in a separate cohort, reduced Scond values by 30% in the 1st week and 42% at 1 year. No improvements in Sacin were detectable [...

    Paul D. Robinsonet al. Inert Gas Washout: Theoretical Background and Clinical Utility in Resp...

    • ...In this issue of the Journal, Verbanck and coworkers (pages 853–857), in an elegant example of “translational” research, have used the MBW to investigate where the lung gets injured after cigarette smoke exposure and what is the outcome after smoking cessation (11)...

    Manuel G. Cosio. Looking at the Acinus with Function Tests Can You Believe It?

    • ...We reasoned that, in mild COPD, a higher intensity of exertional dyspnea compared with age-matched healthy participants would be associated with the following: (1) greater ventilatory demand, (2) increased mechanical loading of the ventilatory muscles during exercise, or (3) a combination of both...
    • ...The main findings of this study are as follows: (1) exercise capacity was significantly reduced and exertional dyspnea ratings were higher at a given work rate in symptomatic patients with GOLD stage I COPD, compared with healthy control subjects; (2) resting pulmonary function tests confirmed that patients had significant small airway dysfunction; (3) ventilatory abnormalities during exercise in patients with mild COPD included higher ...
    • ...We considered the following potential contributors to exertional dyspnea in patients with mild COPD: (1) higher ventilatory demand as a result of pulmonary gas exchange or metabolic abnormalities, (2) greater abnormalities of dynamic ventilatory mechanics and muscle function that would cause dyspnea to increase for any given ventilation compared with health, or (3) a combination of both of these...
    • ...The presence of clinically significant small airway dysfunction was suggested by the following: (1) maximal expiratory flow rates were uniformly diminished over the effort-independent portion of the maximal flow‐volume curve, (2) closing capacity was increased, (3) maldistribution of ventilation was suggested by the nitrogen washout test, and (4) all plethysmographic lung volumes were elevated...

    Dror Ofiret al. Mechanisms of Dyspnea during Cycle Exercise in Symptomatic Patients wi...

    • ...An RCT demonstrated that the risk of sudden death was increased (8)...
    • ...6C Can Respir J Vol 15 Suppl C November/December 2008 5-lo/flap inhibitors New agents that could possibly block not only the cysteinyl leukotrienes, but also leukotriene B4, therefore possibly influencing neutrophilic as well as eosinophilic inflammation, could be of interest (8)...
    • ...For active TB, efforts are being made to optimize sputum smear microscopy using simple light-emitting diode-based fluorescence microscopy systems, and sputum processing methods such as bleach (7,8)...
    • ...Although there are promising new technologies that will provide drug sensitivities earlier, their availability where they are most needed will be limited for the foreseeable future (8)...
    • ...However, LVR alone is superior to manually assisted cough alone in increasing the maximum insufflation capacity and PCF (8)...
    • ...“Hardwiring” best practice includes: specific weaning approach (1) (slow-paced with gradually lengthening of self-breathing trials with nonfatiguing comfortable ventilatory support between weaning trials); continuing ICU weaning best practice (daily spontaneous breathing trials, minimized sedation, nurse and/or respiratory therapist weaning protocols, daily wakeup and breathe) (8-10); and minimizing complications (central line and ...
    • ...Though they provide restricted information regarding physiologic contributors and mechanisms of exercise limitation, they are now used commonly (8)...
    • ...In addition to the known benefits of oxygen for maintaining arterial saturation, oxygen supplementation may also be beneficial for nonhypoxemic patients as oxygen slows ventilation and reduces dyspnea (8)...
    • ...Can Respir J Vol 15 Suppl C November/December 2008 17C Spectroscopy Spectroscopic measurements during bronchoscopy provides information regarding the physiological state and chemical composition of bronchial tissues (8)...
    • ...Gibson et al’s original systematic review (8) and subsequent updates indicate that those who receive asthma self-management education, visit the doctor regularly and have a written action plan experience fewer urgent visits to the emergency room and physician, hospital admissions, nocturnal awakenings and missed days of work...
    • ...Overall, evidence suggests that action plans supported by self-management education and regular follow-up improve clinical outcomes (8,9,11)...
    • ...Although reasons for hospitalizations vary due to comorbidities (5), acute exacerbations are the main cause, and result in poor quality of life (6) and increased costs (7,8)...
    • ...Third, experimental studies of patients with OSA treated with continuous positive airway pressure (CPAP) have demonstrated reductions in a variety of cardiovascular risk markers including blood pressure, systemic inflammation and endothelial dysfunction (8-10)...
    • ...Several studies have demonstrated that autotitrating CPAP can guide initiation of effective treatment on an ambulatory basis as reliably as polysomnographic CPAP titration in moderate to severe OSA (7,8)...
    • ...28C Can Respir J Vol 15 Suppl C November/December 2008 In addition to the role of HRV-infected epithelial cells in airway inflammation, recent evidence suggests that they also produce a range of growth factors that may be expected to contribute to airway remodelling (8)...
    • ...This observation is supported by a pooled analysis of three studies (5,8,9) of exercise response to bronchodilation in patients with COPD...
    • ...Morphometric changes, such as a reduction in highly oxidative type I fibres in favour of fatigue-susceptible type IIx fibres, predispose patients to fatigue (8,12), and quadriceps mitochondrial enzyme activity is diminished in COPD compared with healthy controls (13)...
    • ...Patients with OSAHS have increased health care expenditures and before diagnosis, patients with SDB use health care services at approximately twice the rate of control subjects (8)...
    • ...Although OSA most often occurs in otherwise healthy children, those with the following abnormalities are at higher risk and may warrant screening: adenotonsillary hypertrophy, craniofacial abnormalities (eg, Down syndrome), neurological disorders (eg, cerebral palsy) and obesity (8,9)...
    • ...Patients with preserved FEV1 may have extensive small airway dysfunction as measured by closing volume and tests of abnormal distribution of ventilation (7-9)...

    Gordon H Guyatt. 1st Canadian Respiratory Conference: A Breath of f resh Air

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