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KMID : 1044520240870020165
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Tuberculosis and Respiratory Diseases
2024 Volume.87 No. 2 p.165 ~ p.175
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Oscillometry-Defined Small Airway Dysfunction in Patients with Chronic Obstructive Pulmonary Disease
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Amit K. Rath
Dibakar Sahu
Sajal De
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Abstract
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Background: The prevalence of small airway dysfunction (SAD) in patients with chronicobstructive pulmonary disease (COPD) across different ethnicities is poorly understood.
This study aimed to estimate the prevalence of SAD in stable COPD patients.
Methods: We conducted a cross-sectional study of 196 consecutive stable COPD patients.
We measured pre- and post-bronchodilator (BD) lung function and respiratoryimpedance. The severity of COPD and lung function abnormalities was graded in accordancewith the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines.
SAD was defined as either difference in whole-breath resistance at 5 and 19 Hz >upper limit of normal or respiratory system reactance at 5 Hz < lower limit of normal.
Results: The cohort consisted of 95.9% men, with an average age of 66.3 years. Themean forced expiratory volume 1 second (FEV1) % predicted was 56.4%. The medianCOPD assessment test (CAT) scores were 14. The prevalence of post-BD SAD acrossthe GOLD grades 1 to 4 was 14.3%, 51.1%, 91%, and 100%, respectively. The post-BDSAD and expiratory flow limitation at tidal breath (EFLT) were present in 62.8% (95%confidence interval [CI], 56.1 to 69.9) and 28.1% (95% CI, 21.9 to 34.2), respectively.
COPD patients with SAD had higher CAT scores (15.5 vs. 12.8, p<0.01); poor lung function(FEV1% predicted 46.6% vs. 72.8%, p<0.01); lower diffusion capacity for CO (4.8mmol/min/kPa vs. 5.6 mmol/min/kPa, p<0.01); hyperinflation (ratio of residual volumeto total lung capacity % predicted: 159.7% vs. 129%, p<0.01), and shorter 6-minute walkdistance (367.5 m vs. 390 m, p=0.02).
Conclusion: SAD is present across all severities of COPD. The prevalence of SAD increaseswith disease severity. SAD is associated with poor lung function and highersymptom burden. Severe SAD is indicated by the presence of EFLT.
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KEYWORD
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Chronic Obstructive Pulmonary Disease, Small Airway Dysfunction, Oscillometry, Expiratory Flow Limitation at Tidal Breaths, COPD Assessment Test Score
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