Role of Small Airway Dysfunction in Unexplained Exertional Dyspnoea

Details

• Personal Author:
  Addrizzo-Harris D ; Berger KI ; Bohart I ; Goldring RM ; Kwok B ; Liu M ; Oppenheimer BW ; Reibman J ; Shao Y ; Sharpe AL ; Sterman DH ; Weinstein T
• Description:
  Background: Isolated small airway abnormalities may be demonstrable at rest in patients with normal spirometry; however, the relationship of these abnormalities to exertional symptoms remains uncertain. This study uses an augmented cardiopulmonary exercise test (CPET) to include evaluation of small airway function during and following exercise to unmask abnormalities not evident with standard testing in individuals with dyspnoea and normal spirometry. Methods: Three groups of subjects were studied: 1) World Trade Center (WTC) dust exposure (n=20); 2) Clinical Referral (n=15); and Control (n=13). Baseline evaluation included respiratory oscillometry. Airway function during an incremental workload CPET was assessed by: 1) tidal flow versus volume curves during exercise to assess for dynamic hyperinflation and expiratory flow limitation; and 2) post-exercise spirometry and oscillometry to evaluate for airway hyperreactivity. Results: All subjects demonstrated normal baseline forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC). Dyspnoea was reproduced during CPET in WTC and Clinical Referral groups versus Control without abnormality in respiratory pattern and minute ventilation. Tidal flow-volume curves uncovered expiratory flow limitation and/or dynamic hyperinflation with increased prevalence in WTC and Clinical Referral versus Control (55%, 87% versus 15%; p<0.001). Post-exercise oscillometry uncovered small airway hyperreactivity with increased prevalence in WTC and Clinical Referral versus Control (40%, 47% versus 0%, p<0.05). Conclusions: We uncovered mechanisms for exertional dyspnoea in subject with normal spirometry that was attributable to either small airway dysfunction during exercise and/or small airway hyperreactivity following exercise. The similarity of findings in WTC environmentally exposed and clinically referred cohorts suggests broad relevance for these evaluations. [Description provided by NIOSH]
• Subjects:
  Dust Occupational Health Particulate Matter Respiratory Function Tests Respiratory System Safety September 11 Terrorist Attacks
• Keywords:
  Cardiopulmonary Function Dust Exposure Particulate Dust Respiratory Function Spirometry World Trade Center WTC
• ISSN:
  2312-0541
• Document Type:
  Text
• Funding:
  Cooperative Agreement ; Contract
• Genre:
  Journal Article
• Place as Subject:
  New York ; OSHA Region 2
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  9
• Issue:
  3
• NIOSHTIC Number:
  nn:20069383
• Citation:
  ERJ Open Res 2023 Jun; 9(3):00603-2022
• Contact Point Address:
  Kenneth I. Berger, Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
• Email:
  kenneth.berger@nyumc.org
• Federal Fiscal Year:
  2023
• Performing Organization:
  New York University School of Medicine
• Peer Reviewed:
  True
• Start Date:
  20160901
• Source Full Name:
  European Respiratory Journal Open Research
• End Date:
  20190831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:05bcfaf592e23ed30cf0e80cfeed902ad167d87fc422b41f38df8f5c36d4f4a48e5bc16b448b5b86134e7f3d024c6f7573fcdf20abbfbf1f0a526b7af0b29c59
• Download URL:
  https://stacks.cdc.gov/view/cdc/207872/cdc_207872_DS1.pdf
• File Type:
  [PDF - 546.57 KB ]