Scripties UMCG - Rijksuniversiteit Groningen
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COMPASS - study : “Comparison of multiple breath washout and particles in exhaled air for assessment of small airway function in children with cystic fibrosis”

(2018) Verhoog, F.A.

Background In early childhood, cystic fibrosis primarily affects the small airways. Conventional lung function measurements have proven to be unsensitive in detecting alterations in small airway function. There is a pressing need for a non-invasive, simple, feasible and repeatable measurement to detect alterations in small airway function. Particles in Exhaled air (PExA) is a novel method to obtain samples from the small airways in a non-invasive way. Small airway pathology in CF may be assessed using PExA. Currently, there is no prior experience in pediatric setting.
Objective The aim of this exploratory study is to assess the feasibility of the PExA method and to determine the potential added value in the evaluation of small airway disease in pediatric patients with CF, beside multiple breath washout.
Methods CF patients and healthy controls aged 10-18 years were recruited between December 2017 and March 2018. All participants performed PExA, MBW, Body plethysmogragphy, Spirometry and a questionnaire about the feasibility of the PExA.
Results 10 CF patients (11.8-16.5) and 13 healthy controls (11.6 -16.8 years) were eligible for analysis. Overall success rate of the PExA was 96.15% and PExA cost up to 3 times less compared to the MBW. Spirometry parameters (FEV1% predicted, FEF75) and LCI were significant different between healthy controls and CF. Particle mass per litre of exhaled breath (PEx (ng l-1)) did not significantly differ between healthy volunteers and mild CF. PEx (ng l-1) was significantly lower in patients with severe CF (1.05 ± 0.63 vs 0.45 ± 0.19, p = 0.007). A statistically significant moderate negative correlation between LCI and PEx (ng l-1) and a moderate positive correlation between PEx (ng l-1) and FEV1 was found.
Conclusion This exploratory study demonstrates that the PExA method is a non-invasive, simple and feasible measurement in children aged 10-18 years. Based on preliminary data we can conclude that the PExA method can detect severe CF but it remains unclear how reliable the PExA can detect alterations in small airway function in early stages of CF.

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