Respiratory impedance and response to salbutamol in healthy individuals and patients with COPD.

BACKGROUND: Recent studies suggested that the bronchodilator response depends on airway obstruction. The forced oscillation technique (FOT) may help improve our understanding of the changes in respiratory mechanics that occur after the application of a bronchodilator. OBJECTIVES: We aimed to (1) assess the response to salbutamol and to compare the impedance changes in healthy individuals and COPD patients, (2) investigate the effects of airway obstruction on this response and (3) evaluate the utility of the FOT as a complementary measurement to assess the response to the bronchodilator. METHODS: Twenty-five healthy individuals and 82 patients with COPD were assessed with the FOT followed by spirometry before and after the use of salbutamol. RESULTS: The changes exhibited by the COPD subgroups were greater than in the healthy individuals (p < 0.05). Increased obstruction resulted in decreased reductions in mean resistance and increased improvements in mean reactance (p < 0.001). In addition, the bronchodilation reduced the ventilation heterogeneity and the impedance modulus in all COPD stages (p < 0.05). The correlation coefficients for the spirometric and FOT changes were low (0.21-0.38). CONCLUSIONS: In the initial phases of COPD (stage I), the effects of bronchodilation are greater than in healthy volunteers. The bronchodilator use improved the oscillatory mechanics in all of the studied groups of COPD patients. These improvements are reduced in more advanced phases of airway obstruction (II, III and IV). The FOT provides information that complements the data supplied by spirometry, contributing to an improvement in the evaluation of the bronchodilator response in COPD.

On the respiratory mechanics measured by forced oscillation technique in patients with systemic sclerosis.

BACKGROUND: Pulmonary complications are the most common cause of death and morbidity in systemic sclerosis (SSc). The forced oscillation technique (FOT) offers a simple and detailed approach to investigate the mechanical properties of the respiratory system. We hypothesized that SSc may introduce changes in the resistive and reactive properties of the respiratory system, and that FOT may help the diagnosis of these abnormalities. METHODOLOGY/PRINCIPAL FINDINGS: We tested these hypotheses in controls (n = 30) and patients with abnormalities classified using spirometry (n = 52) and pulmonary volumes (n = 29). Resistive data were interpreted with the zero-intercept resistance (Ri) and the slope of the resistance (S) as a function of frequency. Reactance changes were evaluated by the mean reactance between 4 and 32 Hz (Xm) and the dynamic compliance (Crs,dyn). The mechanical load was evaluated using the absolute value of the impedance in 4 Hz (Z4Hz). A compartmental model was used to obtain central (R) and peripheral (Rp) resistances, and alveolar compliance (C). The clinical usefulness was evaluated by investigating the area under the receiver operating characteristic curve (AUC). The presence of expiratory flow limitation (EFL) was also evaluated. For the groups classified using spirometry, SSc resulted in increased values in Ri, R, Rp and Z4Hz (p<0.003) and reductions in Crs,dyn, C and Xm (p<0.004). Z4Hz, C and Crs,dyn exhibited a high diagnostic accuracy (AUC>0.90). In groups classified by pulmonary volume, SSc resulted in reductions in S, Xm, C and Crs,dyn (p<0.01). Xm, C and Crs,dyn exhibited adequate diagnostic accuracy (AUC>0.80). It was also observed that EFL is not common in patients with SSc. CONCLUSIONS/SIGNIFICANCE: This study provides evidence that the respiratory resistance and reactance are changed in SSc. This analysis provides a useful description that is of particular significance for understanding respiratory pathophysiology and to ease the diagnosis of respiratory abnormalities in these patients.

Improved instrumentation for blood flow velocity measurements in the microcirculation of small animals.

Microcirculation is the generic name of vessels with internal diameter less than 100 microm of the circulatory system, whose main functions are tissue nutrition and oxygen supply. In microcirculatory studies, it is important to know the amount of oxyhemoglobin present in the blood and how fast it is moving. The present work describes improvements introduced in a classical hardware-based instrument that has usually been used to monitor blood flow velocity in the microcirculation of small animals. It consists of a virtual instrument that can be easily incorporated into existing hardware-based systems, contributing to reduce operator related biases and allowing digital processing and storage. The design and calibration of the modified instrument are described as well as in vitro and in vivo results obtained with electrical models and small animals, respectively. Results obtained in in vivo studies showed that this new system is able to detect a small reduction in blood flow velocity comparing arteries and arterioles (p <0.002) and a further reduction in capillaries (p<0.0001). A significant increase in velocity comparing capillaries and venules (p <0.001) and venules and veins (p <0.001) was also observed. These results are in close agreement with biophysical principles. Moreover, the improvements introduced in the device allowed us to clearly observe changes in blood flow introduced by a pharmacological intervention, suggesting that the system has enough temporal resolution to track these microcirculatory events. These results were also in close conformity to physiology, confirming the high scientific potential of the modified system and indicating that this instrument can also be useful for pharmacological evaluations.