Results of lung functional parameters measured by plethysmography in stable copd

Nội dung text: Results of lung functional parameters measured by plethysmography in stable copd

1. Journal of military pharmaco-medicine n o7-2017 RESULTS OF LUNG FUNCTIONAL PARAMETERS MEASURED BY PLETHYSMOGRAPHY IN STABLE COPD Pham Thi Phuong Nam*; Dong Khac Hung*; Nguyen Huy Luc*** Summary Objectives: To determine lung functional parameters of 117 patients with stable chronic obstructive pulmonary disease (COPD) at 103 Hospital from October, 2013 to March, 2016 by plethysmography and to study the relationship among these parameters with stages of stable COPD. Methods: A prospective and cross-descriptive study. Results: A decrease in the pulmonary ventilatory indices, difusing capacity for carbon monoxide (DLCO) and the increase in airway resistance, distention pulmonary indices in patients with stable COPD were recorded. In addition to FEV 1 (forced expiratory volume) parameter, MVV (maximal voluntary ventilation), RV/TLC (residual volume/total lung capacity), raw (resistance air way), DLCO (diffusing capacity for carbon monoxide) parameters highly related with the severity of the disease (eta = 0.737; eta = 0.686; eta = 0.414, eta = 0.583), respectively with p < 0.05. Conclusions: There were variations of lung functional parameters and these variations related with the classification of the severity of COPD. MVV, raw, RV/TLC are very important parameters in prognosis the severity of COPD. * Keywords: Lung functional parameters; Chronic obstructive pulmonary disease; Plethysmography; Stable COPD. INTRODUCTION one of the three major components to Chronic obstructive pulmonary disease evaluate the severity of COPD with (COPD) is a respiratory disease with an clinical characteristics and comorbidity increase in morbidity and mortality. In factors. Whole body plethysmography is a 2012, there were about 3 million deaths modern equipment that allows for due to COPD, accounting for nearly 6% of comprehensive and accurate parameters the causes of death. Particularly, in Vietnam, of respiratory functional exploration. In the incidence of disease is quite high Vietnam, the complete exploration is not (6.7%), which is the top of 12 countries in widely applied for patients with COPD. Southeast Asia [11]. Pulmonary ventilation, Therefore, the purpose of this research static lung, resistance airway, diffusion of was to: Assess the result of lung alveoli - capillaries explorations are very functional parameters measured by valuable in the complete evaluation of COPD, plethysmography in stable COPD. * Viettiep Hospital ** Vietnam Military Medical University *** 103 Military Hospital Corresponding author: Pham Phuong Thi Nam (ptpm@gmail.com) Date received: 20/07/2017 Date accepted: 21/08/2017 97
2. Journal of military pharmaco-medicine N o7-2017 SUBJECTS AND METHODS Classify the stages of stable COPD: groups A, B, C, D, GOLD 2016 [9]. 1. Subjects . Determine the mean values of lung 117 patients diagnosed with COPD functional parameters, mean percentage (GOLD 2016) were treated at 103 of predicted value. Predicted value was Hospital from September, 2013 to the end based on Knudson's 1983 standard for of March, 2017, without contradication of Asians. respiratory fronctional exploration, after - Material: The Care Fusion whole the exacerbation of COPD and volunteer body plethysmography is daily calibrated to participate in research. for accuracy, stability, tolerability. 2. Methods. - Lung functional test: Patients were * Study design: Prospective, cross- prepared at least 15 minutes before the descriptive study. test and do not use stimulants. Patients * Sample size calculation: based on were measured for pulmonary ventilation, convenience. pulmonary static volume and resistance airway, in which 75 patients were * Data collection, data grouping, data measured for DLCO. Take 5-minute classification: Age, gender, height, weight. measurement each and repeat this Evaluation for the effect of COPD on the procedure three times. The results are health and patients’ daily life by score mean values of two best times which CAT (COPD Assessment Test) with were different less than 10%. 8 questionnaires for each patients. * Statistical analysis: Statistical Lung functional parameters test for Program for Social Science (SPSS) 117 patients was measured by whole version 16.0. The relation between body plethysmography: FVC, FEV 1, MVV, parameters and severity classification RV, FRC, TLC, Raw, DLCO. were measured by Association of Anova Diagnosis of COPD: Standard GOLD Table. The level of significance was set at 2016. p value of less than 0.05. RESULTS 1. Characteristics of the study patients with stable COPD. Table 1: Characteristics of patients (n = 117) n % 50 - 59 23 19.7% Age (year) 60 - 69 68 58.1% 70 - 80 26 22.2% BMI < 18.5 55 47% BMI 18.5 ≤ BMI < 23 57 48.7% BMI ≥ 23 5 4.3% 98
3. Journal of military pharmaco-medicine n o7-2017 Male 114 97.4% Genders Female 3 2.6% A 16 13.7% B 17 14.5% Classification C 17 14.5% D 67 55.3% Table 1 showed that the patients were over 50 years old and male represented predominantly (97.4%). There were a large proportion of malnutrition patients, 47% of the patients had BMI < 18. Patients in group D (high risks, multiple symptoms group) had the highest proportion (57.3%). 2. Determination of parameters values in patients with COPD. Table 2: Values of lung functional parameters of patients with COPD. Lung functional n Parameters (unit) mean ± SD % parameters VC (lit) 2.36 ± 0.73 84.6 ± 24.8 Pulmonary 117 FEV 1 (lit) 1.19 ± 0.59 51.8 ± 23.9 ventilation MVV (lit) 44.3 ± 23.1 40.0 ± 19.8 TLC (lit) 6.45 ± 1.42 130.5 ± 26.1 Pulmonary FRC (lit) 4.74 ± 1.50 145.6 ± 42.0 117 static RV (lit) 4.08 ± 1.55 207.2 ± 76.7 RV/TLC 0.62 ± 0.13 Pulmonary Raw 117 7.87 ± 4.2 570.0 ± 336.0 mechanic (cmH 2O/lit/second) DLCOadj 12.4 ± 11.2 77.8 ± 29.6 Diffusing capacity (mmolCO/min/mmHg) 75 for carbon monoxide KCOadj 2.9 ± 0.9 77.6 ± 24.4 (mmolCO/lmin/mmHg) There was a decrease in mean value of pulmonary ventilation parameter (VC = 84.6%PRED, FEV 1 = 51.8%PRED, MVV = 40.0%PRED) and diffusion parameter (DLCOadj = 77.8%PRED). This study also indicated a increase in the mean values of pulmonary static parameter (TLC = 130%PRED, FRC = 145%PRED, RV = 207% PRED) and resistance airway (Raw = 570%SLT). 99
4. Journal of military pharmaco-medicine N o7-2017 3. Relationship between parameters values and the stages of COPD. Figure 1: Relationship between pulmonary ventilation parameters and stages of COPD. Figure 2: Relationship between pulmonary statics parameters and stages of COPD. Figure 3: Relationship between raw parameter and stages of COPD. Figure 4: Relationship between the alveolar capillary diffusion and stages of COPD. 100
5. Journal of military pharmaco-medicine n o7-2017 The relationship between parameters musculature system and this measuring of respiratory functional exploration and technique is not only uncomplicated but it the stages of COPD was shown in figure provides standard and early ventilatory 1, 2, 3, 4. In addition to FEV 1, the information as well. Further, Tual’s parameters reflecting high relationship study showed that if MVV value was more with stages of COPD include MVV than 60% of PRED, respiratory complications (eta = 0.701), RV/TLC (eta = 0.686), Raw after surgery were less likely [9]. Thus, (eta = 0.414), DLCO (eta = 0.583). MVV examination was also necessary to DISCUSSION apply the technique of reducing volume pulmonary for patients with COPD for 1. Characteristics of the study patients previous risk of complication. with COPD . In this study, male represented Table 2 also showed an increase in predominantly (97.4%), female made up mean values for pulmonary expansion only 3.2%, which reflects the gender parameters in patients with COPD: mean characteristics of the COPD in Vietnam. TLC = 130.5%PRED, mean FRC = Dinh Ngoc Sy's research showed that the 145.6%PRED, mean RV = 207.2% prevalence in men was higher than that in PRED, mean RV/TLC = 0.628. Fishman women (7.1% vs. 1.9%) [3]. There was a A.P [8] also found that the first change in large proportion of malnutritionpatients the lung volume of patients with COPD (47%). Study by Mai Xuan Khan (2005) was RV values and then increased the also had the same results (38% of FRC value, to TLC value (at the fin). patients had BMI < 18) [1]. There are many causes leading to poor health in Increasing raw value was an early sign patients with COPD: poor eating, in the diagnosis of airway obstruction in anorexia, inadequate diet, fatigue, patients. In patiens with COPD, the depression, while their muscle respiratory resistance of small airway (less than 2 mm must require a lot of energy. In this study, in diameter) was more than 50%. group D (high risk, multiple symptoms) Meanwhile, in healthy people, this rate had the highest number of patients was only 25%. (57.3%). Therefore, patients with COPD In this study, difusing parameters were were hospitalized at the late stage. taken after adjustment for Hb. Table 2 2. Identify the lung functional showed a significant reduction in mean parameters. parameter of alveoli capillary diffusion CO Table 2 showed that a decrease in in patients with COPD; 12.4 ± 11.2 mean values of pulmonary ventilation mmolCO/min/mmHg, respectively, 77.8 ± parameters: mean VC = 84.6%PRED, 29.6%PRED. The main cause of mean FEV1 = 51.8%PRED, mean MVV = decrease in DLCO parameter value is due 40.0%PRED in patients with COPD. MVV to chronic airway obstruction. The KCO or was a parameter of the global respiratory DLCO/VA (carbon monoxide transfer 101
6. Journal of military pharmaco-medicine N o7-2017 coefficient) was also reduced by 2.9 ± 0.9 correlated with dyspne, so it was and only 77.6 ± 24.4%PRED. This is a proposed to evaluate the treatment result of CO transport across 1 unit of efficacy. Figure 3 showed that resistance pulmonary volume. KCO reduction is airway was related (eta = 0.414) with more meaningful than whole reduction of stages of severity of disease. The result DLCO. Because if partial reduction of of figure 4 demonstrated DLCO parameters KCO is usually compensated by also associated moderately with the severity increasing the volume of the alveoli, the A, B, C, D of the COPD (eta = 0.583). total DLCO may not change. However, in In particular, the study showed a patients with emphysema, pulmonary serious and significant change of all capillary was damaged by partial parameters in COPD patients of group D. reduction of vascular system attached. Beside FEV parameter, MVV, RV/TLC Therefore, the alveolar volume may be ratio, Raw, DLCO parameters can also increased, the diffusing capacity of the help to evaluate the patient's prognosis. lungs for carbon monoxide decreases [7]. CONCLUSIONS 3. Relationship between parameters In patients with COPD, there was a values and the stages of COPD. decrease in pulmonary ventilation Figure 1, 2, 3, 4 showed that all parameters value (FEV 1, VC, MVV) and parameters were related with the stages alveolar capillary diffusion (DLCO, KCO) and an increase in the parameters for of A, B, C, D. For pulmonary ventilation lung statics (RV, TLC) and resistance parameters in figure 1, FEV had the 1 airway (Raw). This change associated highestassociation (eta = 0.737), followed with the severity of stages of COPD. In by MVV (eta = 0.701), VC (eta = 0.542). addition to FEV 1 parameter, MVV, RV/TLC, This study confirms that FEV 1, MVV Raw, DLCO parameters were significantly parameters also were alway good related with stages of severity (eta = 0.701, representatives for the classification. eta = 0.686, eta = 0.414, eta = 0.583 with Figure 2 found that in static pulmonary p < 0.05). parameters, the RV/TLC ratio was most strongly related with the classification A, REFERENCES B, C, D (eta = 0.686). The Deesomchok’s 1. Mai Xuân Kh ẩn. Một s ố đặ c điểm lâm study suggested that the extention sàng, ch ức n ăng hô h ấp, n ội soi và t ế bào pulmonary means evaluating the severity dịch r ửa ph ế qu ản c ủa b ệnh ph ổi t ắc ngh ẽn mạn tính. Lu ận án Ti ến s ỹ Y h ọc. H ọc vi ện of the disease [6]. Chen H [5] Quân y. 2005. demonstrated that emphysema had 2. Nguy ễn Huy L ực. Nghiên c ứu đặ c điểm moderate correlation with RV (r = 0.68) thông khí ph ổi và khí máu động m ạch ở b ệnh but only weak correlation with FEV 1 nhân b ệnh ph ổi t ắc ngh ẽn m ạn tính (COPD). (r = -0.13). Casanova C [4] also found Tạp chí Y h ọc Th ực hành. 2010, 4 (712), that RV/TLC ratio was significantly tr.34-35. 102
7. Journal of military pharmaco-medicine n o7-2017 3. Nguy ễn Th ị Xuyên, Đinh Ng ọc S ỹ, 6. Deesomchok A et al. Lung hyperinflation Nguy ễn Vi ết Nhung . Nghiên c ứu tình hình and its reversibility in patients with airway dịch t ễ b ệnh ph ổi ph ế qu ản t ắc ngh ẽn m ạn obstruction of varying severity. COPD. 2010, tính ở Vi ệt Nam. Tạp chí Y h ọc Th ực hành. Vol 7, pp.428-437. 2010, 2 (704), tr.3-8. 7. GOLD. Global initiative for chronic 4. Casanova C et al. Inspiratory-to-total obstructive lung disease. Pocket guide to lung capacity ratio predicts mortality in COPD diagnosis, management and prevention. patients with chronic obstructive pulmonary A guide for Health Care Professionals. disease.Am J Respir Crit Care Med. 2005, Updated 2035. 2016. 171 (6), pp. 591-597. 8. Tual L, Pr Gilles Dhonneur . Quels intérêts 5. Chen H et al. Correlation of pulmonary à la réalisation de EFR en préoperatoire. J function indexes determined by low-dose MDCT with spirometric pulmonary function Verdier. 2007. tests in patients with chronic obstructive 9. Wanc Tan et al . COPD prevalence in 12 pulmonary disease. AJR Am J Roentgenol. Asia-pacific countries and regions. Respirology. 2014, 202 (4), pp.711-718. 2003, 8 (2), pp.192-198. 103