BMJ open respiratory research · 2025
Standard pulmonary function tests and respiratory oscillometry patterns in hypersensitivity pneumonitis and idiopathic pulmonary fibrosis.
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Wu Joyce K Y, Xu Jessica Jia-Ni, Numakura Tadahisa, Ryan Clodagh M, McInnis Micheal Chad, Binnie Matthew, Shapera Shane, Fisher Jolene H, Hantos Zoltán, Chow Chung-Wai
Аннотация
BACKGROUND: Hypersensitivity pneumonitis (HP) is an interstitial lung disease (ILD) caused by repeated exposure to inhaled antigens, leading to small airway and parenchymal inflammation. Diagnosis is based on a detailed clinical history, chest imaging and invasive tests such as bronchoalveolar lavage. Distinguishing HP from other ILDs is challenging. Respiratory oscillometry, a novel pulmonary function test (PFT), is highly sensitive to small airway abnormalities. Oscillometry measurement of reactance is strongly correlated with gender-age-physiology score, a prognostic tool used to predict mortality and disease severity in idiopathic pulmonary fibrosis (IPF).
OBJECTIVE: To determine if oscillometry and standard PFT patterns are different in HP and IPF.
METHODS: 39 HP (79.5% with fibrotic HP) were enrolled from October 2022 to December 2023 for oscillometry before clinically-indicated standard PFTs and compared with 39 age-matched and sex-matched patients with IPF who also had same day oscillometry and standard PFTs. The main oscillometry metrics of interest were R5-19 (the difference in resistance from 5 to 19 Hz, a metric of small airway function and ventilatory inhomogeneity that increases with worsening respiratory mechanics), X5 (reactance at 5 Hz) which primarily reflects respiratory elastance and AX (area of reactance), a summative measure of the respiratory system stiffness across a range of frequencies, that behaves similarly but in opposite direction to X5.
RESULTS: Patients with HP exhibited higher residual volume/total lung capacity (RV/TLC), lower per cent predicted (%) forced expiratory volume in 1 s (FEV1) and % predicted forced vital capacity (FVC) than IPF (p<0.05) while FEV1/FVC and %TLC were similar. Oscillometry showed higher R5-19 in HP. RV/TLC ratio correlated with AX (r2=0.72), X5 (r2=0.66) and R5-19 (r2=0.64).
CONCLUSION: Gas trapping (RV/TLC>0.40) is a feature of HP not observed in IPF. The strong correlations of RV/TLC with AX, X5 and R5-19 suggest that oscillometry can provide non-invasive markers of small airway obstruction in HP that can differentiate it from IPF.
OBJECTIVE: To determine if oscillometry and standard PFT patterns are different in HP and IPF.
METHODS: 39 HP (79.5% with fibrotic HP) were enrolled from October 2022 to December 2023 for oscillometry before clinically-indicated standard PFTs and compared with 39 age-matched and sex-matched patients with IPF who also had same day oscillometry and standard PFTs. The main oscillometry metrics of interest were R5-19 (the difference in resistance from 5 to 19 Hz, a metric of small airway function and ventilatory inhomogeneity that increases with worsening respiratory mechanics), X5 (reactance at 5 Hz) which primarily reflects respiratory elastance and AX (area of reactance), a summative measure of the respiratory system stiffness across a range of frequencies, that behaves similarly but in opposite direction to X5.
RESULTS: Patients with HP exhibited higher residual volume/total lung capacity (RV/TLC), lower per cent predicted (%) forced expiratory volume in 1 s (FEV1) and % predicted forced vital capacity (FVC) than IPF (p<0.05) while FEV1/FVC and %TLC were similar. Oscillometry showed higher R5-19 in HP. RV/TLC ratio correlated with AX (r2=0.72), X5 (r2=0.66) and R5-19 (r2=0.64).
CONCLUSION: Gas trapping (RV/TLC>0.40) is a feature of HP not observed in IPF. The strong correlations of RV/TLC with AX, X5 and R5-19 suggest that oscillometry can provide non-invasive markers of small airway obstruction in HP that can differentiate it from IPF.