Abstract
Bronchiolitis obliterans (BO) following allogeneic haematopoietic stem cell transplantation (HSCT) affects peripheral airways. Detection of BO is presently delayed by the low sensitivity of spirometry.
We examined the relationship between peripheral airway function and time since HSCT, and compared it with spirometry and clinical indices in 33 clinically stable allogeneic HSCT recipients. The following measurements were performed: lung function, exhaled nitric oxide, forced oscillatory respiratory system resistance and reactance, acinar (Sacin) and conductive airways ventilation heterogeneity and lung clearance index (LCI) measured by multiple breath nitrogen washout. 22 patients underwent repeat visits from which short-term changes were examined.
Median time post HSCT was 12 months. Eight patients were clinically diagnosed as having BO. In multivariate analysis, time since HSCT was predicted by Sacin and forced expiratory volume in 1 s % predicted. 20 patients had abnormal Sacin with normal spirometry, whereas none had airflow obstruction with normal Sacin. Sacin and LCI were the only measures to change significantly between two visits, with both worsening. Change in Sacin was the only parameter to correlate with change in chronic graft-versus-host disease grade.
In conclusion, peripheral airways ventilation heterogeneity worsens with time after HSCT. Sacin may be more sensitive than spirometry in detecting BO at an early stage, which needs confirmation in a prospective study.
- Airway physiology
- airway resistance
- exhaled nitric oxide
- lung function in disease
- obliterative bronchiolitis
- stem cell transplantation
Footnotes
Support Statement
S. Lahzami was supported by Fondation SICPA, Fondation Andreas P. Naef pour la chirurgie thoracique, Fondation pour la recherche et le traitement des maladies respiratoires, and Société Académique Vaudoise. G.G. King was supported by a NH&MRC Practitioner Fellowship. The study was supported in part by University of Sydney Bridging Grant U1089 and the Cooperative Research Centre for Asthma and Airways (project 2.1).
Statement of Interest
A statement of interest for G.G. King can be found at www.erj.ersjournals.com/site/misc/statements.xhtml
- Received February 1, 2011.
- Accepted April 11, 2011.
- ©ERS 2011