Volumetric Capnography to Assess Functional Respiratory Disturbances in Patients with Bronchial Asthma

Spirometry, which implies carrying out forced expiration procedure, frequently, presents a problem, especially in patients with severe asthma, providing no idea of small airways condition. Volumetric capnography has no limitations typical for spirometry.

The aim of the investigation was to study the capabilities of volumetric capnography to determine functional respiratory disturbances in patients with bronchial asthma.

Materials and Methods. 171 male and female patients were examined, including 46 patients with severe bronchial asthma and 42 patients with moderate bronchial asthma. A control group consisted of 83 apparently healthy volunteers. All the subjects under study underwent a clinical examination. In addition, their spirometry and volumetric capnography findings were evaluated using an ultrasound computed spirograph SpiroScout (Ganshorn, Germany) capable of volumetric capnography. In addition, body plethysmography was carried out.

Results. Volumetric capnography revealed the following changes in bronchial asthma patients compared to the controls: phase III inclination angle increase (g/mol·L), which indicates heterogeneity of lung periphery ventilation and perfusion due to small airways pathology, and an emphysema index characterizing pulmonary hyperinflation. Phase III inclination angle alterations were significant in different bronchial asthma severity degrees. A post-bronchodilator test with Salbutamol (400 µg) in the patients with bronchial asthma were found to show an increase in anatomical dead space (ml) and phase II inclination angle decrease (g/mol·L). Phase III inclination angle and an emphysema index of volumetric capnography demonstrated a correlation relationship with spirometry and body plethysmography parameters.

Conclusion. Volumetric capnography extends the concept of the nature and degree of an impaired respiratory function in bronchial asthma. It enables to assess small airways function and determine the presence and extent of lung hyperinflation in patients with bronchial asthma.

1. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention (2015 update).
2. Russian Respiratory Society. Federal’nye klinicheskie rekomendatsii po diagnostike i lecheniyu bronkhial’noy astmy [Federal clinical guidelines on diagnosis and treatment of bronchial asthma]. Moscow; 2016.
3. Ferguson G.T., Enright P.L., Buist A.S., Higgins M.W. Office spirometry for lung health assessment in adults: a consensus statement from the National Lung Health Education Program. Chest 2000; 117(4): 1146–1161, https://doi.org/10.1378/chest.117.4.1146.
4. Miller M.R., Hankinson J., Brusasco V., Burgos F., Casaburi R., Coates A., Crapo R., Enright P., van der Grinten C.P., Gustafsson P., Jensen R., Johnson D.C., MacIntyre N., McKay R., Navajas D., Pedersen O.F., Pellegrino R., Viegi G., Wanger J.; ATS/ERS Task Force. Standardisation of spirometry. Eur Respir J 2005; 26(2): 319–338, https://doi.org/10.1183/09031936.05.00034805.
5. Russian Respiratory Society. Federal’nye klinicheskie rekomendatsii po ispol’zovaniyu metoda spirometrii [Federal clinical guidelines on using spirometry]. Moscow; 2013.
6. Funktsional’naya diagnostika v pul’monologii [Functional diagnostics in pulmonology]. Pod red. Chuchalina A.G. [Chuchalin A.G. (editor)]. Moscow: Atmosfera; 2009; 192 p.
7. Solov’eva A.V., Byalovskiy Yu.Yu., Rakita D.R. The change of capnographic and spirometric indices in metabolic syndrome. Rossiyskiy mediko-biologicheskiy vestnik im. akademika I.P. Pavlova 2009; 3: 1–5.
8. Baraldo S., Saetta M., Cosio M.G. Pathophysiology of the small airways. Semin Respir Crit Care Med 2003; 24(5): 465–472.
9. Burgel P.R., Bourdin A., Chanez P., Chabot F., Chaouat A., Chinet T., de Blic J., Devillier P., Deschildre A., Didier A., Garcia G., Jebrak G., Laurent F., Morel H., Perez T., Pilette C., Roche N., Tillie-Leblond I., Verbanck S., Dusser D. Update on the roles of distal airways in COPD. Eur Respir Rev 2011; 20(119): 7–22, https://doi.org/10.1183/09059180.10010610.
10. Contoli M., Bousquet J., Fabbri L.M., Magnussen H., Rabe K.F., Siafakas N.M., Hamid Q., Kraft M. The small airways and distal lung compartment in asthma and COPD: a time for reappraisal. Allergy 2010; 65(2): 141–151, https://doi.org/10.1111/j.1398-9995.2009.02242.x.
11. Nenasheva N.M. Role of small airways in bronchial asthma. Pul’monologiya i allergologiya 2010; 4: 27–33.
12. Saetta M., Di Stefano A., Rosina C., Thiene G., Fabbri L.M. Quantitative structural analysis of peripheral airways and arteries in sudden fatal asthma. Am Rev Respir Dis 1991; 143(1): 138–143, https://doi.org/10.1164/ajrccm/143.1.138.
13. Carroll N., Cooke C., James A. The distribution of eosinophils and lymphocytes in the large and small airways of asthmatics. Eur Respir J 1997; 10(2): 292–300, https://doi.org/10.1183/09031936.97.10020292.
14. Booker R. Interpretation and evaluation of pulmonary function tests. Nurs Stand 2009; 23(39): 46–56, https://doi.org/10.7748/ns2009.06.23.39.46.c7040.
15. Byalovskiy Yu.Yu., Abrosimov V.N. Kapnografiya v obshchey vrachebnoy praktike [Capnography in general medical practice]. LAP Lambert Academic Publishing; 2014; 136 p.
16. Suarez-Sipmann F., Bohm S.H., Tusman G. Volumetric capnography. Curr Opin Crit Care 2014; 20(3): 333–339, https://doi.org/10.1097/mcc.0000000000000095.
17. Veronez L., Pereira M., Silva S., Barcaui L., Capitani E., Moreira M., Paschoalz I. Volumetric capnography for the evaluation of chronic airways diseases. Int J Chron Obstruct Pulmon Dis 2014; 9(1): 983–989, https://doi.org/10.2147/copd.s62886.
18. Capnography. Gravenstein J.S., Jaffe M.B., Gravenstein N., Paulus D.A. (editors). Cambridge University Press; 2011; 475 p.
19. Almeida C.C., Almeida-Júnior A.A., Ribeiro M.A., Nolasco-Silva M.T., Ribeiro J.D. Volumetric capnography to detect ventilation inhomogeneity in children and adolescents with controlled persistent asthma. J Pediatr 2011; 87(2): 163–168, https://doi.org/10.2223/jped.2077.
20. Qi G.-S., Gu W.-C., Yang W.-L., Xi F., Wu H., Liu J.-M. The ability of volumetric capnography to distinguish between chronic obstructive pulmonary disease patients and normal subjects. Lung 2014; 192(5): 661–668, https://doi.org/10.1007/s00408-014-9615-4.
21. Verschuren F., Liistro G., Coffeng R., Thys F., Roeseler J., Zech F., Reynaert M. Volumetric capnography as a screening test for pulmonary embolism in the emergency department. Chest 2004; 125(3): 841–850, https://doi.org/10.1378/chest.125.3.841.
22. Ponomareva I.B., Subbotin S.V. Possibilities of volumetric capnography method in the study of pulmonary functions in patients with COPD. Nauka molodykh — Eruditio Juvenium 2016; 1: 68–73.
23. Verschuren F., Heinonen E., Clause D., Roeseler J., Thys F., Meert P., Marion E., El Gariani A., Col J., Reynaert M., Liistro G. Volumetric capnography as a bedside monitoring of thrombolysis in major pulmonary embolism. Intensive Care Med 2004; 30(11): 2129–2132, https://doi.org/10.1007/s00134-004-2444-9.
24. Tusman G., Suarez-Sipmann F., Böhm S.H., Pech T., Reissmann H., Meschino G., Scandurra A., Hedenstierna G. Monitoring dead space during recruitment and PEEP titration in an experimental model. Intensive Care Med 2006; 32(11): 1863–1871, https://doi.org/10.1007/s00134-006-0371-7.
25. Cheifetz I.M., Myers T.R. Respiratory therapies in the critical care setting. Should every mechanically ventilated patient be monitored with capnography from intubation to extubation? Respir Care 2007; 52(4): 423–442.
26. Tusman G., Böhm S.H., Sipmann F.S., Maisch S. Lung recruitment improves the efficiency of ventilation and gas exchange during one-lung ventilation anesthesia. Anesth Analg 2004; 98(6): 1604–1609, https://doi.org/10.1213/01.ane.0000068484.67655.1a.
27. Gustafsson P.M., Ljungberg H.K., Kjellman B. Peripheral airway involvement in asthma assessed by single-breath SF6and He washout. Eur Respir J 2003; 21(6): 1033–1039, https://doi.org/10.1183/09031936.03.00049302.
28. Arnold J.H., Stenz R.I., Grenier B., Thompson J.E. Single-breath CO2 analysis as a predictor of lung volume change in a model of acute lung injury. Crit Care Med 2000; 28(3): 760–764, https://doi.org/10.1097/00003246-200003000-00026.
29. Kline J.A., Israel E.G., Michelson E.A., O’Neil B.J., Plewa M.C., Portelli D.C. Diagnostic accuracy of a bedside D-dimer assay and alveolar dead-space measurement for rapid exclusion of pulmonary embolism. JAMA 2001; 285(6): 761–768, https://doi.org/10.1001/jama.285.6.761.
30. Verschuren F., Heinonen E., Clause D., Roeseler J., Thys F., Meert P., Marion E., El Gariani A., Col J., Reynaert M., Liistro G. Volumetric capnography as a bedside monitoring of thrombolysis in major pulmonary embolism. Intensive Care Med 2004; 30(11): 2129–2132, https://doi.org/10.1007/s00134-004-2444-9.
31. Moreira M.M., Terzi R.G., Carvalho C.H., de Oliveira Neto A.F., Pereira M.C., Paschoal I.A. Alveolar dead space and capnographic variables before and after thrombolysis in patients with acute pulmonary embolism. Vasc Health Risk Manag 2008; 5(1): 9–12, https://doi.org/10.2147/vhrm.s4499.
32. Moreira M.M., Terzi R.G., Paschoal I.A., Martins L.C., Oliveira E.P., Falcão A.L. Thrombolysis in massive pulmonary embolism based on the volumetric capnography. Arq Bras Cardiol 2010; 95(4): e97–e99, https://doi.org/10.1590/s0066-782x2010001400025.
33. Kallet R.H., Daniel B.M., Garcia O., Matthay M.A. Accuracy of physiologic dead space measurements in patients with acute respiratory distress syndrome using volumetric capnography: comparison with the metabolic monitor method. Respir Care 2005; 50(4): 462–467.
34. Romero P.V., Lucangelo U., Lopez Aguilar J., Fernandez R., Blanch L. Physiologically based indices of volumetric capnography in patients receiving mechanical ventilation. Eur Respir J 1997; 10(6): 1309–1315, https://doi.org/10.1183/09031936.97.10061309.
35. Koulouris N.G., Latsi P., Stavrou E., Chroneou A., Gaga M., Jordanoglou J. Unevenness of ventilation assessed by the expired CO2 gas volume versus V(T) curve in asthmatic patients. Respir Physiol Neurobiol 2004; 140(3): 293–300, https://doi.org/10.1016/j.resp.2004.01.005.
36. Kars A.H., Goorden G., Stijnen T., Bogaard J.M., Verbraak A.F., Hilvering C. Does phase 2 of the expiratory PCO2 versus volume curve have diagnostic value in emphysema patients? Eur Respir J 1995; 8(1): 86–92, https://doi.org/10.1183/09031936.95.08010086.
37. Romero P.V., Rodriguez B., de Oliveira D., Blanch L., Manresa F. Volumetric capnography and chronic obstructive pulmonary disease staging. Int J Chron Obstruct Pulmon Dis 2007; 2(3): 381–391.
38. Ribeiro M.Â., Silva M.T., Ribeiro J.D., Moreira M.M., Almeida C.C., Almeida-Junior A.A., Ribeiro A.F., Pereira M.C., Hessel G., Paschoal I.A. Volumetric capnography as a tool to detect early peripheric lung obstruction in cystic fibrosis patients. J Pediatr 2012; 88(6): 509–517, https://doi.org/10.2223/jped.2233.

Subbotin S.V., Ponomaryova I.B., Byalovskiy Yu.Yu., Abrosimov V.N. Volumetric Capnography to Assess Functional Respiratory Disturbances in Patients with Bronchial Asthma. Sovremennye tehnologii v medicine 2017; 9(3): 93, https://doi.org/10.17691/stm2017.9.3.13