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John, T; Kovacs, G; Douschan, P; Foris, V; Gumpoldsberger, M; John, N; Zeder, K; Zirlik, A; Olschewski, H; Pienn, M.
Detection of structural pulmonary changes with real-time high-fidelity analysis of expiratory CO₂.
J Breath Res. 2025; 19(4): Doi: 10.1088/1752-7163/adf253
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Leading authors Med Uni Graz: John Teresa
Co-authors Med Uni Graz: Douschan Philipp; Foris Vasile; John Nikolaus; Kovacs Gabor; Olschewski Horst; Pienn Michael; Zeder Katarina Eleonora; Zirlik Andreas
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Abstract:: There is an unmet need for breath-based markers for pulmonary vascular disease (PVD). We developed a fully-automatic algorithm to analyze expiratory CO₂flow from resting ventilation and evaluated the clinical associations of our readouts. We enrolled patients with chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), pulmonary arterial hypertension (PAH) and healthy controls and evaluated fractionated volumes for dead space, mixed space (MSV) and alveolar space, their respective CO₂volumes and ventilatory equivalents for CO₂(EqCO₂) and the maximum slope of the first derivative of the cumulative expiratory CO₂volume over expired volume (MSV-slope) as primary readouts. Differences between groups were analyzed using non-parametric tests. Associations were analyzed by Spearman correlation. The discriminatory power was determined with receiver operating characteristic analysis. Eleven COPD (median (IQR) age 64 (63-69) years), 10 ILD (61 (54-77) years), 10 PAH (64 (61-73) years) and 21 healthy controls (56 (52-61) years) were investigated. Patients vs healthy controls showed increased MSV and mixed space CO₂(221 (164-270) ml vs 144 (131-167) ml, and 3.9 (3.2-4.9) ml vs 3.0 (2.7-3.4) ml,p< 0.001 andp= 0.002) and EqCO₂(38 (34-42) vs 30 (29-35),p< 0.001), and decreased MSV-slopes (0.16 (0.12-0.21) vs 0.27 (0.23-0.32) l CO₂l^-2,p< 0.001). Area under the curve (AUC) for MSV and MSV-slope for disease prediction was 0.81 (95% CI 0.69-0.93) and 0.84 (0.73-0.95), respectively. MSV and mixed space CO₂were only strongly increased in COPD and ILD but not PAH, resulting in a significant difference between PAH and COPD&ILD (AUC 0.74 (95% CI: 0.56-0.92). MSV and MSV-slope were significantly correlated with DLCO (ρ=-0.69 andρ= 0.72, respectively; bothp< 0.001). Fully-automatic high-fidelity expiratory CO₂flow analysis is technically feasible, easy and safe to perform, and may represent a novel approach to detect PVD with or without structural changes of the airways and lung parenchyma. Prospective studies with larger sample size are needed to validate these findings.
Find related publications in this database (using NLM MeSH Indexing): Humans - administration & dosage; Middle Aged - administration & dosage; Carbon Dioxide - analysis, metabolism; Male - administration & dosage; Female - administration & dosage; Aged - administration & dosage; Pulmonary Disease, Chronic Obstructive - physiopathology, diagnosis; Exhalation - administration & dosage; Lung - physiopathology, pathology; Lung Diseases, Interstitial - physiopathology, diagnosis; Algorithms - administration & dosage; Respiratory Function Tests - methods; Case-Control Studies - administration & dosage; Breath Tests - methods
Find related publications in this database (Keywords): expiratory CO2 analysis; gas analysis; lung function; pulmonary arterial hypertension; pulmonary structural changes