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Multiple breath washout: measuring early manifestations of lung pathology

Sanja Stanojevic, Cole Bowerman, Paul Robinson
Breathe 2021 17: 210016; DOI: 10.1183/20734735.0016-2021
Sanja Stanojevic
1Dept of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
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  • ORCID record for Sanja Stanojevic
  • For correspondence: sanja.stanojevic@dal.ca
Cole Bowerman
1Dept of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
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Paul Robinson
2Dept of Respiratory Medicine, Children's Hospital at Westmead, Sydney, Australia
3The Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, Australia
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  • Figure 1
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    Figure 1

    Schematic illustration of a generic inert gas washout system. Hardware required for washout is relatively simple: a flow meter, a fast-responding inert gas analyser, a gas delivery system, and a patient interface. The equipment-related deadspace volume (VD) can be divided into pre- and post-gas sampling points. Post-gas sampling point VD effectively introduces a small rebreathing chamber. Pre-gas sampling point VD is an extension of anatomical VD. Reproduced from [10] with permission.

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    Figure 2

    Example of a washout curve. From top to bottom, the breath-by-breath tracings show the volume/flow (red/black), nitrogen (N2) concentration (red), oxygen (O2) concentration (blue), and carbon dioxide (CO2) concentration (green). In this example there are multiple instances of gas leaks, apparent as increases or spikes in nitrogen concentration, where external nitrogen has been entrained and measured by the system. As the test measures the washout of nitrogen from the lungs, nitrogen contained in room air that enters the system will increase the measured gas concentration and over-estimate the LCI [26].

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    Figure 3

    Bland–Altman plot of the difference in repeated LCI measurements. The difference between LCI measurements is greater at higher LCI values. CF: cystic fibrosis. Reproduced from [31] with permission.

Tables

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  • Table 1

    Summary of potential utility across disease groups

    Disease groupUse
    HealthyAssess airway function in individuals too young to perform spirometry
    AsthmaAssess ventilation inhomogeneity Assess asthma control
    CFDetect early lung damage Tracking longitudinal changes in lung function Assessing response to treatment
    BronchiectasisDetect early peripheral airway involvement
    COPDDetect early peripheral airway involvement
    BOSDetection of early post-transplant BOS
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Vol 17 Issue 3 Table of Contents
Breathe: 17 (3)
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Multiple breath washout: measuring early manifestations of lung pathology
Sanja Stanojevic, Cole Bowerman, Paul Robinson
Breathe Sep 2021, 17 (3) 210016; DOI: 10.1183/20734735.0016-2021

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Multiple breath washout: measuring early manifestations of lung pathology
Sanja Stanojevic, Cole Bowerman, Paul Robinson
Breathe Sep 2021, 17 (3) 210016; DOI: 10.1183/20734735.0016-2021
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