title: Aerosol bolus dispersion in patients with bronchiolitis obliterans after heart-lung and double-lung transplantation. The Munich Lung Transplantation Group.
abstract: Bronchiolitis obliterans (BO) is one of the main late complications in patients after lung transplantation. Because BO is located in small airways, conventional lung function tests are supposed to be rather insensitive to detect early stages of this disease. In this study, the capability of the aerosol bolus dispersion test to detect BO was tested in 12 subjects with heart-lung and double-lung transplantation. Four of these patients had histological evidence of BO. The broadening (dispersion) of inhaled boluses consisting of monodispersed inert test particles during respiration was repeatedly measured in each subject. Additional measurements of spirometric and bodyplethysmographic measurements were performed. Patients with evidence of BO showed significantly increased aerosol bolus dispersion and significantly reduced maximal airflow parameters. Calculation of receiver operating characteristics (ROCs) revealed that from all lung function parameters under consideration, aerosol bolus dispersion divided by the maximum expiratory flow rate at 50% of vital capacity (MEF50) and MEI50 had the highest sensitivity and specificity for the detection of BO. Both parameters showed a sensitivity and specificity of 100%. Therefore, it may be speculated that even in early stages of disease, the combination of MEF50 measurement with aerosol bolus dispersion measurements may be a powerful tool for the detection of BO in patients with lung transplantation.
authors.affiliation: GSF-Research Center for Environment and Health, Institute for Inhalation Biology, Ludwig-Maximilians-Universität, Munich, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Brand
authors.forename: E M
authors.initials: EM
authors.lastname: App
authors.forename: T
authors.initials: T
authors.lastname: Meyer
authors.forename: F
authors.initials: F
authors.lastname: Kur
authors.forename: C
authors.initials: C
authors.lastname: Müller
authors.forename: H
authors.initials: H
authors.lastname: Dienemann
authors.forename: B
authors.initials: B
authors.lastname: Reichart
authors.forename: G
authors.initials: G
authors.lastname: Fruhmann
authors.forename: J
authors.initials: J
authors.lastname: Heyder
mesh_terms: D000293:Adolescent; D000328:Adult; D000336:Aerosols / Q000008:administration & dosage / Q000494:pharmacology*; D001989:Bronchiolitis Obliterans / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D016041:Heart-Lung Transplantation / Q000009:adverse effects*; D006801:Humans; D008168:Lung / Q000502:physiology; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008448:Maximal Expiratory Flow Rate; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D012129:Respiratory Function Tests; D012680:Sensitivity and Specificity