title: Calculation of the capnographic index based on expiratory molar mass-volume-curves--a suitable tool to screen for cystic fibrosis lung disease.
abstract: BACKGROUND
  Volumetric capnography reflecting the course of CO2-exhalation is used to assess ventilation inhomogeneity. Calculation of the slope of expiratory phase 3 and the capnographic index (KPIv) from expirograms allows quantification of extent and severity of small airway impairment. However, technical limitations have hampered more widespread use of this technique. Using expiratory molar mass-volume-curves sampled with a handheld ultrasonic flow sensor during tidal breathing is a novel approach to extract similar information from expirograms in a simpler manner possibly qualifying as a screening tool for clinical routine. The aim of the present study was to evaluate calculation of the KPIv based on molar mass-volume-curves sampled with an ultrasonic flow sensor in patients with CF and controls by assessing feasibility, reproducibility and comparability with the Lung Clearance Index (LCI) derived from multiple breath washout (MBW) used as the reference method.
  
  
  METHODS
  Measurements were performed in patients with CF and healthy controls during a single test occasion using the EasyOne Pro, MBW Module (ndd Medical Technologies, Switzerland).
  
  
  RESULTS
  Capnography and MBW were performed in 87/96 patients with CF and 38/42 controls, with a success rate of 90.6% for capnography. Mean age (range) was 12.1 (4-25) years. Mean (SD) KPIv was 6.94 (3.08) in CF and 5.10 (2.06) in controls (p=0.001). Mean LCI (SD) was 8.0 (1.4) in CF and 6.2 (0.4) in controls (p=<0.001) and correlated significantly with the KPIv (p=<0.001).
  
  
  CONCLUSIONS
  Calculation of the KPIv based on molar mass-volume-curves is feasible. KPIv is significantly different between patients with CF and controls and correlates with the LCI. However, individual data revealed a relevant overlap between patients and controls requiring further evaluation, before this method can be recommended for clinical use.
authors.affiliation: Department of Paediatrics and Research Institute, Marien-Hospital Wesel gGmbH, Pastor Janßen Straße 8-38, 46483 Wesel, Germany.
authors.forename: Susanne I
authors.initials: SI
authors.lastname: Fuchs
authors.forename: Sibylle
authors.initials: S
authors.lastname: Junge
authors.forename: Helmut
authors.initials: H
authors.lastname: Ellemunter
authors.forename: Manfred
authors.initials: M
authors.lastname: Ballmann
authors.forename: Monika
authors.initials: M
authors.lastname: Gappa
mesh_terms: D000293:Adolescent; D019296:Capnography / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000175:diagnosis* / Q000378:metabolism; D045853:Exhalation; D006801:Humans; D011446:Prospective Studies; D055815:Young Adult