Identifying Bronchoconstriction from the Ratio of Diaphragm EMG to Tidal Volume

Bai-Ting He; Ying-Mei Luo; Li-Shuang Wang; Yong-Yi Chen; Caroline Jolley; Joerg Steier; John Moxham; Michael L Polkey; Yuanming Luo

doi:10.1016/j.resp.2021.103692

Identifying Bronchoconstriction from the Ratio of Diaphragm EMG to Tidal Volume

Bai-Ting He, Ying-Mei Luo, Li-Shuang Wang, Yong-Yi Chen, Caroline Jolley, Joerg Steier, John Moxham, Michael L Polkey, Yuanming Luo

Centre for Human & Applied Physiological Sciences

Research output: Contribution to journal › Article › peer-review

3 Citations (Scopus)

Abstract

Background: A fall of ≥ 20 % in forced expiratory volume in the first second (FEV1) with a cumulative dose of histamine ≤ 7.8 μmol is considered to indicate bronchial hyperactivity, but no method exists for patients who cannot perform spirometry properly. Here we hypothesized that increases in respiratory central output measured by chest wall electromyography of the diaphragm (EMGdi-c) expressed as a function of tidal volume (EMGdi-c/VT) would have discriminative power to detect a ‘positive’ challenge test. Methods: In a physiological study EMGdi was recorded from esophageal electrode (EMGdi-e) in 16 asthma patients and 16 healthy subjects during a histamine challenge test. In a second study, EMGdi from chest wall surface electrodes (EMGdi-c) was measured during a histamine challenge in 44 asthma patients and 51 healthy subjects. VT was recorded from a digital flowmeter during both studies. Results: With histamine challenge test the change in EMGdi-e/VT in patients with asthma was significantly higher than that in healthy subjects (104.2 % ± 48.6 % vs 0.03 % ± 17.1 %, p < 0.001). Similarly there was a significant difference in the change of EMGdi-c/VT between patients with asthma and healthy subjects (90.5 % ± 75.5 % vs 2.4 % ± 21.7 %, p < 0.001). At the optimal cut-off point (29 % increase in EMGdi-c/VT), the area under the ROC curve (AUC) for detection of a positive test was 0.91 (p < 0.001) with sensitivity 86 % and specificity 92 %. Conclusions: We conclude that EMGdi-c/VT may be used as an alternative for the assessment of bronchial hypersensitivity and airway reversibility to differentiate patients with asthma from healthy subjects.

Original language	English
Article number	103692
Pages (from-to)	103692
Journal	RESPIRATORY PHYSIOLOGY AND NEUROBIOLOGY
Volume	291
Early online date	18 May 2021
DOIs	https://doi.org/10.1016/j.resp.2021.103692
Publication status	Published - Sept 2021

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@article{66732c60c6134c418398f4f1438c8df9,

title = "Identifying Bronchoconstriction from the Ratio of Diaphragm EMG to Tidal Volume",

abstract = "Background: A fall of ≥ 20 % in forced expiratory volume in the first second (FEV1) with a cumulative dose of histamine ≤ 7.8 μmol is considered to indicate bronchial hyperactivity, but no method exists for patients who cannot perform spirometry properly. Here we hypothesized that increases in respiratory central output measured by chest wall electromyography of the diaphragm (EMGdi-c) expressed as a function of tidal volume (EMGdi-c/VT) would have discriminative power to detect a {\textquoteleft}positive{\textquoteright} challenge test. Methods: In a physiological study EMGdi was recorded from esophageal electrode (EMGdi-e) in 16 asthma patients and 16 healthy subjects during a histamine challenge test. In a second study, EMGdi from chest wall surface electrodes (EMGdi-c) was measured during a histamine challenge in 44 asthma patients and 51 healthy subjects. VT was recorded from a digital flowmeter during both studies. Results: With histamine challenge test the change in EMGdi-e/VT in patients with asthma was significantly higher than that in healthy subjects (104.2 % ± 48.6 % vs 0.03 % ± 17.1 %, p < 0.001). Similarly there was a significant difference in the change of EMGdi-c/VT between patients with asthma and healthy subjects (90.5 % ± 75.5 % vs 2.4 % ± 21.7 %, p < 0.001). At the optimal cut-off point (29 % increase in EMGdi-c/VT), the area under the ROC curve (AUC) for detection of a positive test was 0.91 (p < 0.001) with sensitivity 86 % and specificity 92 %. Conclusions: We conclude that EMGdi-c/VT may be used as an alternative for the assessment of bronchial hypersensitivity and airway reversibility to differentiate patients with asthma from healthy subjects.",

author = "Bai-Ting He and Ying-Mei Luo and Li-Shuang Wang and Yong-Yi Chen and Caroline Jolley and Joerg Steier and John Moxham and Polkey, {Michael L} and Yuanming Luo",

note = "Funding Information: This study was supported by Chinese National Key Research Project (Grant No. 2016YFC1304200 ), Guangdong Major Project (Grant No. 2016B010108011 ), Independent Project of State Key Laboratory of Respiratory Disease (Grant No. SKLRD-Z-202011 ) and National Natural Science Foundation of China (Grant Number: 82070090 ). Publisher Copyright: {\textcopyright} 2021 Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

month = sep,

doi = "10.1016/j.resp.2021.103692",

language = "English",

volume = "291",

pages = "103692",

journal = "RESPIRATORY PHYSIOLOGY AND NEUROBIOLOGY",

issn = "1569-9048",

publisher = "Elsevier",

}

TY - JOUR

T1 - Identifying Bronchoconstriction from the Ratio of Diaphragm EMG to Tidal Volume

AU - He, Bai-Ting

AU - Luo, Ying-Mei

AU - Wang, Li-Shuang

AU - Chen, Yong-Yi

AU - Jolley, Caroline

AU - Steier, Joerg

AU - Moxham, John

AU - Polkey, Michael L

AU - Luo, Yuanming

N1 - Funding Information: This study was supported by Chinese National Key Research Project (Grant No. 2016YFC1304200 ), Guangdong Major Project (Grant No. 2016B010108011 ), Independent Project of State Key Laboratory of Respiratory Disease (Grant No. SKLRD-Z-202011 ) and National Natural Science Foundation of China (Grant Number: 82070090 ). Publisher Copyright: © 2021 Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/9

Y1 - 2021/9

N2 - Background: A fall of ≥ 20 % in forced expiratory volume in the first second (FEV1) with a cumulative dose of histamine ≤ 7.8 μmol is considered to indicate bronchial hyperactivity, but no method exists for patients who cannot perform spirometry properly. Here we hypothesized that increases in respiratory central output measured by chest wall electromyography of the diaphragm (EMGdi-c) expressed as a function of tidal volume (EMGdi-c/VT) would have discriminative power to detect a ‘positive’ challenge test. Methods: In a physiological study EMGdi was recorded from esophageal electrode (EMGdi-e) in 16 asthma patients and 16 healthy subjects during a histamine challenge test. In a second study, EMGdi from chest wall surface electrodes (EMGdi-c) was measured during a histamine challenge in 44 asthma patients and 51 healthy subjects. VT was recorded from a digital flowmeter during both studies. Results: With histamine challenge test the change in EMGdi-e/VT in patients with asthma was significantly higher than that in healthy subjects (104.2 % ± 48.6 % vs 0.03 % ± 17.1 %, p < 0.001). Similarly there was a significant difference in the change of EMGdi-c/VT between patients with asthma and healthy subjects (90.5 % ± 75.5 % vs 2.4 % ± 21.7 %, p < 0.001). At the optimal cut-off point (29 % increase in EMGdi-c/VT), the area under the ROC curve (AUC) for detection of a positive test was 0.91 (p < 0.001) with sensitivity 86 % and specificity 92 %. Conclusions: We conclude that EMGdi-c/VT may be used as an alternative for the assessment of bronchial hypersensitivity and airway reversibility to differentiate patients with asthma from healthy subjects.

AB - Background: A fall of ≥ 20 % in forced expiratory volume in the first second (FEV1) with a cumulative dose of histamine ≤ 7.8 μmol is considered to indicate bronchial hyperactivity, but no method exists for patients who cannot perform spirometry properly. Here we hypothesized that increases in respiratory central output measured by chest wall electromyography of the diaphragm (EMGdi-c) expressed as a function of tidal volume (EMGdi-c/VT) would have discriminative power to detect a ‘positive’ challenge test. Methods: In a physiological study EMGdi was recorded from esophageal electrode (EMGdi-e) in 16 asthma patients and 16 healthy subjects during a histamine challenge test. In a second study, EMGdi from chest wall surface electrodes (EMGdi-c) was measured during a histamine challenge in 44 asthma patients and 51 healthy subjects. VT was recorded from a digital flowmeter during both studies. Results: With histamine challenge test the change in EMGdi-e/VT in patients with asthma was significantly higher than that in healthy subjects (104.2 % ± 48.6 % vs 0.03 % ± 17.1 %, p < 0.001). Similarly there was a significant difference in the change of EMGdi-c/VT between patients with asthma and healthy subjects (90.5 % ± 75.5 % vs 2.4 % ± 21.7 %, p < 0.001). At the optimal cut-off point (29 % increase in EMGdi-c/VT), the area under the ROC curve (AUC) for detection of a positive test was 0.91 (p < 0.001) with sensitivity 86 % and specificity 92 %. Conclusions: We conclude that EMGdi-c/VT may be used as an alternative for the assessment of bronchial hypersensitivity and airway reversibility to differentiate patients with asthma from healthy subjects.

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Identifying Bronchoconstriction from the Ratio of Diaphragm EMG to Tidal Volume

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