Multiple-breath N2 washouts were performed before and after bronchodilation in 15 patients with moderately severe asthma (mean age 13 years), and in 11 patients with cystic fibrosis (CF; mean age 16 years) matched for FEV1. Eighteen healthy subjects (mean age 15 years) were studied before bronchodilation. The lung clearance index (LCI) was determined from the washout curve and gas trapping was assessed from five subsequent large breaths. Analysis of the progression of the concentration normalized phase III slopes (Sn(III)) over the washout was used to determine inhomogeneity in the conducting airways (S(cond)) and inhomogeneity close to or within the gas exchange zone (S(acin)). Before bronchodilation all washout indexes were abnormal in the CF group, and all but S(acin) in the asthma group. Two indexes were higher in CF than in asthma: LCI (11.5 (3.3) vs. 8.7 (1.3); P < 0.01), and S(acin) (0.307 (0.207) vs. 0.142 (0.071); P < 0.01), while gas trapping indexes and S(cond) (0.151 (0.071) vs. 0.127 (0.041)) did not differ significantly. After bronchodilation, all indexes improved in asthma and only S(cond) remained abnormally elevated. In CF, only a modest but statistically significant S(acin) improvement was seen and all indexes...Continue Reading
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