Lung clearance index is a sensitive, repeatable and practical measure of airways disease in adults with cystic fibrosis

• Published in: Thorax Vol. 63; no. 2; pp. 135 - 140
• Main Authors: Horsley, A R, Gustafsson, P M, Macleod, K A, Saunders, C, Greening, A P, Porteous, D J, Davies, J C, Cunningham, S, Alton, E W F W, Innes, J A
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Thoracic Society 01.02.2008; BMJ; BMJ Publishing Group LTD
• Subjects: Adolescent; Adult; Adults; Age; Asthma; Biological and medical sciences; Cardiology. Vascular system; Case-Control Studies; Child; complications; Cystic Fibrosis; Cystic Fibrosis - complications; Cystic Fibrosis - physiopathology; diagnosis; Errors of metabolism; Female; Forced Expiratory Volume; Gases; Gene therapy; Humans; Lung Diseases; Lung Diseases - diagnosis; Lungs; Male; Medical sciences; Metabolic diseases; Methods; Microbiology in the Medical Area; Middle Aged; Mikrobiologi inom det medicinska området; Miscellaneous hereditary metabolic disorders; physiopathology; Pneumology; Reproducibility of Results; Respiratory Function Tests; Respiratory Function Tests - methods; Respiratory Function Tests - standards; Sensitivity and Specificity; Software; Studies; Ventilation; Human; Respiratory disease; Lung; Metabolic diseases; Cystic fibrosis; Index; Clearance; Genetic disease; Respiratory tract; Digestive diseases; Adult; Anesthesia; Circulatory system; Cardiology; Pancreatic disease
• ISSN: 0040-6376; 1468-3296; 1468-3296
• DOI: 10.1136/thx.2007.082628

Background: Lung clearance index (LCI) is a sensitive marker of early lung disease in children but has not been assessed in adults. Measurement is hindered by the complexity of the equipment required. The aims of this study were to assess performance of a novel gas analyser (Innocor) and to use it as a clinical tool for the measurement of LCI in cystic fibrosis (CF). Methods: LCI was measured in 48 healthy adults, 12 healthy school-age children and 33 adults with CF by performing an inert gas washout from 0.2% sulfur hexafluoride (SF6). SF6 signal:noise ratio and 10–90% rise time of Innocor were compared with a mass spectrometer used in similar studies in children. Results: Compared with the mass spectrometer, Innocor had a superior signal:noise ratio but a slower rise time (150 ms vs 60 ms) which may limit its use in very young children. Mean (SD) LCI in healthy adults was significantly different from that in patients with CF: 6.7 (0.4) vs 13.1 (3.8), p<0.001. Ten of the patients with CF had forced expiratory volume in 1 s ⩾80% predicted but only one had a normal LCI. LCI repeats were reproducible in all three groups of subjects (mean intra-visit coefficient of variation ranged from 3.6% to 5.4%). Conclusions: Innocor can be adapted to measure LCI and affords a simpler alternative to a mass spectrometer. LCI is raised in adults with CF with normal spirometry, and may prove to be a more sensitive marker of the effects of treatment in this group.