Predictive anatomical factors of lung aerosol deposition in obese individuals. Would modified mallampati score be relevant? Clinical trial.

Autor: Rocha T; Department of Physiotherapy, Universidade Federal do Rio Grande do Norte, Natal, Brazil., Rattes C; Department of Physiotherapy, Universidade Federal de Pernambuco, Recife, Brazil., Morais C; Department of Pneumology, Universidade de São Paulo, São Paulo, Brazil., Souza R; Department of Physiotherapy, Universidade Federal do Rio Grande do Norte, Natal, Brazil., Rolim N; Imaging Medicine, Hospital das Clínicas da UFPE, Universidade Federal de Pernambuco, Recife, Brazil., Brandão S; Department of Nuclear Medicine, Hospital das Clínicas da UFPE, Recife, Brazil., Fink JB; Rush University, Chicago, IL, USA., Dornelas de Andrade A; Department of Physiotherapy, Universidade Federal de Pernambuco, Recife, Brazil. Electronic address: armele.andrade@ufpe.br.
Jazyk: angličtina
Zdroj: Respiratory medicine [Respir Med] 2020 Sep; Vol. 171, pp. 106083. Date of Electronic Publication: 2020 Jul 12.
DOI: 10.1016/j.rmed.2020.106083
Abstrakt: Background: Obesity is a highly prevalent condition worldwide that aggravates symptoms of already existing conditions such as asthma and COPD. The limited effectiveness of inhaled medications in these individuals may be related to anatomic characteristics of their upper airways, mainly due to compressive factors.
Methods: Controlled clinical trial with obese and nonobese individuals. The following variables were evaluated: anthropometric characteristics, Lung and airway deposition of radiolabeled aerosol (pulmonary scintigraphy), upper airways anatomy (CT scans), and modified Mallampati score.
Results: 29 subjects (17 nonobese and 12 obese) participated. Obese volunteers presented 30% lower aerosol lung deposition compared to nonobese. Moreover, obese subjects Mallampati classification of 4 presented an aerosol lung deposition two times lower than nonobese subjects (p = 0.021). The cross-sectional area of the retropalatal region and retroglossal region were lower in obese patients (p < 0.05), but no correlation to aerosol lung deposition was observed. BMI was associated with 32% of the variance of lung deposition (p < 0.001; β -0.28; 95% CI -0.43 to -0.11).
Conclusion: High BMI correlated to reduced percentage lung deposition. Also, modified Mallampati class 4 was even more detrimental to aerosol delivery into the lungs. Obese subjects have narrower upper airways, compared to nonobese, but this is not reflected in higher radiolabeled aerosol impaction into their oropharynx and does not predict the percentage of lung deposition in this group.
Clinical Trial Registration: NCT03031093 (clinicaltrials.org).
(Copyright © 2020 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: