{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T15:45:42Z","timestamp":1750952742139,"version":"3.37.3"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T00:00:00Z","timestamp":1727913600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T00:00:00Z","timestamp":1727913600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100004325","name":"AstraZeneca","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004325","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007560","name":"Chiesi Farmaceutici","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007560","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Respir Res"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Expiratory flow limitation (EFL) can be detected using oscillometric reactance and is associated with a worse clinical presentation in chronic obstructive pulmonary disease (COPD). Reactance can show negative swings upon exhalation, which may develop at different rates between patients. We propose a new method to quantify the rate of EFL development; the EFL Development Index (ELDI).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A retrospective analysis of data from 124 COPD patients was performed. Data included lung function tests, Impulse Oscillometry (IOS), St Georges Respiratory Questionnaire (SGRQ), modified Medical Research Council (mMRC) scale and COPD Assessment Test (CAT) score. Fifty four patients had repeat data after 6\u00a0months. Twenty two patients had data recorded after 5\u00a0days of treatment with long acting bronchodilator therapy. EDLI was calculated as the mean expiratory reactance divided by the minimum expiratory reactance.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The mean ELDI was used to categorise patients with rapid onset of EFL (&gt;\u20090.63; n\u2009=\u200929) or gradual onset (\u2264\u20090.63; n\u2009=\u200934). Those with rapid development had worse airflow obstruction, lower quality of life scores, and greater resting hyperinflation, compared to those with gradual development. In patients with EFL, ELDI correlated with symptoms scores, airflow obstruction, lung volumes and gas diffusion. Both EFL and ELDI were stable over 6\u00a0months. EFL and EDLI improved with bronchodilator treatment.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>COPD patients with rapid EFL development (determined by ELDI) had worse clinical characteristics than those with gradual EFL development. The rate of EFL development appears to be associated with clinical and physiological characteristics.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12931-024-02972-2","type":"journal-article","created":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T03:52:00Z","timestamp":1727927520000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Expiratory flow limitation development index (ELDI): a novel method of assessing respiratory mechanics in COPD"],"prefix":"10.1186","volume":"25","author":[{"given":"James","family":"Dean","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen J.","family":"Fowler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dave","family":"Singh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Augusta","family":"Beech","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,10,3]]},"reference":[{"key":"2972_CR1","unstructured":"GOLD. 2024. https:\/\/goldcopd.org\/2024-gold-report\/"},{"key":"2972_CR2","first-page":"198","volume":"8","author":"E Pompe","year":"2021","unstructured":"Pompe E, Moore CM, Mohamed Hoesein FAA, et al. Progression of emphysema and small airways disease in cigarette smokers. Chronic Obstr Pulm Dis. 2021;8:198\u2013212.","journal-title":"Chronic Obstr Pulm Dis"},{"key":"2972_CR3","doi-asserted-by":"publisher","first-page":"2645","DOI":"10.1056\/NEJMoa032158","volume":"350","author":"JC Hogg","year":"2004","unstructured":"Hogg JC, Chu F, Utokaparch S, et al. The nature of small-airway obstruction in chronic obstructive pulmonary disease. N Engl J Med. 2004;350:2645\u201353.","journal-title":"N Engl J Med"},{"key":"2972_CR4","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00753-2019","author":"GG King","year":"2020","unstructured":"King GG, Bates J, Berger KI, et al. Technical standards for respiratory oscillometry. Eur Respir J. 2020. https:\/\/doi.org\/10.1183\/13993003.00753-2019.","journal-title":"Eur Respir J"},{"key":"2972_CR5","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1183\/09031936.00051214","volume":"45","author":"BB Aarli","year":"2015","unstructured":"Aarli BB, Calverley PMA, Jensen RL, et al. Variability of within-breath reactance in COPD patients and its association with dyspnoea. Eur Respir J. 2015;45:625\u201334.","journal-title":"Eur Respir J"},{"key":"2972_CR6","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1183\/09031936.04.00046804","volume":"23","author":"RL Dellaca","year":"2004","unstructured":"Dellaca RL, Santus P, Aliverti A, et al. Detection of expiratory flow limitation in COPD using the forced oscillation technique. Eur Respir J. 2004;23:232\u201340.","journal-title":"Eur Respir J"},{"key":"2972_CR7","doi-asserted-by":"publisher","first-page":"1503","DOI":"10.2147\/COPD.S137865","volume":"12","author":"J Dean","year":"2017","unstructured":"Dean J, Kolsum U, Hitchen P, et al. Clinical characteristics of COPD patients with tidal expiratory flow limitation. Int J Chron Obstruct Dis. 2017;12:1503\u20136.","journal-title":"Int J Chron Obstruct Dis"},{"key":"2972_CR8","doi-asserted-by":"publisher","DOI":"10.1183\/23120541.00680-2021","author":"A Beech","year":"2022","unstructured":"Beech A, Jackson N, Dean J, et al. Expiratory flow limitation in a cohort of highly symptomatic COPD patients. ERJ Open Res. 2022. https:\/\/doi.org\/10.1183\/23120541.00680-2021.","journal-title":"ERJ Open Res"},{"key":"2972_CR9","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2011-000184","author":"J Ohishi","year":"2011","unstructured":"Ohishi J, Kurosawa H, Ogawa H, et al. Application of impulse oscillometry for within-breath analysis in patients with chronic obstructive pulmonary disease: pilot study. BMJ Open. 2011. https:\/\/doi.org\/10.1136\/bmjopen-2011-000184.","journal-title":"BMJ Open"},{"key":"2972_CR10","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01270-2016","author":"A Lorx","year":"2017","unstructured":"Lorx A, Czovek D, Gingl Z, et al. Airway dynamics in COPD patients by within-breath impedance tracking: effects of continuous positive airway pressure. Eur Respir J. 2017. https:\/\/doi.org\/10.1183\/13993003.01270-2016.","journal-title":"Eur Respir J"},{"key":"2972_CR11","doi-asserted-by":"publisher","DOI":"10.1186\/s12931-020-01589-5","author":"J Dean","year":"2020","unstructured":"Dean J, Panainte C, Khan N, et al. The TRIFLOW study: a randomised, cross-over study evaluating the effects of extrafine beclometason\/formoterol\/glycopyrronium on gas trapping in COPD. Respir Res. 2020. https:\/\/doi.org\/10.1186\/s12931-020-01589-5.","journal-title":"Respir Res"},{"key":"2972_CR12","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1183\/09031936.05.00034805","volume":"26","author":"MR Miller","year":"2005","unstructured":"Miller MR, Hankinson J, Brusasco V, et al. Standardisation of spirometry. Eur Respir J. 2005;26:319\u201338.","journal-title":"Eur Respir J"},{"key":"2972_CR13","doi-asserted-by":"publisher","first-page":"e70","DOI":"10.1164\/rccm.201908-1590ST","volume":"200","author":"BL Graham","year":"2019","unstructured":"Graham BL, Steenbruggen I, Miller MR, et al. Standardization of spirometry 2019 update. Am J Respir Crit Care Med. 2019;200:e70-88.","journal-title":"Am J Respir Crit Care Med"},{"key":"2972_CR14","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1183\/09031936.05.00035005","volume":"26","author":"J Wanger","year":"2005","unstructured":"Wanger J, Clausen JL, Coates A, et al. Standardisation of the measurement of lung volumes. Eur Respir J. 2005;26:511\u201322.","journal-title":"Eur Respir J"},{"key":"2972_CR15","first-page":"49","volume":"2017","author":"BL Graham","year":"2017","unstructured":"Graham BL, Brusasco V, Burgos F, et al. ERS\/ATS standards for single-breath carbon monoxide uptake in the lung. Eur Respir J. 2017;2017:49.","journal-title":"Eur Respir J"},{"key":"2972_CR16","doi-asserted-by":"publisher","DOI":"10.1186\/1465-9921-8-52","author":"CM Houghton","year":"2007","unstructured":"Houghton CM, Lawson N, Borrill ZL, et al. Comparison of the effects of salmeterol\/fluticasone propionate with fluticasone propionate on airway physiology in adults with mild persistent asthma. Respir Res. 2007. https:\/\/doi.org\/10.1186\/1465-9921-8-52.","journal-title":"Respir Res"},{"key":"2972_CR17","doi-asserted-by":"publisher","first-page":"1026","DOI":"10.1183\/09031936.03.00089403","volume":"22","author":"E Oostveen","year":"2003","unstructured":"Oostveen E, MacLeod D, Lorino H, et al. The forced oscillation technique in clinical practice: methodology, recommendations and future developments. Eur Respir J. 2003;22:1026\u201341.","journal-title":"Eur Respir J"},{"key":"2972_CR18","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1016\/S0140-6736(86)90837-8","volume":"1","author":"JM Bland","year":"1986","unstructured":"Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307\u201310.","journal-title":"Lancet"},{"key":"2972_CR19","doi-asserted-by":"publisher","first-page":"1106","DOI":"10.1164\/rccm.200506-975OC","volume":"173","author":"LB Herpel","year":"2006","unstructured":"Herpel LB, Kanner RE, Lee SM, et al. Variability of spirometry in chronic obstructive pulmonary disease: results from two clinical trials. Am J Respir Crit Care Med. 2006;173:1106\u201313.","journal-title":"Am J Respir Crit Care Med"},{"key":"2972_CR20","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1378\/chest.80.1.97","volume":"80","author":"BE Pennock","year":"1981","unstructured":"Pennock BE, Rogers RM, McCaffree DR. Changes in measured spirometric indices. What is significant? Chest. 1981;80:97\u20139.","journal-title":"Chest"},{"key":"2972_CR21","first-page":"87","volume":"28","author":"M Nakagawa","year":"2015","unstructured":"Nakagawa M, Hattori N, Haruta Y, et al. Effect of increasing respiratory rate on airway resistance and reactance in COPD patients. Respir. 2015;28:87\u201394.","journal-title":"Respir"},{"key":"2972_CR22","doi-asserted-by":"publisher","first-page":"559","DOI":"10.2169\/internalmedicine.55.5876","volume":"55","author":"T Shirai","year":"2016","unstructured":"Shirai T, Kurosawa H. Clinical application of the forced oscillation technique. Intern Med. 2016;55:559\u201366.","journal-title":"Intern Med"},{"key":"2972_CR23","doi-asserted-by":"publisher","first-page":"157","DOI":"10.2147\/COPD.S225543","volume":"15","author":"SC Zimmerman","year":"2020","unstructured":"Zimmerman SC, Thamrin C, Chan ASL, et al. Relationships between forced oscillatory impedance and 6-minute walk distance after pulmonary rehabilitation in COPD. Int J Chron Obstruct Dis. 2020;15:157\u201366.","journal-title":"Int J Chron Obstruct Dis"},{"key":"2972_CR24","doi-asserted-by":"publisher","first-page":"1079","DOI":"10.1136\/thoraxjnl-2020-216037","volume":"76","author":"VV Polosukhin","year":"2021","unstructured":"Polosukhin VV, Gutor SS, Du R, et al. Small airway determinants of airflow limitation in chronic obstructive pulmonary disease. Thorax. 2021;76:1079\u201388.","journal-title":"Thorax"},{"key":"2972_CR25","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/542769","volume":"2012","author":"D Papandrinopoulou","year":"2012","unstructured":"Papandrinopoulou D, Tzouda V, Tsoukalas G. Lung compliance and chronic obstructive pulmonary disease. Pulm Med. 2012;2012: 542769.","journal-title":"Pulm Med"},{"key":"2972_CR26","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1159\/000452479","volume":"93","author":"E Crisafulli","year":"2017","unstructured":"Crisafulli E, Pisa R, Aiello M, et al. Prevalence of small-airway dysfunction among COPD patients with different GOLD stages and its role in the impact of disease. Respiration. 2017;93:32\u201341.","journal-title":"Respiration"},{"key":"2972_CR27","doi-asserted-by":"publisher","first-page":"2863","DOI":"10.2147\/COPD.S221684","volume":"14","author":"K Li","year":"2019","unstructured":"Li K, Gao Y, Pan Z, et al. Influence of emphysema and air trapping heterogeneity on pulmonary function in patients with COPD. Int J Chron Obstr Dis. 2019;14:2863\u201372.","journal-title":"Int J Chron Obstr Dis"},{"key":"2972_CR28","doi-asserted-by":"publisher","first-page":"1386","DOI":"10.3892\/etm.2021.10822","volume":"22","author":"Y Li","year":"2021","unstructured":"Li Y, Li XY, Yuan LR, et al. Evaluation of small airway function and its application in patients with chronic obstructive pulmonary disease (review). Exp Ther Med. 2021;22:1386.","journal-title":"Exp Ther Med"},{"key":"2972_CR29","doi-asserted-by":"publisher","first-page":"1110","DOI":"10.1136\/thx.2007.086827","volume":"63","author":"FM Franssen","year":"2008","unstructured":"Franssen FM, O\u2019Donnell DE, Goossens GH, et al. Obesity and the lung: 5. Obes COPD Thorax. 2008;63:1110\u20137.","journal-title":"Obes COPD Thorax"},{"key":"2972_CR30","doi-asserted-by":"publisher","DOI":"10.1590\/1806-3713\/e20180311","author":"M de Sant\u2019Anna Jr","year":"2019","unstructured":"de Sant\u2019Anna M Jr, Carvalhal RF, de Oliveira FFB, et al. Respiratory mechanics of patients with morbid obesity. J Bras Pneumol. 2019. https:\/\/doi.org\/10.1590\/1806-3713\/e20180311.","journal-title":"J Bras Pneumol"}],"container-title":["Respiratory Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12931-024-02972-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12931-024-02972-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12931-024-02972-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T03:52:31Z","timestamp":1727927551000},"score":1,"resource":{"primary":{"URL":"https:\/\/respiratory-research.biomedcentral.com\/articles\/10.1186\/s12931-024-02972-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,3]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["2972"],"URL":"https:\/\/doi.org\/10.1186\/s12931-024-02972-2","relation":{},"ISSN":["1465-993X"],"issn-type":[{"type":"electronic","value":"1465-993X"}],"subject":[],"published":{"date-parts":[[2024,10,3]]},"assertion":[{"value":"18 June 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 September 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 October 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was conducted according to the guidelines of the Declaration of Helsinki, and the study protocol was reviewed and approved by local Ethics Committees (16\/NW\/0836; 18\/NI\/0194). Written informed consent was obtained from all subjects involved in the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"JD; the author declares that they have no competing interests. SJF; the author declares that they have no competing interests. DS has received personal fees from Aerogen, AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, CSL Behring, Epidendo, Genentech, GlaxoSmithKline, Glenmark, Gossamerbio, Kinaset, Menarini, Novartis, Orion, Pulmatrix, Sanofi, Synairgen, Teva, Theravance and Verona. AB; the author declares that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"357"}}