Internal Medicine
doi: 10.25005/2074-0581-2021-23-1-25-31
EVALUATION OF VENTILATION-PERFUSION RATIO IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE

T.A. Miroshkina1, S .A. Shustova1, I .B. Ponomaryova2

1Department of Pathophysiology, Ryazan State Medical University named after Academician I .P. Pavlov, Ryazan, Russian Federation
2Department of Faculty Therapy with Course of Therapy, Faculty of Continuing Professional Education, Ryazan State Medical University named after Academician I .P. Pavlov, Ryazan, Russian Federation

Objective: To study ventilation-perfusion ratio (VPR) in patients with chronic obstructive pulmonary disease (COPD) using method of volumetric capnography.

Methods: 35 patients with COPD II-IV stages and 17 volunteers without pathology of the respiratory system (control group) were examined. Using SpiroScout (Ganshorn, Germany) with built-in function of volumetric capnography, spirography and volumetric capnography were implemented. Symptoms in patients with COPD were evaluated using mMRC and CAT.

Results: Statistically significant differences between the patients with COPD and the control group were identified in a number of parameters of volumetric capnography characterizing VPR. VDBohr, VDalv and their ratio to VT in patients with COPD were higher than in individuals of the control group (VDBohr – 361 [299-486] and 280 [215-463] ml, p=0.042; VDBohr/VT – 0.43 [0.40-0.51] and 0.35 [0.31-0.44], p=0.001; VDalv – 211 [142-290] and 81 [49.5-244.5] ml, p=0.012; VDalv/VT – 0.24 [0.20-0.34] and 0.13 [0.08-0.23], p=0.001). The slope of the 2nd phase of the capnogram in COPD was more smooth (dMM/dV2 – 2.0 [1.7-2.7] and 2.5 [2.2-3.2] g/mol×l, respectively; p=0.013), and the slope of the 3rd phase was steeper than in the individuals without pathology of the respiratory system (dMM/dV3 – 0.38 [0.29-0.51] and 0.22 [0.13-0.34] g/mol×l, respectively; p<0.001). Angle α in the group with COPD was increased in comparison with the control group (136

Conclusion: The conducted study identified derangement of VPR in patients with COPD. Volumetric capnography is an easy-to-use technique that allows evaluating VPR.

Keywords: Ventilation-perfusion ratio, dead space, chronic obstructive pulmonary disease, volumetric capnography.

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References
  1. Kent BD, Mitchell PD, McNicholas WT. Hypoxemia in patients with COPD: cause, effects, and disease progression. Int J Chron Obstruct Pulmon Dis. 2011;6:199-208. Available from: https://doi.org/10.2147/copd.s10611
  2. Sarkar M, Niranjan N, Banyal P. Mechanisms of hypoxemia. Lung India. 2017;34(1):47. Available from: https://doi.org/10.4103/0970-2113.197116
  3. Levin DL, Schiebler ML, Hopkins SR. Physiology for the pulmonary functional imager. Eur J Radiol. 2017;86:308-12. Available from: https://doi. org/10.1016/j.ejrad.2016.09.027
  4. Glenny RW, Robertson HT. Spatial distribution of ventilation and perfusion: Mechanisms and regulation. Compr Physiol. 2011;1(1):375-395. Available from: https://doi.org/10.1002/cphy.c100002
  5. Mortensen J, Berg RMG. Lung scintigraphy in COPD. Semin Nucl Med. 2019;49(1):16-21. Available from: https://doi.org/10.1053/j.semnuclmed. 2018.10.010
  6. Peinado VI, Pizarro S, Barberà JA. Pulmonary vascular involvement in COPD. Chest. 2008;134(4):808-14. Available from: http://doi.org/10.1378/ chest.08-0820
  7. Mountain JE, Santer P, O’Neill DP, Smith NMJ, Ciaffoni L, Couper JH, et al. Potential for noninvasive assessment of lung inhomogeneity using highly precise, highly time-resolved measurements of gas exchange. J Appl Physiol. 2018;124(3):615-31. Available from: https://doi.org/10.1152/japplphysiol. 00745.2017
  8. Bajc M, Markstad H, Jarenbäck L, Tufvesson E, Bjermer L, Jögi J. Grading obstructive lung disease using tomographic pulmonary scintigraphy in patients with chronic obstructive pulmonary disease (COPD) and long-term smokers. Ann Nucl Med. 2014;29(1):91-9. Available from: https://doi.org/10.1007/ s12149-014-0913-y
  9. Subbotin SV. Diagnosticheskoe znachenie metoda ob’’yomnoy kapnografii v obsledovanii patsientov s bronkhial’noy astmoy [Diagnostic significance of volumetric capnography in examination of patients with bronchial asthma]. Rossiiskiy mediko-biologicheskiy vestnik imeni akademika I.P. Pavlova. 2018;26(3):388-95.
  10. Miroshkina T.A., Shustova S.A., Ponomareva I.B. Ventilyacionno-perfuzionnoe otnoshenie v norme I patologii. Nauka molodykh (Eruditio Juvenium). 2020;8(3):422-432. Available from: http://doi.org/10.23888/hmj202083422- 432
  11. Miroshkina TA, Shustova SA. Opredelenie ob’’yoma dykhatel’nykh myortvykh prostranstv metodom kapnovolyumetrii [Measurement of lung dead space volume by capnovolumetry]. Vestnik Avitsenny [Avicenna Bulletin]. 2020;22(3):471-7. Available from: https://doi.org/10.25005/2074-0581- 2020-22-3-471-477
  12. Hoffbrand BI. The expiratory capnogram: a measure of ventilation-perfusion inequalities. Thorax. 1966;21(6):518-23. Available from: http://doi. org/10.1136/thx.21.6.518
  13. Moreira M, Veronez L, Pereira M, Silva S, Capitani E, Paschoal I, et al. Volumetric capnography for the evaluation of chronic airways diseases. Int J Chron Obstruct Pulmon Dis. 2014;9(1);983-9. Available from: https://doi. org/10.2147/copd.s62886
  14. Jarenbäck L, Tufvesson E, Ankerst J, Bjermer L, Jonson B. The Efficiency Index (EFFi), based on volumetric capnography, may allow for simple diagnosis and grading of COPD. Int J Chron Obstruct Pulmon Dis. 2018;13:2033-9. Available from: https://doi.org/10.2147/copd.s161345
  15. Smidt U. Semi-quantitative diagnosis of the degree of emphysema from CO2 expirograms. Pneumologie. 1997;51(1):55-9.
  16. Silva S, Paschoal I, De Capitani E, Moreira M, Palhares L, Pereira M. COPD phenotypes on computed tomography and its correlation with selected lung function variables in severe patients. Int J Chron Obstruct Pulmon Dis. 2016;11(1):503-13. Available from: https://doi.org/10.2147/copd.s90638
  17. Qi G-S, Gu W-C, Yang W-L, Xi F, Wu H, Liu J-M. The ability of volumetric capnography to distinguish between chronic obstructive pulmonary disease patients and normal subjects. Lung. 2014;192(5):661-8. Available from: https:// doi.org/10.1007/s00408-014-9615-4
  18. Kellerer C, Jankrift N, Jörres RA, Klütsch K, Wagenpfeil S, Linde K, et al. Diagnostic accuracy of capnovolumetry for the identification of airway obstruction – results of a diagnostic study in ambulatory care. Respir Res. 2019;20(1):92. Available from: https://doi.org/10.1186/s12931-019-1067-1
  19. Rodríguez-Roisin R, Drakulovic M, Rodríguez DA, Roca J, Barberà JA, Wagner PD. Ventilation-perfusion imbalance and chronic obstructive pulmonary disease staging severity. J Appl Physiol. 2009;106(6):1902-8. Available from: https://doi.org/10.1152/japplphysiol.00085.2009

Authors' information:

Miroshkina Tatiana Aleksandrovna
Candidate of Medical Sciences, Associate Professor of the Department of Pathophysiology, Ryazan State Medical University named after Academician I.P. Pavlov
Researcher ID: AAG-5068-2020
ORCID ID: 0000-0002-9179-5181
Author ID: 966788
SPIN: 2779-0313
E-mail: mirta62@yandex.ru

Shustova Svetlana Aleksandrovna
Candidate of Medical Sciences, Associate Professor of the Department of Pathophysiology, Ryazan State Medical University named after Academician I.P. Pavlov
Researcher ID: AAG-50-64-2020
Scopus ID: 57201741897
ORCID ID: 0000-0002-5528-6742
Author ID: 988258
SPIN: 8866-5935
E-mail: sv_shustova@mail.ru

Ponomaryova Irina Borisovna
Candidate of Medical Sciences, Associate Professor of the Department of Faculty Therapy with Course of Therapy, Faculty of Continuing Professional Education, Ryazan State Medical University named after Academician I.P. Pavlov
Researcher ID: D-6849-2018
ORCID ID: 0000-0002-0273-4388
Author ID: 759667
SPIN: 3984-1944
E-mail: docib@yandex.ru

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Miroshkina Tatiana Aleksandrovna
Candidate of Medical Sciences, Associate Professor of the Department of Pathophysiology, Ryazan State Medical University named after Academician I.P. Pavlov

390026, Russian Federation, Ryazan, Vysokovoltnaya Str., 9

Tel.: +7 (910) 5603646

E-mail: mirta62@yandex.ru

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