Predictive anatomical factors of lung aerosol deposition in obese individuals. Would modified mallampati score be relevant? Clinical trial - 09/09/20
Abstract |
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)
Le texte complet de cet article est disponible en PDF.Highlights |
• | Mallampati should be given due consideration on aerosol therapy in obese subjects. |
• | Aerosol lung deposition is mostly predicted by BMI, rather than anatomy exclusively. |
• | Combined, obesity and Mallampati IV are detrimental to aerosol lung deposition. |
Keywords : Inhalation, Obesity, Critical care, Respiratory therapy, Mallampati, Aerosol drug therapy
Plan
Vol 171
Article 106083- septembre 2020 Retour au numéro
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