Sophie Yammine, Florian Singer, Per Gustafsson, Philipp Latzin

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Impact of different breathing protocols on multiple-breath washout outcomes in children Sophie Yammine, Florian Singer, Per Gustafsson, Philipp Latzin Journal of Cystic Fibrosis Volume 13, Issue 2, Pages 190-197 (March 2014) DOI: 10.1016/j.jcf.2013.08.010 Copyright © 2013 European Cystic Fibrosis Society. Terms and Conditions

Fig. 1 Mean lung clearance index (LCI) of triplicate nitrogen multiple-breath washout at free tidal breathing (baseline) and fixed 1L breathing (1L) in 35 children (15 with cystic fibrosis). Journal of Cystic Fibrosis 2014 13, 190-197DOI: (10.1016/j.jcf.2013.08.010) Copyright © 2013 European Cystic Fibrosis Society. Terms and Conditions

Fig. 2 Mean Scond of triplicate nitrogen multiple-breath washout at free tidal breathing (baseline) and fixed 1L breathing (1L) in 35 children (15 with cystic fibrosis). Journal of Cystic Fibrosis 2014 13, 190-197DOI: (10.1016/j.jcf.2013.08.010) Copyright © 2013 European Cystic Fibrosis Society. Terms and Conditions

Fig. 3 Changes of FRC and LCI at fixed 1L breathing in 20 healthy children (Fig. 3A) and in 15 children with cystic fibrosis (Fig. 3B). The arrows represent changes of functional residual capacity (FRC) and lung clearance index (LCI) when performing triplicate nitrogen multiple-breath washout at free tidal breathing (arrow beginning) and fixed 1L breathing (arrow ending). The dashed line in Fig. 3A represents the upper limit of normal. Journal of Cystic Fibrosis 2014 13, 190-197DOI: (10.1016/j.jcf.2013.08.010) Copyright © 2013 European Cystic Fibrosis Society. Terms and Conditions

Fig. 4 Example of nitrogen multiple-breath washout at free tidal breathing (Fig. 4A) and at 1L breathing (Fig. 4B) in the same girl with cystic fibrosis (age 11years, weight 29kg). End-tidal nitrogen (N2) concentration normalized to 100% as white bars (left y-axis) and functional residual capacity (FRC) as open circles (righty y-axis) are plotted against washout breaths (x-axis). The breath marked in gray represents the last breath at 1/40th (2.5%) of the N2 starting concentration. Likewise the circle marked in gray represents the final FRC taken for lung clearance index calculation (calculated as cumulative expired volume divided by FRC). Journal of Cystic Fibrosis 2014 13, 190-197DOI: (10.1016/j.jcf.2013.08.010) Copyright © 2013 European Cystic Fibrosis Society. Terms and Conditions

Fig. 5 Association of LCI change with FRC change at fixed 1L breathing, both expressed as percentage of their baseline value at free tidal breathing. Percentage of change in functional residual capacity (FRC) and lung clearance index (LCI) when performing triplicate nitrogen multiple breath washout at fixed 1L breathing (1L VT) instead of free tidal breathing representing baseline values. The dashed line represents the natural between-test variability of 12% and thereby the cut-off for group I with LCI change ≤12%, within natural variability and group II with LCI change >12%, exceeding natural variability. Closed circles represent children with CF (n=15), open circles represent healthy children (n=20). Journal of Cystic Fibrosis 2014 13, 190-197DOI: (10.1016/j.jcf.2013.08.010) Copyright © 2013 European Cystic Fibrosis Society. Terms and Conditions