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King GG, Bates J, Berger KI, Calverley P, de Melo PL, Dellacà RL, Farré R, Hall GL, Ioan I, Irvin CG, Kaczka DW, Kaminsky DA, Kurosawa H, Lombardi E, Maksym GN, Marchal F, Oppenheimer BW, Simpson SJ, Thamrin C, van den Berge M, Oostveen E. Technical standards for respiratory oscillometry. Eur Respir J 2020; 55:13993003.00753-2019. [PMID: 31772002 DOI: 10.1183/13993003.00753-2019] [Citation(s) in RCA: 265] [Impact Index Per Article: 66.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 10/15/2019] [Indexed: 12/11/2022]
Abstract
Oscillometry (also known as the forced oscillation technique) measures the mechanical properties of the respiratory system (upper and intrathoracic airways, lung tissue and chest wall) during quiet tidal breathing, by the application of an oscillating pressure signal (input or forcing signal), most commonly at the mouth. With increased clinical and research use, it is critical that all technical details of the hardware design, signal processing and analyses, and testing protocols are transparent and clearly reported to allow standardisation, comparison and replication of clinical and research studies. Because of this need, an update of the 2003 European Respiratory Society (ERS) technical standards document was produced by an ERS task force of experts who are active in clinical oscillometry research.The aim of the task force was to provide technical recommendations regarding oscillometry measurement including hardware, software, testing protocols and quality control.The main changes in this update, compared with the 2003 ERS task force document are 1) new quality control procedures which reflect use of "within-breath" analysis, and methods of handling artefacts; 2) recommendation to disclose signal processing, quality control, artefact handling and breathing protocols (e.g. number and duration of acquisitions) in reports and publications to allow comparability and replication between devices and laboratories; 3) a summary review of new data to support threshold values for bronchodilator and bronchial challenge tests; and 4) updated list of predicted impedance values in adults and children.
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Affiliation(s)
- Gregory G King
- Dept of Respiratory Medicine and Airway Physiology and Imaging Group, Royal North Shore Hospital and The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Jason Bates
- Dept of Medicine, Pulmonary/Critical Care Division, University of Vermont, Larner College of Medicine, Burlington, VT, USA
| | - Kenneth I Berger
- Division of Pulmonary, Critical Care, and Sleep Medicine, NYU School of Medicine and André Cournand Pulmonary Physiology Laboratory, Belleuve Hospital, New York, NY, USA
| | - Peter Calverley
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Pedro L de Melo
- Institute of Biology and Faculty of Engineering, Department of Physiology, Biomedical Instrumentation Laboratory, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Raffaele L Dellacà
- Dipartimento di Elettronica, Informazione e Bioingegneria - DEIB, Politecnico di Milano University, Milano, Italy
| | - Ramon Farré
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona-IDIBAPS, Barcelona, Spain.,CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Graham L Hall
- Children's Lung Health, Telethon Kids Institute, School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Iulia Ioan
- Dept of Pediatric Lung Function Testing, Children's Hospital, Vandoeuvre-lès-Nancy, France.,EA 3450 DevAH - Laboratory of Physiology, Faculty of Medicine, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Charles G Irvin
- Dept of Medicine, Pulmonary/Critical Care Division, University of Vermont, Larner College of Medicine, Burlington, VT, USA
| | - David W Kaczka
- Depts of Anesthesia, Biomedical Engineering and Radiology, University of Iowa, Iowa City, IA, USA
| | - David A Kaminsky
- Dept of Medicine, Pulmonary/Critical Care Division, University of Vermont, Larner College of Medicine, Burlington, VT, USA
| | - Hajime Kurosawa
- Dept of Occupational Health, Tohoku University School of Medicine, Sendai, Japan
| | - Enrico Lombardi
- Pediatric Pulmonary Unit, Meyer Pediatric University Hospital, Florence, Italy
| | - Geoffrey N Maksym
- School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
| | - François Marchal
- Dept of Pediatric Lung Function Testing, Children's Hospital, Vandoeuvre-lès-Nancy, France.,EA 3450 DevAH - Laboratory of Physiology, Faculty of Medicine, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Beno W Oppenheimer
- Division of Pulmonary, Critical Care, and Sleep Medicine, NYU School of Medicine and André Cournand Pulmonary Physiology Laboratory, Belleuve Hospital, New York, NY, USA
| | - Shannon J Simpson
- Children's Lung Health, Telethon Kids Institute, School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Cindy Thamrin
- Dept of Respiratory Medicine and Airway Physiology and Imaging Group, Royal North Shore Hospital and The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Maarten van den Berge
- University of Groningen, University Medical Center Groningen, Dept of Pulmonary Diseases, Groningen, The Netherlands
| | - Ellie Oostveen
- Dept of Respiratory Medicine, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
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Raywood E, Lum S, Aurora P, Pike K. The bronchodilator response in preschool children: A systematic review. Pediatr Pulmonol 2016; 51:1242-1250. [PMID: 27273556 DOI: 10.1002/ppul.23459] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 04/05/2016] [Accepted: 04/18/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND The bronchodilator response (BDR) is frequently used to support diagnostic and therapeutic decision-making for children who wheeze. However, there is little evidence-based guidance describing the role of BDR testing in preschool children and it is unclear whether published cut-off values, which are derived from adult data, can be applied to this population. METHODS We searched MEDLINE, EMBASE, Web of Science, and Cochrane databases (inception-September 2015) for studies reporting response to a bronchodilator in healthy preschool children, response following placebo inhalation, and the diagnostic efficacy of BDR compared with a clinical diagnosis of asthma/recurrent wheezing. FINDINGS We included 14 studies. Thirteen studies provided BDR data from healthy preschool children. Two studies reported response to placebo in preschool children with asthma/recurrent wheezing. Twelve studies compared BDR measurements from preschool children with asthma/recurrent wheeze to those from healthy children and seven of these studies reported diagnostic efficacy. Significant differences between the BDR measured in healthy preschool children compared with that in children with asthma/recurrent wheeze were demonstrated in some, but not all studies. Techniques such as interrupter resistance, oscillometry, and plethysmography were more consistently successfully completed than spirometry. Between study heterogeneity precluded determination of an optimum technique. INTERPRETATION There is little evidence to suggest spirometry-based BDR can be used in the clinical assessment of preschool children who wheeze. Further evaluation of simple alternative techniques is required. Future studies should recruit children in whom airways disease is suspected and should evaluate the ability of BDR testing to predict treatment response. Pediatr Pulmonol. 2016;51:1242-1250. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Emma Raywood
- Respiratory, Critical Care and Anaesthesia Section, University College London Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom
| | - Sooky Lum
- Respiratory, Critical Care and Anaesthesia Section, University College London Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom
| | - Paul Aurora
- Respiratory, Critical Care and Anaesthesia Section, University College London Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Katharine Pike
- Respiratory, Critical Care and Anaesthesia Section, University College London Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom.
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
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Ioan I, Coutier L, Bonabel C, Albrecht J, Demoulin B, Marchal F, Schweitzer C, Varechova S. Airway obstruction, upper airway artifact and response to bronchodilator in asthmatic and healthy children. Pediatr Pulmonol 2015; 50:1053-9. [PMID: 25384559 DOI: 10.1002/ppul.23131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 05/28/2014] [Accepted: 07/31/2014] [Indexed: 11/06/2022]
Abstract
BACKGROUND The forced oscillation technique (FOT) may be affected by the upper airway artifact in children with airway obstruction. The aim was to test the impact of the artifact on FOT ability to diagnose asthma in children as recommended by current guidelines. METHODS The FOT was performed in 58 asthmatics and 27 controls before and after salbutamol. Respiratory resistance (Rrs) was measured at 8 Hz with a standard generator (SG), and a head generator (HG) that minimizes the upper airway artifact. The response to salbutamol was computed as change in respiratory resistance (Δ%Rrs) and admittance (Δ%Ars) that almost cancels the effect of the upper airway artifact. RESULTS Rrs and Δ%Rrs were significantly larger in patients than controls by HG (respectively P < 0.001 and P = 0.002) but not SG, while Δ%Ars was larger in asthma than control by both (P < 0.04). Best discriminators between patients and controls were Rrs or Δ%Rrs by HG and Δ%Ars by SG. CONCLUSION In asthmatic children, the upper airway artifact significantly impacts FOT measurements. The diagnostic value may be improved by minimization of the shunt, such as the computation of Δ%Ars.
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Affiliation(s)
- Iulia Ioan
- Service d'explorations fonctionnelles pédiatriques, Hôpital d'enfants, CHU de Nancy, France
| | - Laurianne Coutier
- EA 3450 DevAH-Laboratoire de Physiologie, Faculté de Médecine, Université Lorraine, Vandoeuvre, France
| | - Claude Bonabel
- Service d'explorations fonctionnelles pédiatriques, Hôpital d'enfants, CHU de Nancy, France.,EA 3450 DevAH-Laboratoire de Physiologie, Faculté de Médecine, Université Lorraine, Vandoeuvre, France
| | - Joris Albrecht
- EA 3450 DevAH-Laboratoire de Physiologie, Faculté de Médecine, Université Lorraine, Vandoeuvre, France
| | - Bruno Demoulin
- EA 3450 DevAH-Laboratoire de Physiologie, Faculté de Médecine, Université Lorraine, Vandoeuvre, France
| | - François Marchal
- Service d'explorations fonctionnelles pédiatriques, Hôpital d'enfants, CHU de Nancy, France.,EA 3450 DevAH-Laboratoire de Physiologie, Faculté de Médecine, Université Lorraine, Vandoeuvre, France
| | - Cyril Schweitzer
- Service d'explorations fonctionnelles pédiatriques, Hôpital d'enfants, CHU de Nancy, France.,EA 3450 DevAH-Laboratoire de Physiologie, Faculté de Médecine, Université Lorraine, Vandoeuvre, France
| | - Silvia Varechova
- Service d'explorations fonctionnelles pédiatriques, Hôpital d'enfants, CHU de Nancy, France.,EA 3450 DevAH-Laboratoire de Physiologie, Faculté de Médecine, Université Lorraine, Vandoeuvre, France
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