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Bayat S. [Respiratory oscillometry: Theoretical foundations and clinical applications]. Rev Mal Respir 2024; 41:593-604. [PMID: 39174416 DOI: 10.1016/j.rmr.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 07/22/2024] [Indexed: 08/24/2024]
Abstract
Oscillometry measures the mechanical properties of the respiratory system. As they are carried out during spontaneous breathing, oscillometry measurements do not require forced breathing maneuvers or the patient's active cooperation. The technique is complementary to conventional pulmonary function testing methods for the investigation of respiratory function, diagnosis and monitoring of respiratory diseases, and assessment of response to treatment. The present review aims to describe the theoretical foundations and practical methodology of oscillometry. It describes the gaps in scientific evidence regarding its clinical utility, and provides examples of current research and clinical applications.
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Affiliation(s)
- S Bayat
- Unité d'explorations fonctionnelles cardiorespiratoires, service de pneumologie et physiologie, CHU Grenoble Alpes, Grenoble, France; STROBE, Inserm UA07, université Grenoble Alpes, Grenoble, France.
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González Vera R, Vidal Grell A, Castro-Rodríguez JA, Palomino Montenegro MA, Méndez Yarur A. Reactance inversion in moderate to severe persistent asthma: low birth weight, prematurity effect, and bronchodilator response. J Asthma 2024; 61:1076-1082. [PMID: 38426671 DOI: 10.1080/02770903.2024.2324865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 02/04/2024] [Accepted: 02/25/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Reactance inversion (RI) has been associated with impaired peripheral airway function in persistent asthma. However, there is little to no data about the difference between asthmatic children with and without RI. This study aimed to detect clinical and lung function differences in moderate-severe asthmatic children with and without RI. METHODS This study was conducted between 2021 and 2022 in asthmatic school-age children. Impulse oscillometry (IOS) and spirometry were performed according to ATS/ERS standards. RESULTS A total of 62 patients, with a mean age of 8.4 years, 54.8% were males and were divided into three groups: group 1 (32.3%) with no RI, group 2 (27.4%) with RI but disappearing after bronchodilator test and group 3 (40.3%) with persistent RI after bronchodilator test. Children in groups 2 and 3 had significantly lower birth weights than in group 1. Group 2 had lower gestational age compared to group 1. FEV1 and FEF25-75 of forced vital capacity were significantly lower in groups 2 and 3. In group 3, R5, AX, R5-20, and R5-R20/R5 ratios were significantly higher. Bronchodilator responses (BDR) in X5c, AX, and R5-R20 were significantly different between groups and lower in group 3. CONCLUSION RI is frequently found in children with moderate-severe persistent asthma, particularly in those with a history of prematurity or low birth weight. In some patients, RI disappears after the bronchodilator test; however, it, persists in those with the worst pulmonary function. RI could be a small airway dysfunction marker.
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Choi JS, Kwak SH, Kim MC, Seol CH, Heo SJ, Kim SR, Lee EH. Usefulness of Impulse Oscillometry in Predicting the Severity of Bronchiectasis. Tuberc Respir Dis (Seoul) 2024; 87:368-377. [PMID: 38783483 PMCID: PMC11222088 DOI: 10.4046/trd.2023.0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/17/2024] [Accepted: 04/19/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Bronchiectasis is a chronic respiratory disease that leads to airway inflammation, destruction, and airflow limitation, which reflects its severity. Impulse oscillometry (IOS) is a non-invasive method that uses sound waves to estimate lung function and airway resistance. The aim of this study was to assess the usefulness of IOS in predicting the severity of bronchiectasis. METHODS We retrospectively reviewed the IOS parameters and clinical characteristics in 145 patients diagnosed with bronchiectasis between March 2020 and May 2021. Disease severity was evaluated using the FACED score, and patients were divided into mild and moderate/severe groups. RESULTS Forty-four patients (30.3%) were in the moderate/severe group, and 101 (69.7%) were in the mild group. Patients with moderate/severe bronchiectasis had a higher airway resistance at 5 Hz (R5), a higher difference between the resistance at 5 and 20 Hz (R5-R20), a higher resonant frequency (Fres), and a higher area of reactance (AX) than patients with mild bronchiectasis. R5 ≥0.43, resistance at 20 Hz (R20) ≥0.234, R5-R20 ≥28.3, AX ≥1.02, reactance at 5 Hz (X5) ≤-0.238, and Fres ≥20.88 revealed significant univariable relationships with bronchiectasis severity (p<0.05). Among these, only X5 ≤-0.238 exhibited a significant multivariable relationship with bronchiectasis severity (p=0.039). The receiver operating characteristic curve for predicting moderate- to-severe bronchiectasis of FACED score based on IOS parameters exhibited an area under the curve of 0.809. CONCLUSION The IOS assessed by the disease severity of FACED score can effectively reflect airway resistance and elasticity in bronchiectasis patients and serve as valuable tools for predicting bronchiectasis severity.
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Affiliation(s)
- Ji Soo Choi
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Se Hyun Kwak
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Min Chul Kim
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Chang Hwan Seol
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Seok-Jae Heo
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Ryeol Kim
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Eun Hye Lee
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
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Meoli A, Trischler J, Hutter M, Dressler M, Esposito S, Blümchen K, Zielen S, Schulze J. Impulse oscillometry bronchodilator response in preschool children. Pediatr Pulmonol 2024; 59:1321-1329. [PMID: 38353391 DOI: 10.1002/ppul.26909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 01/03/2024] [Accepted: 01/31/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND In preschoolers, performing an acceptable spirometry and measuring bronchodilator response (BDR) is challenging; in this context, impulse oscillometry (IOS) represents a valid alternative. However, more studies on the standardization of BDR for IOS in young children are required. OBJECTIVE The objective of the study was to identify optimal thresholds to define a positive BDR test with IOS in preschoolers with suspected asthma. METHODS Children aged 3-6 years with suspected asthma and their lung function investigated with both IOS and spirometry pre- and post-BDR were retrospectively analyzed. The spirometric BDR was defined as positive when the change of FEV1 was ≥12% or ≥200 mL. The oscillometric BDR was defined as positive in case of change of at least -40% in R5, +50% in X5, and -80% in AX. RESULTS Among 72 patients, 36 (age 5.2 ± 1 years; 64% boys) were selected for the subsequent analysis according to ATS/ERS quality criteria of measurements; specifically, 19 patients did not meet IOS and 36 did not meet spirometry criteria. The spirometric BDR was found positive in seven subjects (19.4%); conversely, a positive oscillometric BDR was identified in four patients (11.1%). No patient presented a positive BDR response with both methods. In IOS, the mean decrease in R5 and AX was 19.9% ± 10% and 44% ± 22.1%, and the mean increase in X5 was 23.3% ± 17.8%, respectively. A decrease in R5 of 25.7% (AUC 0.77, p = .03) and an increase in X5 of 25.7% (AUC 0.75, p = .04) showed the best combination of sensitivity and specificity to detect an increase of FEV1 ≥ 12% and/or ≥200 mL. CONCLUSION The IOS represents a valid alternative to spirometry to measure BDR in preschool children and should be the gold standard in this age group. We are considering a decrease of 26% in R5 and an increase of 26% in X5 as diagnostic threshold for BDR.
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Affiliation(s)
- Aniello Meoli
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Frankfurt am Main, Germany
- Department of Medicine and Surgery, Pediatric Clinic, University Hospital of Parma, Parma, Italy
| | - Jordis Trischler
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Frankfurt am Main, Germany
| | - Martin Hutter
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Frankfurt am Main, Germany
| | - Melanie Dressler
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Frankfurt am Main, Germany
| | - Susanna Esposito
- Department of Medicine and Surgery, Pediatric Clinic, University Hospital of Parma, Parma, Italy
| | - Katharina Blümchen
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Frankfurt am Main, Germany
| | - Stefan Zielen
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Frankfurt am Main, Germany
| | - Johannes Schulze
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Frankfurt am Main, Germany
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Siroux V, Boudier A, Lyon-Caen S, Quentin J, Gioria Y, Hantos Z, Slama R, Pin I, Bayat S. Intra-breath changes in respiratory mechanics are sensitive to history of respiratory illness in preschool children: the SEPAGES cohort. Respir Res 2024; 25:99. [PMID: 38402379 PMCID: PMC10893684 DOI: 10.1186/s12931-024-02701-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/22/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Intra-breath oscillometry has been proposed as a sensitive means of detecting airway obstruction in young children. We aimed to assess the impact of early life wheezing and lower respiratory tract illness on lung function, using both standard and intra-breath oscillometry in 3 year old children. METHODS History of doctor-diagnosed asthma, wheezing, bronchiolitis and bronchitis and hospitalisation for respiratory problems were assessed by questionnaires in 384 population-based children. Association of respiratory history with standard and intra-breath oscillometry parameters, including resistance at 7 Hz (R7), frequency-dependence of resistance (R7 - 19), reactance at 7 Hz (X7), area of the reactance curve (AX), end-inspiratory and end-expiratory R (ReI, ReE) and X (XeI, XeE), and volume-dependence of resistance (ΔR = ReE-ReI) was estimated by linear regression adjusted on confounders. RESULTS Among the 320 children who accepted the oscillometry test, 281 (88%) performed 3 technically acceptable and reproducible standard oscillometry measurements and 251 children also performed one intra-breath oscillometry measurement. Asthma was associated with higher ReI, ReE, ΔR and R7 and wheezing was associated with higher ΔR. Bronchiolitis was associated with higher R7 and AX and lower XeI and bronchitis with higher ReI. No statistically significant association was observed for hospitalisation. CONCLUSIONS Our findings confirm the good success rate of oscillometry in 3-year-old children and indicate an association between a history of early-life wheezing and lower respiratory tract illness and lower lung function as assessed by both standard and intra-breath oscillometry. Our study supports the relevance of using intra-breath oscillometry parameters as sensitive outcome measures in preschool children in epidemiological cohorts.
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Affiliation(s)
- Valérie Siroux
- University Grenoble Alpes, Inserm U1209, CNRS UMR5309, Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, IAB, Grenoble, 38000, France.
| | - Anne Boudier
- University Grenoble Alpes, Inserm U1209, CNRS UMR5309, Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, IAB, Grenoble, 38000, France
- CHU Grenoble-Alpes, Grenoble, France
| | - Sarah Lyon-Caen
- University Grenoble Alpes, Inserm U1209, CNRS UMR5309, Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, IAB, Grenoble, 38000, France
| | - Joane Quentin
- University Grenoble Alpes, Inserm U1209, CNRS UMR5309, Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, IAB, Grenoble, 38000, France
- CHU Grenoble-Alpes, Grenoble, France
| | - Yoann Gioria
- University Grenoble Alpes, Inserm U1209, CNRS UMR5309, Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, IAB, Grenoble, 38000, France
- CHU Grenoble-Alpes, Grenoble, France
| | - Zoltán Hantos
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
- Department of Technical Informatics and Engineering, University of Szeged, Szeged, Hungary
| | - Rémy Slama
- University Grenoble Alpes, Inserm U1209, CNRS UMR5309, Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, IAB, Grenoble, 38000, France
| | - Isabelle Pin
- University Grenoble Alpes, Inserm U1209, CNRS UMR5309, Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, IAB, Grenoble, 38000, France
- CHU Grenoble-Alpes, Grenoble, France
| | - Sam Bayat
- University Grenoble Alpes, Dept. of Pulmonology, STROBE Inserm UA7 Laboratory, Grenoble, France
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Galant SP, Morphew T. Adding oscillometry to spirometry in guidelines better identifies uncontrolled asthma, future exacerbations, and potential targeted therapy. Ann Allergy Asthma Immunol 2024; 132:21-29. [PMID: 37625502 DOI: 10.1016/j.anai.2023.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/26/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023]
Abstract
The objective of this review is to provide new advances in our understanding of the clinical importance of establishing peripheral airway impairment (PAI) by impulse oscillometry (IOS) and targeted therapy, which could result in better asthma outcomes. Data sources include PubMed and Google search, limited to English language and human disease, with key words IOS and asthma. Key findings include PAI being consistently associated with uncontrolled asthma across ethnicities, using IOS reference equations factoring Hispanic and White reference algorithms. It is noted that PAI is common even in patients considered well-controlled by asthma guidelines. In a large longitudinal analysis (Assessment of Small Airways Involved in Asthma or ATLANTIS study), a composite of R5-R20, AX, and X5 ordinal scores were independently predictive of asthma control and exacerbation in a multivariate analysis, but forced expiratory volume in 1 second was not significantly predictive of morbidities. However, combining forced expiratory volume in 1 second less than 80% with PAI resulted in greater odds of identifying uncontrolled asthma and exacerbations, than either alone. Applying an external validation method in children with asthma offers the clinician the IOS reference equations best fit for their own specific population. Several clinical phenotypes can also identify PAI with high probability, useful when IOS is not available. Poor asthma outcomes for obese patients with asthma are associated with dysanapsis and PAI, not obesity alone. Extrafine inhaled corticosteroids achieve better asthma control and improve peripheral airway function with fewer exacerbations at lower dosages than nonextrafine inhaled corticosteroid aerosols. In conclusion, these data support the benefit of adding IOS to spirometry in future asthma guidelines and suggest the potential benefit from targeted therapy.
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Affiliation(s)
- Stanley P Galant
- Children's Hospital of Orange County, Orange County, California; University of California Irvine, Irvine, California.
| | - Tricia Morphew
- Morphew Consulting LLC, Bothell, Washington; Children's Research Institute, Children's Hospital of Orange County, Orange, California
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Smith EF, Bradshaw TK, Urs RC, Evans DJ, Hemy NR, Hall GL, Wilson AC, Simpson SJ. Oscillometry and spirometry are not interchangeable when assessing the bronchodilator response in children and young adults born preterm. Pediatr Pulmonol 2023; 58:3122-3132. [PMID: 37539845 PMCID: PMC10947568 DOI: 10.1002/ppul.26632] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION The European Respiratory Society Oscillometry Taskforce identified that clinical correlates of bronchodilator responses are needed to advance oscillometry in clinical practice. The understanding of bronchodilator-induced oscillometry changes in preterm lung disease is poor. Here we describe a comparison of bronchodilator assessments performed using oscillometry and spirometry in a population born very preterm and explore the relationship between bronchodilator-induced changes in respiratory function and clinical outcomes. METHODS Participants aged 6-23 born ≤32 (N = 288; 132 with bronchopulmonary dysplasia) and ≥37 weeks' gestation (N = 76, term-born controls) performed spirometry and oscillometry. A significant bronchodilator response (BDR) to 400 μg salbutamol was classified according to published criteria. RESULTS A BDR was identified in 30.9% (n = 85) of preterm-born individuals via spirometry and/or oscillometry, with poor agreement between spirometry and oscillometry definitions (k = 0.26; 95% confidence interval [CI] 0.18-0.40, p < .001). Those born preterm with a BDR by oscillometry but not spirometry had increased wheeze (33% vs. 11%, p = .010) and baseline resistance (Rrs5 z-score mean difference (MD) = 0.86, 95% CI 0.07-1.65, p = .025), but similar baseline spirometry to the group without a BDR (forced expiratory volume in 1 s [FEV1 ] z-score MD = -0.01, 95% CI -0.66 to 0.68, p > .999). Oscillometry was more feasible than spirometry (95% success rate vs. 85% (FEV1 ), 69% (forced vital capacity) success rate, p < .001), however being born preterm did not affect test feasibility. CONCLUSION In the preterm population, oscillometry is a feasible and clinically useful supportive test to assess the airway response to inhaled salbutamol. Changes measured by oscillometry reflect related but distinct physiological changes to those measured by spirometry, and thus these tests should not be used interchangeably.
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Affiliation(s)
- Elizabeth F. Smith
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
- Curtin School of Allied HealthFaculty of Health SciencesBentleyAustralia
| | - Tiffany K. Bradshaw
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
| | - Rhea C. Urs
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
- Curtin School of Allied HealthFaculty of Health SciencesBentleyAustralia
| | - Denby J. Evans
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
- Curtin School of Allied HealthFaculty of Health SciencesBentleyAustralia
| | - Naomi R. Hemy
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
| | - Graham L. Hall
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
- Curtin School of Allied HealthFaculty of Health SciencesBentleyAustralia
| | - Andrew C. Wilson
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
- Curtin School of Allied HealthFaculty of Health SciencesBentleyAustralia
- Child and Adolescent Health ServicePerth Children's HospitalNedlandsAustralia
| | - Shannon J. Simpson
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
- Curtin School of Allied HealthFaculty of Health SciencesBentleyAustralia
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Qvarnström B, Engström G, Frantz S, Zhou X, Zaigham S, Sundström J, Janson C, Wollmer P, Malinovschi A. Impulse oscillometry indices in relation to respiratory symptoms and spirometry in the Swedish Cardiopulmonary Bioimage Study. ERJ Open Res 2023; 9:00736-2022. [PMID: 37753278 PMCID: PMC10518858 DOI: 10.1183/23120541.00736-2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/03/2023] [Indexed: 09/28/2023] Open
Abstract
Background Impulse oscillometry (IOS) is sensitive in detecting lung function impairment. In small studies, impaired IOS relates better to respiratory symptoms than spirometry. We studied how IOS related to spirometry and respiratory symptoms in a large population of individuals (n=10 360) in a cross-sectional analysis. Methods Normal values for IOS and spirometry were defined in healthy, never-smoking individuals, aged 50-64 years, from the Swedish CArdioPulmonary bioImage Study (n=3664 for IOS and 3608 for spirometry). For IOS, abnormal values for resistance at 5 Hz (R5) and at 20 Hz and area of reactance were defined using the 95th percentile. Abnormal reactance at 5 Hz for IOS and abnormal conventional spirometry indices (forced expiratory volume in 1 s (FEV1), forced and slow vital capacity and their ratios) were defined using the 5th percentile. Results Abnormal IOS parameters were found in 16% of individuals and were associated with increased odds ratios for nearly all respiratory symptoms when adjusted for age, gender and smoking. In individuals with normal spirometry, abnormal IOS resistance was related to cough and dyspnoea, while abnormal reactance was related to wheeze. In these individuals, the combination of abnormal R5 with abnormal reactance resulted in approximately two-fold higher likelihood for having cough, chronic bronchitis and dyspnoea, even when further adjusting for FEV1, expressed as % predicted. Conclusions Abnormal IOS is related to increased respiratory burden in middle-aged individuals with normal spirometry, especially when resistance and reactance parameters are combined. The different relationships between respiratory symptoms and reactance and resistance warrant further research.
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Affiliation(s)
- Björn Qvarnström
- Dept of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Gunnar Engström
- Dept of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Sophia Frantz
- Dept of Translational Medicine, Lund University, Malmö, Sweden
| | - Xingwu Zhou
- Dept of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden
- Dept of Medical Sciences: Respiratory Medicine, Sleep and Allergy, Uppsala University, Uppsala, Sweden
| | - Suneela Zaigham
- Dept of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden
- Dept of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Johan Sundström
- Dept of Medical Sciences: Clinical Epidemiology, Uppsala University, Uppsala, Sweden
| | - Christer Janson
- Dept of Medical Sciences: Respiratory Medicine, Sleep and Allergy, Uppsala University, Uppsala, Sweden
| | - Per Wollmer
- Dept of Translational Medicine, Lund University, Malmö, Sweden
| | - Andrei Malinovschi
- Dept of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden
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Reyes Noriega N, Del-Río-Navarro BE, Berber A, de Jesús Romero Tapia S, Molina Díaz DJM. Effect of Obesity on Lung Function in the Pediatric and Adult Populations with Asthma: A Review. J Clin Med 2023; 12:5385. [PMID: 37629427 PMCID: PMC10456025 DOI: 10.3390/jcm12165385] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
Obesity and asthma are major global health concerns, particularly in industrialized nations. Obesity has been shown to have detrimental effects on the respiratory system and lung function owing to metabolic issues and immunological consequences. Research has indicated that obese patients with asthma (atopic or T2-high and non-atopic or T2-low) have diminished lung function in terms of functional residual capacity (FRC), residual volume (RV), expiratory reserve volume (ERV), the FEV1/FVC ratio, and FEF 25-75% due to mechanical fat loading on the diaphragm and central adiposity when compared to non-obese asthmatic patients. Therefore, it is plausible that changes in lung function are the result of a combination of mechanical (fat loading on the diaphragm, central adiposity, bronchial hyper-reactivity, and an increase in cholinergic tone), environmental (diet and exercise), and inflammatory factors (local and systemic), which can lead to the obesity-related asthma phenotype characterized by severe asthma symptoms, poor response to corticosteroid treatment, loss of lung function, and poor quality of life from an early age.
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Affiliation(s)
- Nayely Reyes Noriega
- Allergy and Immunology Pediatric Department, Hospital Infantil de México Federico Gómez, Ciudad de México 06720, Mexico; (N.R.N.); (A.B.)
| | - Blanca E. Del-Río-Navarro
- Allergy and Immunology Pediatric Department, Hospital Infantil de México Federico Gómez, Ciudad de México 06720, Mexico; (N.R.N.); (A.B.)
| | - Arturo Berber
- Allergy and Immunology Pediatric Department, Hospital Infantil de México Federico Gómez, Ciudad de México 06720, Mexico; (N.R.N.); (A.B.)
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Tikkakoski AP, Tikkakoski A, Sipilä K, Kivistö JE, Huhtala H, Kähönen M, Karjalainen J, Lehtimäki L. Exercise-induced bronchoconstriction is associated with air humidity and particulate matter concentration in preschool children. Pediatr Pulmonol 2023; 58:996-1003. [PMID: 36530015 DOI: 10.1002/ppul.26284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/11/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Long-term exposure to air pollution is connected to asthma morbidity in children. Exercise-induced bronchoconstriction (EIB) is common in asthma, and the free running test outdoors is an important method for diagnosing asthma in children. It is not known whether momentary air pollution exposure affects the results of outdoor exercise tests in children. METHODS We analyzed all reliable exercise challenge tests with impulse oscillometry in children (n = 868) performed between January 2012 and April 2015 at Tampere University Hospital. Pollutant concentrations (PM2.5 , NO2 , and O3 ) at the time of the exercise test were collected from public registers. We compared the pollutant concentrations with the proportion and severity of EIB and adjusted the analyses for air humidity and pollen counts. RESULTS Pollution levels were rarely high (median PM2.5 6.0 µg/m3 , NO2 12.0 µg/m3 , and O3 47.0 µg/m3 ). The relative change in resistance at 5 Hz after exercise did not correlate with O3 , NO2 or PM2.5 concentrations (p values 0.065-0.884). In multivariate logistic regression, we compared the effects of PM2.5 over 10 µg/m³, absolute humidity (AH) over 10 g/m³ and alder or birch pollen concentration over 10 grains/m³. High (over 10 g/m3 ) AH was associated with decreased incidence (OR 0.31, p value 0.004), and PM2.5 over 10 µg/m³ was associated with increased incidence (OR 1.69, p value 0.036) of EIB. CONCLUSIONS Even low PM2.5 levels may have an effect on EIB in children. Of the other properties of air, only AH was associated with the incidence of EIB.
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Affiliation(s)
- Anna P Tikkakoski
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Antti Tikkakoski
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Kalle Sipilä
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Juho E Kivistö
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Mika Kähönen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Jussi Karjalainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
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11
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Gunawardana S, Harris C, Greenough A. Use of impulse oscillometry to assess lung function in prematurely born children and young people: Comparisons with spirometry. Paediatr Respir Rev 2023; 45:52-57. [PMID: 36270894 DOI: 10.1016/j.prrv.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/18/2022] [Accepted: 07/18/2022] [Indexed: 11/24/2022]
Abstract
Premature birth is a risk factor for bronchopulmonary dysplasia (BPD); both of which are associated with obstructive airway disease throughout childhood. Impulse oscillometry (IOS) is an effort-independent, passive measure of tidal breathing, which could have benefits in assessing lung function amongst younger patients unable to perform valid spirometry. A literature search was conducted to investigate the use of IOS in prematurely born children and young people. IOS results correlate with those of spirometry. Reversibility of airway obstruction in children with BPD is variable. IOS could have benefits in assessing individual patient response and suitability for bronchodilator therapy. More work, however, is required to establish multi-ethnic reference ranges and standardise commercially available devices prior to its routine incorporation into clinical practice.
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Affiliation(s)
- Shannon Gunawardana
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, UK.
| | - Christopher Harris
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, UK; Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK.
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, UK; NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London, UK.
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12
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Morphew T, Tirakitsoontorn P, Galant SP. External validation can provide the clinician with IOS equations that best predict the risk of uncontrolled asthma in their population. Pediatr Pulmonol 2023; 58:130-139. [PMID: 36183193 DOI: 10.1002/ppul.26170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/16/2022] [Accepted: 09/27/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Peripheral airway impairment (PAI) has been shown to have a close association to risk of uncontrolled asthma in children. However, clear methods have not been established for the clinician to select impulse oscillometry (IOS) reference equations best suited for their population. Our study aimed to develop a practical external validation analytic approach for the clinician to determine which of the available reference equations best predicts uncontrolled asthma for their patients. METHODS This is a post hoc analyses of data collected at baseline in a randomized controlled study that occurred from March 2016 to 2018. The study population consisted of 227 children, ages 4-18 years, with moderate to severe asthma. Discrimination and calibration predictive performance of available and suitable IOS equations were assessed by using uncontrolled asthma as the criterion outcome. Discrimination statistics of accuracy, sensitivity, and specificity served as the primary performance indicators. Rank scores were determined by the number of acceptable limit thresholds met for these measures (≥60%, ≥50%, and ≥60%, respectively) across IOS metrics (R5, R5-R20, AX, and X5) resulting in a total possible score of 12. RESULTS External validity assessment determined the rank order of best to worst equations as being Gochicoa-Rangel (rank score = 10) > Nowowiejska (rank score = 9) > Assumapcao (rank score = 6) > Amra (rank score = 2). Gochicoa-Rangel reference equations provided the best option for universal application with accuracy of 73.1%, 72.2%, 76.7%, and 66.2% for R5, R5-R20, AX, and X5, respectively. CONCLUSIONS External validation, particularly discrimination in asthmatic children, offers the clinician a practical approach to selecting the most suitable predictive equations for their patients.
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Affiliation(s)
- Tricia Morphew
- Morphew Consulting, LLC, Bothell, Washington, USA.,Breathmobile Department, CHOC Children's Hospital Orange County, Orange, California, USA
| | - Pornchai Tirakitsoontorn
- Pulmonary Division, CHOC Children's Hospital Orange County, Orange, California, USA.,Department of Pediatrics, Irvine School of Medicine, University of California, Irvine, California, USA
| | - Stanley P Galant
- Breathmobile Department, CHOC Children's Hospital Orange County, Orange, California, USA.,Department of Pediatrics, Irvine School of Medicine, University of California, Irvine, California, USA
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13
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Kaminsky DA, Simpson SJ, Berger KI, Calverley P, de Melo PL, Dandurand R, Dellacà RL, Farah CS, Farré R, Hall GL, Ioan I, Irvin CG, Kaczka DW, King GG, Kurosawa H, Lombardi E, Maksym GN, Marchal F, Oostveen E, Oppenheimer BW, Robinson PD, van den Berge M, Thamrin C. Clinical significance and applications of oscillometry. Eur Respir Rev 2022; 31:31/163/210208. [PMID: 35140105 PMCID: PMC9488764 DOI: 10.1183/16000617.0208-2021] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/29/2021] [Indexed: 12/28/2022] Open
Abstract
Recently, “Technical standards for respiratory oscillometry” was published, which reviewed the physiological basis of oscillometric measures and detailed the technical factors related to equipment and test performance, quality assurance and reporting of results. Here we present a review of the clinical significance and applications of oscillometry. We briefly review the physiological principles of oscillometry and the basics of oscillometry interpretation, and then describe what is currently known about oscillometry in its role as a sensitive measure of airway resistance, bronchodilator responsiveness and bronchial challenge testing, and response to medical therapy, particularly in asthma and COPD. The technique may have unique advantages in situations where spirometry and other lung function tests are not suitable, such as in infants, neuromuscular disease, sleep apnoea and critical care. Other potential applications include detection of bronchiolitis obliterans, vocal cord dysfunction and the effects of environmental exposures. However, despite great promise as a useful clinical tool, we identify a number of areas in which more evidence of clinical utility is needed before oscillometry becomes routinely used for diagnosing or monitoring respiratory disease. This paper provides a current review of the interpretation, clinical significance and application of oscillometry in respiratory medicine, with special emphasis on limitations of evidence and suggestions for future research.https://bit.ly/3GQPViA
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Affiliation(s)
- David A Kaminsky
- Dept of Medicine, Pulmonary and Critical Care Medicine, University of Vermont, Larner College of Medicine, Burlington, VT, USA.,These authors have contributed equally to this manuscript
| | - Shannon J Simpson
- Children's Lung Health, Telethon Kids Institute, School of Allied Health, Curtin University, Perth, Australia.,These authors have contributed equally to this manuscript
| | - 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
- Dept of Physiology, Biomedical Instrumentation Laboratory, Institute of Biology and Faculty of Engineering, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ronald Dandurand
- Lakeshore General Hospital, Pointe-Claire, QC, Canada.,Montreal Chest Institute, Meakins-Christie Labs, Oscillometry Unit of the Centre for Innovative Medicine, McGill University Health Centre and Research Institute, and McGill University, Montreal, QC, Canada
| | - Raffaele L Dellacà
- Dipartimento di Elettronica, Informazione e Bioingegneria - DEIB, Politecnico di Milano University, Milan, Italy
| | - Claude S Farah
- Dept of Respiratory Medicine, Concord Repatriation General Hospital, Sydney, Australia
| | - 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 Allied Health, Curtin University, Perth, Australia
| | - Iulia Ioan
- Dept of Paediatric 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 and Critical Care Medicine, University of Vermont, Larner College of Medicine, Burlington, VT, USA
| | - David W Kaczka
- Depts of Anaesthesia, Biomedical Engineering and Radiology, University of Iowa, Iowa City, IA, USA
| | - Gregory G King
- Dept of Respiratory Medicine and Airway Physiology and Imaging Group, Royal North Shore Hospital, St Leonards, Australia.,Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Hajime Kurosawa
- Dept of Occupational Health, Tohoku University School of Medicine, Sendai, Japan
| | - Enrico Lombardi
- Paediatric Pulmonary Unit, Meyer Paediatric University Hospital, Florence, Italy
| | - Geoffrey N Maksym
- School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
| | - François Marchal
- Dept of Paediatric 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
| | - Ellie Oostveen
- Dept of Respiratory Medicine, Antwerp University Hospital and University of Antwerp, Belgium
| | - 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
| | - Paul D Robinson
- Woolcock Institute of Medical Research, Children's Hospital at Westmead, Sydney, Australia
| | - Maarten van den Berge
- Dept of Pulmonary Diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Cindy Thamrin
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
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14
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Kulkarni S, Kurane A, Sakate D. Impulse Oscillometry System for the Diagnosis of Wheezing Episode in Children in Office Practice. J Asthma Allergy 2022; 15:353-362. [PMID: 35320988 PMCID: PMC8935627 DOI: 10.2147/jaa.s344643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Objective Objectively differentiating between wheezing episodes and other respiratory disorders will be helpful in treatment in office practice. The impulse oscillometry system has been useful in assessing airway resistance in children 3–6 years old. As the reference values are different in geographical regions the use of the impulse oscillometry is still limited. Comparison between the percent change in IOS parameters as compared to reference standards and changes in actual IOS parameters was done to diagnose wheezing episodes. Methodology Three to six years old children with a history of fever, cough, cold, and/or breathlessness with noisy breathing and who were not on any regular medications, whose parents gave consent were recruited in the study. The children underwent an impulse oscillometry system examination as per the guidelines. The test was repeated after they were given nebulization by salbutamol (2.5 mg) (before COVID 19 pandemic). Final diagnosis was done by following patients for 7 days. Results About 106 children were recruited in the study. Five children could not perform the IOS test. Eighteen children did not complete the follow-up. Hence, 83 children were analyzed. There were 47 males and 36 female patients. The change in actual values of AX, R5, and X20 showed statistically significant difference in wheezing episode group (p-value<0.001). The percentage change as compared to predicted values of R5 and X20 also showed a statistically significant difference in the wheezing episode group and the others group (p-value<0.001). Conclusion The change in actual values of AX, R5, X20, and resonant frequency may help to differentiate wheezing episode from other respiratory diseases.
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Affiliation(s)
- Suhas Kulkarni
- Department of Pediatrics, D.Y. Patil Medical College, Kolhapur, Maharashtra, India
- Correspondence: Suhas Kulkarni, D.Y. Patil Medical College, Kolhapur, Maharashtra, India, Tel +91 231 2601235, Fax +91 231260138, Email
| | - Anil Kurane
- Department of Pediatrics, D.Y. Patil Medical College, Kolhapur, Maharashtra, India
| | - Deepak Sakate
- Department of Statistics and Applied Mathematics, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, India
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15
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Tikkakoski AP, Karjalainen J, Sipilä K, Kivistö JE, Kähönen M, Lehtimäki L, Tikkakoski A. Outdoor pollen concentration is not associated with exercise-induced bronchoconstriction in children. Pediatr Pulmonol 2022; 57:695-701. [PMID: 34894109 DOI: 10.1002/ppul.25782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 11/07/2021] [Accepted: 12/01/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Free running exercise test outdoors is an important method to diagnose asthma in children. However, the extent of how much exposure to pollens of outdoor air affects the results of the test is not known. METHODS We analyzed all reliable exercise challenge tests with impulse oscillometry in children (n = 799) between January 2012 and December 2014 in Tampere University Hospital. Pollen concentrations at the time of the test were collected from the register of Biodiversity Unit of the University of Turku. We compared the frequency of exercise-induced bronchoconstriction and pollen concentrations. RESULTS The analyses were restricted to birch and alder pollen as high counts of grass and mugwort pollen were so infrequent. The relative change in resistance at 5 Hz after exercise or the frequency of exercise-induced bronchoconstriction were not related to alder or birch pollen concentrations over 10 grains/m3 (p = 0.125-0.398). In logistic regression analysis comparing the effects of alder or birch pollen concentrations, immunoglobulin E (IgE)-mediated alder or birch allergy and absolute humidity over 10 g/m3 only absolute humidity was independently associated with change in airway resistance (odds ratio [OR]: 0.32, confidence interval [CI]: 0.13-0.67, p: 0.006). CONCLUSIONS In our large clinical sample, outdoor air pollen concentration was not associated with the probability of exercise-induced bronchoconstriction in free running test in children while low absolute humidity was the best predictor of airway obstruction.
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Affiliation(s)
- Anna P Tikkakoski
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jussi Karjalainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Kalle Sipilä
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Juho E Kivistö
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Mika Kähönen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Antti Tikkakoski
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
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16
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Kumari MV, Amarasiri L, Rajindrajith S, Devanarayana NM. Gastric motility and pulmonary function in children with functional abdominal pain disorders and asthma: A pathophysiological study. PLoS One 2022; 17:e0262086. [PMID: 34982797 PMCID: PMC8726504 DOI: 10.1371/journal.pone.0262086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 12/17/2021] [Indexed: 11/18/2022] Open
Abstract
Background An association has been shown between functional abdominal pain disorders (FAPDs) and asthma. However, the exact reason for this association is obscured. The main objective of this study is to identify the possible underlying pathophysiological mechanisms for the association between FAPDs and asthma using gastric motility and lung function tests. Methods This was a cross-sectional comparative study that consisted of four study groups. Twenty-four children (age 7–12 years) each were recruited for four study groups; asthma only, FAPDs only, both asthma and FAPDs, and healthy controls. Asthma was diagnosed using the history and bronchodilator reversibility test. The diagnosis of FAPDs was made using Rome IV criteria. All subjects underwent ultrasound assessment of gastric motility and pulmonary function assessment by spirometry, using validated techniques. Results All gastric motility parameters, gastric emptying rate, amplitude of antral contraction, and antral motility index, were significantly impaired in children with FAPDs only, children with asthma only, and children with both asthma & FAPDs, compared to controls (p<0.05). Pulmonary function parameters indicating airway obstruction (FEV1/FVC ratio, peak expiratory flow rate, FEF25-75%) were not impaired in children with FAPDs only compared to controls (p>0.05), but significantly impaired in children with asthma and children with both disorders. Antral motility index correlated with the FEV1/FVC ratio (r = 0.60, p = 0.002) and FEF25%-75% (r = 0.49, p = 0.01) in children with both asthma and FAPDs. Conclusions Gastric motor functions were significantly impaired in children with asthma, children with FAPDs, and children with both disorders. Motility index, measuring overall gastric motor activity, showed a significant positive correlation with lung function parameters that measure airflow limitation. Therefore, these diseases might arise as a result of primary disturbance of smooth muscle activity in the airways and gastrointestinal wall, which could be a possible pathophysiological mechanism for this association between asthma and FAPDs.
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Affiliation(s)
- Manori Vijaya Kumari
- Department of Physiology, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, North Central Province, Sri Lanka
| | - Lakmali Amarasiri
- Department of Physiology, Faculty of Medicine, University of Colombo, Colombo, Western Province, Sri Lanka
| | - Shaman Rajindrajith
- Department of Pediatrics, Faculty of Medicine, University of Colombo, Colombo, Western Province, Sri Lanka
| | - Niranga Manjuri Devanarayana
- Department of Physiology, Faculty of Medicine, University of Kelaniya, Ragama, Western Province, Sri Lanka
- * E-mail:
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17
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Bokov P, Jallouli-Masmoudi D, Amat F, Houdouin V, Delclaux C. Small airway dysfunction is an independent dimension of wheezing disease in preschool children. Pediatr Allergy Immunol 2022; 33:e13647. [PMID: 34378250 DOI: 10.1111/pai.13647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Whether small airway dysfunction (SAD), which is prevalent in asthma, helps to characterize wheezing phenotypes is undetermined. The objective was to assess whether SAD parameters obtained from impedance measurement and asthma probability are linked. METHODS One hundred and thirty-nine preschool children (mean age 4.7 years, 68% boys) suffering from recurrent wheezing underwent impulse oscillometry that allowed calculating peripheral resistance and compliance of the respiratory system (markers of SAD) using the extended RIC model (central and peripheral resistance, inertance, and peripheral compliance). Children were classified using the probability-based approach of GINA guidelines (few, some, and most having asthma). A principal component analysis (PCA) that determined the dimensions of wheezing disease evaluated the links between SAD and asthma probability. RESULTS Forty-seven children belonged to the few, 28 to the some, and 64 to the most having asthma groups. Whereas their anthropometrics and measured parameters were similar, the most having asthma group exhibited the lowest mean value of airway inertance after bronchodilator probably due to airway inhomogeneities. PCA characterized four independent dimensions including a peripheral resistance (constituted by baseline peripheral compliance, Frs, R5Hz, R5-20Hz, X5Hz, and AX), a central resistance (baseline central resistance, R20Hz), anthropometrics (age and height), and asthma probability (wheezing patterns and therapeutic steps). Thus, PCA showed that the SAD markers were independent from clinical dimensions and were unable to differentiate wheezing phenotypes. CONCLUSIONS Lung function parameters obtained from impulse oscillometry and asthma probability were belonging to independent dimensions of the wheezing disease.
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Affiliation(s)
- Plamen Bokov
- Service de Physiologie Pédiatrique-Centre du Sommeil, INSERM NeuroDiderot, AP-HP, Hôpital Robert Debré, Université de Paris, Paris, France
| | - Donies Jallouli-Masmoudi
- Service de Physiologie Pédiatrique-Centre du Sommeil, AP-HP, Hôpital Robert Debré, Paris, France
| | - Flore Amat
- Service de Pneumopédiatrie, INSERM UMR S 1136, AP-HP, Hôpital Robert Debré, Paris, France
| | - Véronique Houdouin
- Service de Pneumopédiatrie, INSERM UMR S 976, AP-HP, Hôpital Robert Debré, Paris, France
| | - Christophe Delclaux
- Service de Physiologie Pédiatrique-Centre du Sommeil, INSERM NeuroDiderot, AP-HP, Hôpital Robert Debré, Université de Paris, Paris, France
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18
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Kilci F, Uyan ZS, Çelakıl ME, Doğan K, Bek K. Respiratory function in children with nephrotic syndrome: Comparative evaluation of impulse oscillometry and spirometry. Pediatr Pulmonol 2021; 56:3301-3309. [PMID: 34289254 DOI: 10.1002/ppul.25589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/01/2021] [Accepted: 07/15/2021] [Indexed: 11/09/2022]
Abstract
AIM To evaluate the respiratory functions of children with nephrotic syndrome (NS) by impulse oscillometry (IOS) and its correlation with spirometry. METHODS Fifty-five NS patients aged 3-18 years were included as the study group and 40 healthy children of the same age formed the control group. Patients were divided into nephrotic phase (first attack and relapse) and remission. Demographic, anthropometric, and laboratory data of the children were recorded. Respiratory functions were evaluated by IOS and spirometry. Children over 6-years old performed both IOS and spirometry while children under 6 years performed only IOS. RESULTS The R (R5%, R10%, R5-20), AX and Z5% values of IOS in patients with nephrotic phase were higher than remission patients and control group while spirometry indices of PEF% and MEF25-75% were lower. Z scores of MEF25-75 were significantly negatively correlated with z scores of R5, R10, Z5, and Fres while they were significantly positively correlated with z scores of X values (5, 10, 15, and 20 Hz). Z scores of forced expiratory volume in 1 /forced vital capacity significantly negatively correlated with z scores of R values (R5, R10), Z5 and AX and positively correlated with z scores of X values (X5, X10, X15 Hz). CONCLUSION Our study demonstrated that respiratory functions measured by IOS and spirometry were affected at the time of nephrotic phase in NS patients. IOS, a novel method easily applicable even in small children, is a potentially valuable tool to detect this condition; given its good correlation with spirometry.
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Affiliation(s)
- Fatih Kilci
- Department of Pediatrics, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Zeynep S Uyan
- Department of Pediatrics, Division of Pediatric Pulmonology, School of Medicine, Koç University, İstanbul, Turkey
| | - Mehtap E Çelakıl
- Department of Pediatrics, Division of Pediatric Nephrology, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Kenan Doğan
- Department of Pediatrics, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Kenan Bek
- Department of Pediatrics, Division of Pediatric Nephrology, School of Medicine, Kocaeli University, Kocaeli, Turkey
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19
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Jung Y, Jean T, Morphew T, Galant SP. Peripheral Airway Impairment and Dysanapsis Define Risk of Uncontrolled Asthma in Obese Asthmatic Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 10:759-767.e1. [PMID: 34597851 DOI: 10.1016/j.jaip.2021.09.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Factors that determine the relationship between obesity and poor outcomes in asthmatic children are not well understood. Dysanapsis and peripheral airway impairment (PAI) could provide an explanation in the obese asthmatic patient. OBJECTIVES To determine the effect of obesity on increased dysanapsis and PAI and establish the effect of obesity, dysanapsis, and PAI on increased risk of uncontrolled asthma. METHODS We evaluated 206 children with moderate to severe asthma, aged 4-18 years, to determine the relationship of body mass index (BMI) to increased dysanapsis and PAI, using reference values. We examined the probability of obesity, dysanapsis, and PAI increasing the risk of uncontrolled asthma by BMI categorically and BMI z scores using generalized linear model analyses. RESULTS Compared with normal-weight children, overweight and obese children had increased forced vital capacity % predicted and obesity increased odds of dysanapsis by 2.32 (P = .04), while PAI showed an age-dependent effect, with increased odds of 2.09 for children younger than 12 years (P = .08) and 54.14 for those 12 years and older (P = .003). For each unit increase in BMI z score, there was an increased odds ratio of 1.57 for dysanapsis (P = .009), greater in males, OR of 3.10, P = .009, and of 1.39 for PAI for those younger than 12 years (P = .042) and of 4.60 for those 12 years and older (P = .002). Obesity's relationship to uncontrolled asthma was indirect, as not significant when adjusted for the direct effect of dysanapsis and PAI, which were highly significant predictors, with increased odds of 28.01 for dysanapsis for those younger than 12 years (P < .001) and of 3.09 for PAI (P = .005). CONCLUSIONS Overweight and obesity significantly increase odds of dysanapsis and PAI, in an age and gender-specific manner, increasing the probability of uncontrolled asthma.
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Affiliation(s)
- Yela Jung
- Department of Medicine, University of California Irvine, Orange, Calif
| | - Tiffany Jean
- Division of Basic & Clinical Immunology, Department of Medicine, University of California Irvine, Orange, Calif
| | | | - Stanley P Galant
- Children's Hospital of Orange County, Breathmobile Department, Department of Pediatrics, Orange, Calif; Department of Pediatrics, University of California, Irvine, Orange, Calif.
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20
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Tan C, Zheng X, Sun F, He J, Shi H, Chen M, Tu C, Huang Y, Wang Z, Liang Y, Wu J, Liu Y, Liu J, Huang J. Hypersensitivity may be involved in severe COVID-19. Clin Exp Allergy 2021; 52:324-333. [PMID: 34570395 PMCID: PMC8652637 DOI: 10.1111/cea.14023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/06/2021] [Accepted: 09/22/2021] [Indexed: 12/23/2022]
Abstract
Background Deaths attributed to Coronavirus Disease 2019 (COVID‐19) are mainly due to severe hypoxemic respiratory failure. Although the inflammatory storm has been considered the main pathogenesis of severe COVID‐19, hypersensitivity may be another important mechanism involved in severe cases, which have a perfect response to corticosteroids (CS). Method We detected the serum level of anti‐SARS‐CoV‐2–spike S1 protein‐specific IgE (SP‐IgE) and anti‐SARS‐CoV‐2 nucleocapsid protein‐specific IgE (NP‐IgE) in COVID‐19. Correlation of levels of specific IgE and clinical severity were analysed. Pulmonary function test and bronchial provocation test were conducted in early convalescence of COVID‐19. We also obtained histological samples via endoscopy to detect the evidence of mast cell activation. Result The levels of serum SP‐IgE and NP‐IgE were significantly higher in severe cases, and were correlated with the total lung severity scores (TLSS) and the PaO2/FiO2 ratio. Nucleocapsid protein could be detected in both airway and intestinal tissues, which was stained positive together with activated mast cells, binded with IgE. Airway hyperresponsiveness (AHR) exists in the early convalescence of COVID‐19. After the application of CS in severe COVID‐19, SP‐IgE and NP‐IgE decreased, but maintained at a high level. Conclusion Hypersensitivity may be involved in severe COVID‐19.
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Affiliation(s)
- Cuiyan Tan
- Department of Pulmonary and Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Xiaobin Zheng
- Department of Pulmonary and Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Fengfei Sun
- Department of Pulmonary and Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Jianzhong He
- Department of Pathology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Honglei Shi
- Department of Pulmonary and Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Meizhu Chen
- Department of Pulmonary and Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Changli Tu
- Department of Pulmonary and Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Yiying Huang
- Department of Pulmonary and Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Zhenguo Wang
- Department of Pulmonary and Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Yingjian Liang
- Department of Pulmonary and Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Jian Wu
- Department of Pulmonary and Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Ye Liu
- Department of Pathology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Jing Liu
- Department of Pulmonary and Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Jin Huang
- Department of Pulmonary and Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
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21
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Hosseini B, Berthon BS, Starkey MR, Collison A, McLoughlin RF, Williams EJ, Nichol K, Wark PA, Jensen ME, Da Silva Sena CR, Baines KJ, Mattes J, Wood LG. Children With Asthma Have Impaired Innate Immunity and Increased Numbers of Type 2 Innate Lymphoid Cells Compared With Healthy Controls. Front Immunol 2021; 12:664668. [PMID: 34220812 PMCID: PMC8248177 DOI: 10.3389/fimmu.2021.664668] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/17/2021] [Indexed: 12/20/2022] Open
Abstract
Background Asthma is the most frequent cause of hospitalisation among children; however, little is known regarding the effects of asthma on immune responses in children. Objective The present study aimed to evaluate cytokine responses of peripheral blood mononuclear cells (PBMCs), PBMC composition and lung function in children with and without asthma. Methods Using a case-control design, we compared 48 children with asthma aged 3-11 years with 14 age-matched healthy controls. PBMC composition and cytokine production including interferon (IFN)-γ, interleukin (IL)-1β, IL-5 and lL-6 following stimulation with rhinovirus-1B (RV1B), house dust mite (HDM) and lipopolysaccharide (LPS) were measured. Lung function was assessed using impulse oscillometry and nitrogen multiple breath washout. Results The frequency of group 2 innate lymphoid cells were significantly higher in asthmatics and PBMCs from asthmatics had deficient IFN-γ production in response to both RV1B and LPS compared with controls (P<0.01). RV1B-induced IL-1β response and HDM-stimulated IL-5 production was higher in asthmatics than controls (P<0.05). In contrast, IL-1β and IL-6 were significantly reduced in response to HDM and LPS in asthmatics compared to controls (P<0.05). Children with asthma also had reduced pulmonary function, indicated by lower respiratory reactance as well as higher area of-reactance and lung clearance index values compared with controls (P<0.05). Conclusion Our study indicates that children with asthma have a reduced lung function in concert with impaired immune responses and altered immune cell subsets. Improving our understanding of immune responses to viral and bacterial infection in childhood asthma can help to tailor management of the disease.
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Affiliation(s)
- Banafshe Hosseini
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Bronwyn S Berthon
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Malcolm R Starkey
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia.,Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia.,Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Adam Collison
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia.,Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Rebecca F McLoughlin
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Evan J Williams
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Kristy Nichol
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Peter Ab Wark
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
| | - Megan E Jensen
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Carla Rebeca Da Silva Sena
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Katherine J Baines
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Joerg Mattes
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
| | - Lisa G Wood
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia.,Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
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22
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Bao W, Zhang X, Yin J, Han L, Huang Z, Bao L, Lv C, Hao H, Xue Y, Zhou X, Zhang M. Small-Airway Function Variables in Spirometry, Fractional Exhaled Nitric Oxide, and Circulating Eosinophils Predicted Airway Hyperresponsiveness in Patients with Mild Asthma. J Asthma Allergy 2021; 14:415-426. [PMID: 33907426 PMCID: PMC8071078 DOI: 10.2147/jaa.s295345] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/09/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose Patients with variable symptoms suggestive of asthma but with normal forced expiratory volume in 1 second (FEV1) often fail to be diagnosed without a bronchial provocation test, but the test is expensive, time-consuming, risky, and not readily available in all clinical settings. Patients and Methods A cross-sectional study was performed in 692 patients with FEV1≥80% predicted; normal neutrophils and chest high-resolution computed tomography; and recurrent dyspnea, cough, wheeze, and chest tightness. Results Compared with subjects negative for AHR (n=522), subjects positive for AHR (n=170) showed increased FENO values, peripheral eosinophils (EOS), and R5-R20; decreased FEV1, FEV1/Forced vital capacity (FVC), and forced expiratory flow (FEFs) (P≤.001 for all). Small-airway dysfunction was identified in 104 AHR+ patients (61.17%), and 132 AHR− patients (25.29%) (P<0.001). The areas under the curve (AUCs) of variables used singly for an AHR diagnosis were lower than 0.77. Using joint models of FEF50%, FEF75%, or FEF25%-75% with FENO increased the AUCs to 0.845, 0.824, and 0.844, respectively, significantly higher than univariate AUCs (P <0.001 for all). Patients who reported chest tightness (n=75) had lower FEFs than patients who did not (P<0.001 for all). In subjects with chest tightness, the combination of FEF50% or FEF25%-75% with EOS also increased the AUCs substantially, to 0.815 and 0.816, respectively (P <0.001 for all versus the univariate AUCs). Conclusion FENO combined with FEF50% and FEF25%-75% predict AHR in patients with normal FEV1. FEF25%-75%, FEF50%, or FEF25%-75% together with EOS also can potentially suggest asthma in patients with chest tightness.
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Affiliation(s)
- Wuping Bao
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Xue Zhang
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Junfeng Yin
- School of Mathematical Sciences, Tongji University, Shanghai, People's Republic of China
| | - Lei Han
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Zhixuan Huang
- School of Mathematical Sciences, Tongji University, Shanghai, People's Republic of China
| | - Luhong Bao
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Chengjian Lv
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Huijuan Hao
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yishu Xue
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Xin Zhou
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Min Zhang
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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23
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Burman J, Malmberg LP, Remes S, Jartti T, Pelkonen AS, Mäkelä MJ. Impulse oscillometry and free-running tests for diagnosing asthma and monitoring lung function in young children. Ann Allergy Asthma Immunol 2021; 127:326-333. [PMID: 33819614 DOI: 10.1016/j.anai.2021.03.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Separating individuals with viral-induced wheezing from those with asthma is challenging, and there are no guidelines for children under 6 years of age. Impulse oscillometry, however, is feasible in 4-year-old children. OBJECTIVE To explore the use of impulse oscillometry in diagnosing and monitoring asthma in young children and evaluating treatment response to inhaled corticosteroid (ICS). METHODS A total of 42 children (median age 5.3 years, range 4.0-7.9 years) with physician-diagnosed asthma and lability in oscillometry were followed for 6 months after initiation of ICS treatment. All children performed the 6-minute free-running test and impulse oscillometry at 3 time points. After the baseline, they attended a second visit when they had achieved good asthma control and a third visit approximately 60 days after the second visit. A positive ICS response was defined as having greater than 19 points in asthma control test and no hyperreactivity on the third visit. RESULTS In total, 38 of 42 children responded to ICS treatment. Exercise-induced increases of resistance at 5 Hz decreased after ICS treatment (61% vs 18% vs 13.5%, P < .001), and running distance during the 6-minute test was lengthened (800 m vs 850 m vs 850 m, P = .001). Significant improvements in childhood asthma control scores occurred between the baseline and subsequent visits (21 vs 24 vs 24, P < .001) and acute physicians' visits for respiratory symptoms (1, (0-6) vs 0, (0-2), P = .001). Similar profiles were observed in children without aeroallergen sensitization and among those under 5 years of age. CONCLUSION Impulse oscillometry is a useful tool in diagnosing asthma and monitoring lung function in young children.
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Affiliation(s)
- Janne Burman
- Department of Allergology, Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Leo Pekka Malmberg
- Department of Allergology, Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sami Remes
- Department of Paediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Tuomas Jartti
- Department of Pediatrics, Turku University Hospital and University of Turku, Turku, Finland; Department of Pediatrics, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Anna S Pelkonen
- Department of Allergology, Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mika J Mäkelä
- Department of Allergology, Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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24
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Elenius V, Chawes B, Malmberg PL, Adamiec A, Ruszczyński M, Feleszko W, Jartti T. Lung function testing and inflammation markers for wheezing preschool children: A systematic review for the EAACI Clinical Practice Recommendations on Diagnostics of Preschool Wheeze. Pediatr Allergy Immunol 2021; 32:501-513. [PMID: 33222297 DOI: 10.1111/pai.13418] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 11/06/2020] [Accepted: 11/13/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Preschool wheeze is highly prevalent; 30%-50% of children have wheezed at least once before age six. Wheezing is not a disorder; it is a symptom of obstruction in the airways, and it is essential to identify the correct diagnosis behind this symptom. An increasing number of studies provide evidence for novel diagnostic tools for monitoring and predicting asthma in the pediatric population. Several techniques are available to measure airway obstruction and airway inflammation, including spirometry, impulse oscillometry, whole-body plethysmography, bronchial hyperresponsiveness test, multiple breath washout test, measurements of exhaled NO, and analyses of various other biomarkers. METHODS We systematically reviewed all the existing techniques available for measuring lung function and airway inflammation in preschool children to assess their potential and clinical value in the routine diagnostics and monitoring of airway obstruction. RESULTS If applicable, measuring FEV1 using spirometry is considered useful. For those unable to perform spirometry, whole-body plethysmography and IOS may be useful. Bronchial reversibility to beta2-agonist and hyperresponsiveness test with running exercise challenge may improve the sensitivity of these tests. CONCLUSIONS The difficulty of measuring lung function and the lack of large randomized controlled trials makes it difficult to establish guidelines for monitoring asthma in preschool children.
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Affiliation(s)
- Varpu Elenius
- Department of Pediatrics, Turku University Hospital and Turku University, Turku, Finland
| | - Bo Chawes
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Pekka L Malmberg
- The Skin and Allergy Hospital, University of Helsinki, Helsinki, Finland
| | - Aleksander Adamiec
- Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland.,Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Marek Ruszczyński
- Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Wojciech Feleszko
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Tuomas Jartti
- Department of Pediatrics, University of Oulu and Oulu University Hospital, Oulu, Finland
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25
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Gupta N, Sachdev A, Gupta D, Gupta S. Assessment of airway reversibility in asthmatic children using forced oscillation technique - A single-center experience from North India. Lung India 2021; 38:229-235. [PMID: 33942746 PMCID: PMC8194442 DOI: 10.4103/lungindia.lungindia_354_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background: Lung function testing is recommended for the management of asthma. Due to certain limitations of conventional spirometry in vulnerable patients, forced oscillation technique (FOT) has been studied with promising results. As there is a paucity of data from developing world, we planned to conduct this study in children using FOT. To assess airway reversibility after inhaled salbutamol in asymptomatic children with suspected asthma. Settings: This study was conducted at pediatric asthma clinic of a tertiary care referral hospital in North India. Design: This was a prospective interventional study over 1-year period. Subjects and Methods: Asymptomatic children between 2 and 18 years of age, with history suggestive of asthma, were eligible for participation. Baseline and postbronchodilator pulmonary functions were assessed using FOT. Airway resistance and reactance were monitored at various frequencies. SPSS version 17 was used for statistical analysis. Results: Among the 345 enrolled children, baseline mean ± standard deviation total airway resistance (R5), central airway resistance (R19), peripheral airway resistance (R5–R19), reactance (X5), and resonant frequency (Fres) were 6.85 ± 2.60, 5.23 ± 1.93, 1.6 ± 1.16, and − 2.54 ± 1.36 cmH2O/L/s and 17.28 ± 3.06 Hz. The median (interquartile range) percentage change after inhaled salbutamol was 19.9 (11.40, 29.12), 22.86 (6.88, 38.76), 14.08 (3.40, 22.62), 39.20 (8.20, 62.39), and 15.79 (8.33, 27.27) in respective parameters. All changes were statistically significant. The studied respiratory variables were in maximum negative correlation with height, followed by body mass index. Conclusions: FOT is a simple technique for monitoring lung functions in children during asthma management.
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Affiliation(s)
- Neeraj Gupta
- Department of Pediatrics, Division of Pediatric Emergency, Critical Care, Pulmonology and Allergic Disorders, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
| | - Anil Sachdev
- Department of Pediatrics, Division of Pediatric Emergency, Critical Care, Pulmonology and Allergic Disorders, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
| | - Dhiren Gupta
- Department of Pediatrics, Division of Pediatric Emergency, Critical Care, Pulmonology and Allergic Disorders, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
| | - Suresh Gupta
- Department of Pediatrics, Division of Pediatric Emergency, Critical Care, Pulmonology and Allergic Disorders, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
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26
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Anık A, Anık A, Uysal P. Assessment of pulmonary function by impulse oscillometry and spirometry in children with type 1 diabetes mellitus. Pediatr Pulmonol 2020; 55:3517-3524. [PMID: 32770802 DOI: 10.1002/ppul.25019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/03/2020] [Indexed: 11/07/2022]
Abstract
AIM To assess the lung functions with impulse oscillometry (IOS) and spirometry in children with type 1 diabetes mellitus (T1DM). METHODS Fifty-one children with T1DM, and sex- and age-matched 53 healthy control (HC) subjects were included in this study. Demographic, clinical, and laboratory characteristics of the subjects were recorded and their pulmonary functions were analyzed by IOS and spirometry. RESULTS In IOS, zR5, zR10, and zR20 levels were higher in children with T1DM compared with HCs (P = .019, P = .017, and P = .002, respectively). In spirometry, zFEF75 and zFEF25-75 were lower in children with T1DM compared with HCs (P = .025, P = .001, respectively). In IOS, zR5-20 (P = .008, P = .005, respectively) and zAX (P = .013, P = .009, respectively) were significantly lower in good-controlled group compared with moderate- and poor-controlled group. In spirometry, zFEF25-75 was significantly higher in good-controlled group compared with moderate- and poor-controlled group (P = .005, P = .009, respectively). HbA1c was positively correlated with zR5-20 value (r = .339; P = .017) in male children with T1DM. The duration of the disease was positively correlated with zR5-20 (r = .290; P = .043) and zFres (r = .358; P = .010). According to the receiver operating characteristic curve analysis to estimate optimal cut-offs to discriminate good control level of T1DM (HbA1c < 7%), a zR5-20 ≤ 2.28 demonstrated a 75.0% sensitivity and 82.9% specificity, with an area under the curve of 0.805 ([confidence interval, 0.615-0.995]; P = .007). CONCLUSIONS This study showed subclinical impairment of lung functions which is associated with disease duration and the degree of metabolic control in children with T1DM.
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Affiliation(s)
- Ayşe Anık
- Department of Pediatrics, School of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Ahmet Anık
- Department of Pediatrics, School of Medicine, Division of Endocrinology, Aydın Adnan Menderes University, Aydın, Turkey
| | - Pınar Uysal
- Department of Pediatrics, School of Medicine, Division of Allergy and Immunology, Aydın Adnan Menderes University, Aydın, Turkey
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27
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Sood N, Wasilewski NV, Day AG, Wall T, Fisher T, Fisher JT, Lougheed MD. Methacholine-Induced Cough in the Absence of Asthma: Insights From Impulse Oscillometry. Front Physiol 2020; 11:554679. [PMID: 33123021 PMCID: PMC7573225 DOI: 10.3389/fphys.2020.554679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/11/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction The pathophysiologic differences between methacholine-induced cough but normal airway sensitivity (COUGH) and healthy individuals (CONTROL) are incompletely understood and may be due to differences in the bronchodilating effect of deep inspirations (DIs). The purpose of this study is to compare the bronchodilating effect of DIs in individuals with classic asthma (CA), cough variant asthma (CVA), and COUGH with CONTROL and to assess impulse oscillometry (IOS) measures as predictors of the bronchodilating effect of DIs. Methods A total of 43 adults [18 female; 44.8 ± 12.3 years (mean ± SD); n = 11 CA, n = 10 CVA, n = 7 COUGH, n = 15 CONTROL] underwent modified high-dose methacholine challenge, with IOS and partial/maximal expiratory flow volume (PEFV/MEFV) maneuvers (used to calculate DI Index) to a maximum change (Δ) in FEV1 of 50% from baseline (MAX). Cough count and dyspnea were measured at each dose. The relation between IOS parameters and DI Index was assessed at baseline and MAX using multivariable linear regression analysis. Results Cough frequency, dyspnea intensity, and baseline peripheral resistance (R5-R20) were significantly greater in COUGH compared with CONTROL (p = 0.006, p = 0.029, and p = 0.035, respectively). At MAX, the DI Index was significantly lower in COUGH (0.01 ± 0.36) compared with CA (0.67 ± 0.97, p = 0.008), CVA (0.51 ± 0.73, p = 0.012), and CONTROL (0.68 ± 0.45, p = 0.005). Fres and R5-R20 were independent IOS predictors of the DI Index. Conclusion The bronchodilating effect is impaired in COUGH and preserved in mild CA, CVA, and CONTROL. Increased peripheral airway resistance and decreased resonant frequency are associated with a decreased DI Index. COUGH is a clinical phenotype distinct from healthy normals and asthma.
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Affiliation(s)
- Nilita Sood
- Department of Medicine, School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,Department of Biomedical and Molecular Sciences, School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Nastasia V Wasilewski
- Department of Medicine, School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,Department of Biomedical and Molecular Sciences, School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Andrew G Day
- Kingston General Health Research Institute, Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada
| | - Taylar Wall
- Department of Medicine, School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Thomas Fisher
- Department of Medicine, School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - John T Fisher
- Department of Biomedical and Molecular Sciences, School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - M Diane Lougheed
- Department of Medicine, School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,Department of Biomedical and Molecular Sciences, School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,Kingston General Health Research Institute, Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada
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28
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Lundberg B, Melén E, Thunqvist P, Norman M, Hallberg J. Agreement between spirometry and impulse oscillometry for lung function assessment in 6-year-old children born extremely preterm and at term. Pediatr Pulmonol 2020; 55:2745-2753. [PMID: 32755073 PMCID: PMC7539975 DOI: 10.1002/ppul.24976] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 07/03/2020] [Accepted: 07/17/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Extremely preterm birth is a risk factor for reduced lung function later in life, and clinical follow-up from early childhood is recommended. Dynamic spirometry is the most widely used method to assess airway obstruction, but impulse oscillometry (IOS) may be an alternative method that is easier to perform in young children. The feasibility and agreement between spirometry and IOS outcome variables has not been investigated in children born extremely preterm. AIM To determine the feasibility of and correlation between spirometry and IOS in pre-school children born extremely preterm. METHODS Spirometry and IOS were performed in 6-year-old children born extremely preterm (n = 88) and age-matched term controls (n = 84) in Stockholm, Sweden. Correlations between spirometry and IOS outcome variables were analyzed using Pearson's partial correlation, adjusting for height. RESULTS Success rate for spirometry (60%) was lower than for IOS (93%) but did not differ significantly between the preterm and term groups (56% and 64% for spirometry, P = .25; and 92% and 94% for IOS, P = .61). Correlations between spirometry and IOS outcomes were at best moderate (Spearman's r = -0.31 to -0.56). Normal IOS identified 69% to 90% of those with normal spirometry. A negative predictive value of 90% was found for R5-R20 versus FEV0.75 /FVC, suggesting that IOS may be used to exclude obstructive airway disease as measured by spirometry. CONCLUSION IOS is a more feasible method than spirometry to assess lung function in young children irrespective of gestational age at birth and could be considered an alternative in children who cannot perform spirometry.
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Affiliation(s)
- Björn Lundberg
- Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Erik Melén
- Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Per Thunqvist
- Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatrics Helsingborg Hospital, Helsingborg, Sweden
| | - Mikael Norman
- Division of Pediatrics, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Jenny Hallberg
- Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
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Medeiros D, Castro P, Bianca ACD, Sarinho E, Araújo JF, Correia Junior M, Rizzo JA. Impulse oscillometry: pulmonary function assessment in preschool children. Expert Rev Respir Med 2020; 14:1261-1266. [PMID: 32852224 DOI: 10.1080/17476348.2020.1813573] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES In contrast to spirometry, which requires active participation of the individual and is challenging for the preschool age group, the impulse oscillometry system comprises a test that minimizes the degree of coordination required. The study aimed to compare the results of Impulse Oscillometry System (IOS) in children with and without respiratory symptoms. METHODS A cross-sectional study was conducted in children aged between 3 and 6 years. A short version of the ATS-DLD-78-C questionnaire validated for Brazilian children was applied to identify two groups: children with and without respiratory symptoms. The IOS analysis was carried out measuring the following parameters in triplicate: resistance at 5 Hz (R5Hz) and 20 Hz (R20Hz), respiratory reactance at 5 Hz (X5Hz), and R5-R20Hz before and after bronchodilator application. RESULTS A total of 76 preschoolers were selected, 55 (72.4%) of whom had respiratory complaints. The coefficient of variability of R5Hz was ≤17% in 70/76 (92.1%) of the children. Resistances at R5Hz and R5-R20Hz in the children with respiratory complaints reached values higher than those of children without symptoms before bronchodilation. CONCLUSIONS The results obtained for resistance using IOS in children with respiratory symptoms were higher in the pre-bronchodilator examination for R5Hz and R5-R20Hz compared to those of children without respiratory symptoms. EXPERT OPINION Prospective investigations suggest that irreversible changes in lung function begin in infancy, before reaching school age. Pulmonary function follow-up in children with recurrent wheezing or asthma is important for confirmation of diagnosis and evaluation of the disease severity. The Impulse Oscillometry System (IOS) can be useful in assessing children's pulmonary function since it requires minimal patient cooperation and can be successfully applied to preschool children being an alternative to individuals who have difficulty performing spirometry.
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Affiliation(s)
- Décio Medeiros
- Department of Maternal-Child Health, Universidade Federal de Pernambuco (UFPE) , Recife, Brazil.,Allergy and Immunology Research Center, Hospital das Clínicas, Universidade Federal de Pernambuco (UFPE) , Recife, Brazil
| | - Pedro Castro
- Allergy and Immunology Research Center, Hospital das Clínicas, Universidade Federal de Pernambuco (UFPE) , Recife, Brazil.,Undergraduate Faculty Member in Medicine, Universidade Federal de Pernambuco (UFPE) , Recife, Brazil
| | - Ana Caroline Dela Bianca
- Department of Maternal-Child Health, Universidade Federal de Pernambuco (UFPE) , Recife, Brazil.,Allergy and Immunology Research Center, Hospital das Clínicas, Universidade Federal de Pernambuco (UFPE) , Recife, Brazil
| | - Emanuel Sarinho
- Department of Maternal-Child Health, Universidade Federal de Pernambuco (UFPE) , Recife, Brazil.,Allergy and Immunology Research Center, Hospital das Clínicas, Universidade Federal de Pernambuco (UFPE) , Recife, Brazil
| | - Jaqueline Figueirôa Araújo
- Allergy and Immunology Research Center, Hospital das Clínicas, Universidade Federal de Pernambuco (UFPE) , Recife, Brazil.,Master of Science in Health, Universidade Federal de Pernambuco (UFPE) , Recife, Brazil
| | - Marco Correia Junior
- Allergy and Immunology Research Center, Hospital das Clínicas, Universidade Federal de Pernambuco (UFPE) , Recife, Brazil.,Postgraduate Program in Hebiatrics and Physical Education, Universidade de Pernambuco (UPE) , Recife, Brazil
| | - Jose Angelo Rizzo
- Allergy and Immunology Research Center, Hospital das Clínicas, Universidade Federal de Pernambuco (UFPE) , Recife, Brazil.,Department of Clinical Medicine, Universidade Federal de Pernambuco (UFPE) , Recife, Brazil
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Avila N, Nazeran H, Gordillo N, Meraz E, Gochicoa L. Computer-aided classification of small airways dysfunction using impulse oscillometric features: a children-focused review. ACTA ACUST UNITED AC 2020; 65:121-131. [PMID: 31600137 DOI: 10.1515/bmt-2018-0219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 07/12/2019] [Indexed: 11/15/2022]
Abstract
Background and objective Spirometry, which is the most commonly used technique for asthma diagnosis, is often unsuitable for small children as it requires them to follow exact instructions and perform extreme inspiration and expiration maneuvers. In contrast, impulse oscillometry (IOS) is a child-friendly technique that could serve as an alternative pulmonary function test (PFT) for asthma diagnosis and control in children as it offers several advantages over spirometry. However, the complex test results of IOS may be difficult to be understood by practitioners due to its reliance on mechanical and electrical models of the human pulmonary system. Recognizing this reality, computer-aided decision systems could help to improve the utility of IOS. The main objective of this paper is to understand the current computer-aided classification research works on this topic. Methods This paper presents a methodological review of research works related to the computer-aided classification of peripheral airway obstruction using the IOS technique, which is focused on, but not limited to, asthmatic children. Publications that focused on computer-aided classification of asthma, peripheral dysfunction and/or small airway impairment (SAI) based on impulse oscillometric features were selected for this review. Results Out of the 34 articles that were identified using the selected scientific web databases and topic-related parameters, only eight met the eligibility criteria. The most relevant results of the articles reviewed are related to the performance of the different classifiers using static features which are solely based on the first pulmonary function testing measurements (IOS and spirometry). These results included an overall classifiers' accuracy performance ranging from 42.24% to 98.61%. Conclusion There is still a great opportunity to improve the utility of IOS by developing more computer-aided robust classifiers, specifically for the asthmatic children population as the classification studies performed to date (1) are limited in number, (2) include features derived from tests that are not optimally suitable for children, (3) are solely bi-class (mostly asthma and non-asthma) and therefore fail to include different degrees of peripheral obstruction for disease prevention and control and (4) lack of validation in cases that focus on multi-class classification of the different degrees of peripheral airway obstruction.
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Affiliation(s)
- Nancy Avila
- Deparment of Metallurgical, Materials and Biomedical Engineering, University of Texas at El Paso, 500 West University Ave, El Paso, TX 79968, USA
| | - Homer Nazeran
- Deparment of Metallurgical, Materials and Biomedical Engineering, University of Texas at El Paso, 500 West University Ave, El Paso, TX 79968, USA.,Department of Electrical and Computer Engineering, University of Texas at El Paso, 500 West University Ave, El Paso, TX 79968, USA
| | - Nelly Gordillo
- Department of Electrical and Computer Engineering, Universidad Autónoma de Ciudad Juárez, Ave. del Charro No. 450, Norte, Ciudad Juárez, Chihuahua 32310, Mexico
| | - Erika Meraz
- Department of Electrical and Computer Engineering, Universidad Autónoma de Ciudad Juárez, Ave. del Charro No. 450, Norte, Ciudad Juárez, Chihuahua 32310, Mexico
| | - Laura Gochicoa
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Tlalpan 4502, Col. Sección XVI, Alcaldía Tlalpan, Ciudad de México 14080, Mexico
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31
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Oscillometry for acute asthma in the pediatric emergency department: A feasibility study. Ann Allergy Asthma Immunol 2020; 125:607-609. [PMID: 32652127 DOI: 10.1016/j.anai.2020.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/27/2020] [Accepted: 07/06/2020] [Indexed: 11/21/2022]
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Manti S, Galdo F, Parisi GF, Napolitano M, Decimo F, Leonardi S, Miraglia Del Giudice M. Long-term effects of bronchopulmonary dysplasia on lung function: a pilot study in preschool children's cohort. J Asthma 2020; 58:1186-1193. [PMID: 32508174 DOI: 10.1080/02770903.2020.1779289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Although the long term negative effects of bronchopulmonary dysplasia (BPD) are well known, follow-up studies of preterm infants with BPD into childhood are lacking. METHODS Forty-two preschool children (age range 3-6 years) who were born before 32 weeks of gestational age and affected by BPD were enrolled. Pre-, peri-, and post-natal data were collected. During the follow up appointment complete physical examination and lung function (impulse oscillometry (IOS)) were recorded. The European Community Respiratory Health Survey (ECRHS) questionnaire was administered to all enrolled subjects. RESULTS Thirty patients were included in the final analysis. The BPD group did not differ in comparison to the non-BPD group in terms of lung function (p > 0.05). By comparing all subjects enrolled, We detected extremely low-birth-weight (ELBW) infants with height-, weight-, and gender-related reference values and a significant trend of increasing resistance values (R5Hz, R5-20 Hz) and respiratory impedance (Z5Hz) (p < 0.05). No significant difference in bronchial reversibility test was observed among BPD non-BPD groups (p < 0.05). The frequency of gastroesophageal reflux disease was significantly higher in patients with BPD when compared to non-BPD group (p < 0.05). Significant differences in gestational age, oxygen supplementation (days), mechanical ventilation therapy (days), and sepsis between BPD and non-BPD groups were also observed (p < 0.05). There were no significant differences in the prevalence of family and personal history of atopy and/or allergic diseases, tobacco exposure, respiratory symptoms, respiratory syncytial virus bronchiolitis, exercise induced dyspnea, treatment with ß-2 bronchodilators and inhaled corticosteroids among the groups (p > 0.05). CONCLUSIONS The respiratory function in preschool children born with ELBW is characterized by an increase in impedance and resistance of small airways. No statistically significant differences were found between ELBW children with BPD and without BPD. With regards to the smallest gestational age, the longer duration of O2 therapy during hospitalization, and sepsis significantly resulted in a worse respiratory function.
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Affiliation(s)
- S Manti
- AOU Policlinico-Vittorio Emanuele, Respiratory Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - F Galdo
- Department of Woman. Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - G F Parisi
- AOU Policlinico-Vittorio Emanuele, Respiratory Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | | | - F Decimo
- Department of Woman. Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - S Leonardi
- AOU Policlinico-Vittorio Emanuele, Respiratory Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - M Miraglia Del Giudice
- Department of Woman. Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
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Cui X, Li Z, Teng Y, Barkjohn KK, Norris CL, Fang L, Daniel GN, He L, Lin L, Wang Q, Day DB, Zhou X, Hong J, Gong J, Li F, Mo J, Zhang Y, Schauer JJ, Black MS, Bergin MH, Zhang J. Association Between Bedroom Particulate Matter Filtration and Changes in Airway Pathophysiology in Children With Asthma. JAMA Pediatr 2020; 174:533-542. [PMID: 32250418 PMCID: PMC7136863 DOI: 10.1001/jamapediatrics.2020.0140] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 12/16/2019] [Indexed: 12/19/2022]
Abstract
Importance Fine particles (particulate matter 2.5 μm [PM2.5]), a ubiquitous air pollutant, can deposit in the small airways that play a vital role in asthma. It appears to be unknown whether the use of a PM2.5 filtration device can improve small airway physiology and respiratory inflammation in children with asthma. Objective To discover what pathophysiological changes in the small airways are associated with using a PM2.5-removing device in the bedrooms of children with asthma. Design, Setting, and Participants Children with mild or moderate asthma were enrolled in this double-blind, crossover study. The participants used a true filtration device and a sham filtration device in their bedrooms in a random order for 2 weeks each with a 2-week washout interval. The study was conducted in a suburb of Shanghai, China, during a low-ozone season. Exposures Ozone and PM2.5 were measured inside bedrooms and outside a window. Main Outcomes and Measures Impulse oscillometry, spirometry, and fractional exhaled nitric oxide were measured at the beginning and the end of each intervention. Peak expiratory flow was measured twice daily at home. Results Forty-three children (5-13 years old; 26 boys [60%]) participated. Outdoor 24-hour mean PM2.5 concentrations were moderately high, ranging from 28.6 to 69.8 μg/m3 (median, 53 μg/m3). During true filtration, bedroom PM2.5 concentrations were a mean (SD) of 63.4% (35.9%) lower than during sham filtration. Compared with sham filtration, true filtration was significantly associated with improved airway mechanics, reflected in a 24.4% (95% CI, 11.8%-37.1%) reduction in total airway resistance, a 43.5% (95% CI, 13.7%-73.3%) reduction in small airway resistance, a 22.2% (95% CI, 2.2%-42.2%) reduction in resonant frequency, and a 73.1% (95% CI, 0.3%-145.8%) increase in airway reactance. True filtration was also associated with significant improvements in fractional exhaled nitric oxide (a 27.6% [95% CI, 8.9%-42.4%] reduction) and peak expiratory flow (a 1.6% [95% CI, 0.8%-2.5%] increase). These improvements were significantly associated with bedroom PM2.5 reduction. Improvements in small airway function were nonsignificant (8.4% [95% CI, -1.4% to 18.3%]) in all participants but significant (13.2% [95% CI, 1.2%-25.1%]) in participants without eosinophilic airway inflammation at baseline. No improvements were observed for forced vital capacity, forced expiratory volume during the first second, and the ratio of these in all participants or subgroups. Conclusions and Relevance Per these results, indoor PM2.5 filtration can be a practical method to improve air flow in an asthmatic lung through improved airway mechanics and function as well as reduced inflammation. This warrants a clinical trial to confirm. Trial Registration ClinicalTrials.gov Identifier: NCT03282864.
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Affiliation(s)
- Xiaoxing Cui
- Nicholas School of the Environment, Duke University, Durham, North Carolina
| | - Zhen Li
- Department of Pediatrics, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yanbo Teng
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu Province, China
| | - Karoline K. Barkjohn
- Department of Civil and Environmental Engineering, Duke University, Durham, North Carolina
| | - Christina L. Norris
- Department of Civil and Environmental Engineering, Duke University, Durham, North Carolina
| | - Lin Fang
- Department of Building Science, Tsinghua University, Beijing, China
- Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Beijing, China
| | - Gina N. Daniel
- Nicholas School of the Environment, Duke University, Durham, North Carolina
| | - Linchen He
- Nicholas School of the Environment, Duke University, Durham, North Carolina
| | - Lili Lin
- Department of Pediatrics, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Qian Wang
- Department of Pediatrics, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Drew B. Day
- Nicholas School of the Environment, Duke University, Durham, North Carolina
| | - Xiaojian Zhou
- Department of Pediatrics, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jianguo Hong
- Department of Pediatrics, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jicheng Gong
- Beijing Innovation Center for Engineering Science and Advanced Technology and State Key Joint Laboratory of Environment Simulation and Pollution Control, College of Environmental Sciences and Engineering, Peking University, Beijing, China
| | - Feng Li
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jinhan Mo
- Department of Building Science, Tsinghua University, Beijing, China
- Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Beijing, China
| | - Yinping Zhang
- Department of Building Science, Tsinghua University, Beijing, China
- Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Beijing, China
| | - James J. Schauer
- Department of Civil and Environmental Engineering, College of Engineering, University of Wisconsin–Madison, Madison
| | | | - Michael H. Bergin
- Department of Civil and Environmental Engineering, Duke University, Durham, North Carolina
| | - Junfeng Zhang
- Nicholas School of the Environment, Duke University, Durham, North Carolina
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu Province, China
- Duke Global Health Institute, Durham, North Carolina
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Galant SP, Fregeau W, Pabelonio N, Morphew T, Tirakitsoontorn P. Standardized IOS Reference Values Define Peripheral Airway Impairment-Associated Uncontrolled Asthma Risk Across Ethnicity in Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2698-2706. [PMID: 32304833 DOI: 10.1016/j.jaip.2020.03.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/18/2020] [Accepted: 03/24/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although clinically useful in identifying peripheral airway impairment (PAI), impulse oscillometry (IOS) has not received universal acceptance. This may be due to variable cutoff points, and the perception that available standardized reference values may not be clinically relevant in all populations. OBJECTIVE To establish the relationship between PAI, based on standardized IOS reference values, and uncontrolled asthma as well as interchangeability between Hispanic and white reference algorithms. METHODS IOS reference values were established for upper and lower limits of normal (>95th and <5th percentile, respectively) using published algorithms in Hispanic and white children. Values exceeding normal limits (PAI) were compared in those uncontrolled and controlled for significance of differences. Probability estimates and odds ratio of uncontrolled asthma were determined for R5, R5-R20, AX, and X5 using adjusted generalized estimating equation analyses. Intraclass correlation coefficients determined interchangeability of Hispanic and white reference algorithm values. RESULTS Those with uncontrolled asthma had significantly greater PAI and a higher frequency of PAI than those well controlled (P < .05), whereas odds of uncontrolled asthma increased with increasing PAI (P < .001) for all IOS measures, particularly for X5, where odds ratios ranged from 2.70 to 11.01.There was good to excellent (>70%) agreement between Hispanic and white algorithms, except for R5-R20 (<70%). CONCLUSIONS PAI, defined by IOS reference values, not central airway markers (R20), is consistently related to the risk of uncontrolled asthma. This is true whether using Hispanic or white reference algorithms. Thus, standardized reference values in children offer the clinician readily available IOS cutoff points that are clinically relevant across ethnicity.
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Affiliation(s)
- Stanley P Galant
- Breathmobile Department, Children's Hospital of Orange County, Orange, Calif; Department of Pediatrics, University of California Irvine, Irvine, Calif.
| | - William Fregeau
- Department of Cardiopulmonary Service, Children's Hospital of Orange County, Orange, Calif
| | - Neil Pabelonio
- Department of Cardiopulmonary Service, Children's Hospital of Orange County, Orange, Calif
| | | | - Pornchai Tirakitsoontorn
- Department of Pediatrics, University of California Irvine, Irvine, Calif; Pulmonology Division, Children's Hospital of Orange County, Orange, Calif
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Cottee AM, Seccombe LM, Thamrin C, King GG, Peters MJ, Farah CS. Bronchodilator Response Assessed by the Forced Oscillation Technique Identifies Poor Asthma Control With Greater Sensitivity Than Spirometry. Chest 2020; 157:1435-1441. [PMID: 31982392 DOI: 10.1016/j.chest.2019.12.035] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 12/06/2019] [Accepted: 12/16/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Persistent bronchodilator response (BDR) following diagnosis of asthma is an underrecognized treatable trait, associated with worse lung function and asthma control. The forced oscillation technique (FOT) measures respiratory system impedance, and BDR cutoffs have been proposed for healthy adults; however, the relevance in asthma is unknown. We compared BDR cutoffs, using FOT and spirometry, in asthma and the relationship with asthma control. METHODS Data from patients with asthma who withheld bronchodilator medication for at least 8 h before a tertiary airway clinic visit were reviewed. All subjects performed FOT and spirometry before and after salbutamol administration, and completed the Asthma Control Test. FOT parameters examined included respiratory system resistance (R5) and reactance (X5) at 5 Hz, and area under the reactance curve (AX). BDR was defined by standard recommendations for spirometry and based on the 95th percentile of BDR in healthy adults for FOT. RESULTS Fifty-two subjects (18 men; mean age, 53 ± 18 years) were included. BDR was identified more frequently by FOT than spirometry (54% vs 27% of subjects). BDR assessed by X5 and AX, but not R5, was associated with spirometric BDR (χ2, P < .01) and correlated with asthma control (X5: rs = -0.36, P < .01; AX: rs = 0.34, P = .01). BDR measured by reactance parameters identified more subjects with poor asthma control than did spirometry (AX, 69% vs spirometry, 41%). CONCLUSIONS BDR assessed by FOT can identify poor asthma control. Reactance parameters were more sensitive in identifying poor asthma control than spirometry, supporting the use of FOT to complement spirometry in the clinical management of asthma.
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Affiliation(s)
- Alice M Cottee
- Department of Respiratory Medicine, Concord Repatriation General Hospital, Concord, NSW, Australia; Woolcock Emphysema Centre and Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, Glebe, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - Leigh M Seccombe
- Department of Respiratory Medicine, Concord Repatriation General Hospital, Concord, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Cindy Thamrin
- Woolcock Emphysema Centre and Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, Glebe, NSW, Australia
| | - Gregory G King
- Woolcock Emphysema Centre and Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, Glebe, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Respiratory Medicine, Royal North Shore Hospital, NSW, Australia
| | - Matthew J Peters
- Department of Respiratory Medicine, Concord Repatriation General Hospital, Concord, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health Sciences, Macquarie University, North Ryde, NSW, Australia
| | - Claude S Farah
- Department of Respiratory Medicine, Concord Repatriation General Hospital, Concord, NSW, Australia; Woolcock Emphysema Centre and Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, Glebe, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health Sciences, Macquarie University, North Ryde, NSW, Australia
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Kreetapirom P, Kiewngam P, Jotikasthira W, Kamchaisatian W, Benjaponpitak S, Manuyakorn W. Forced oscillation technique as a predictor for loss of control in asthmatic children. Asia Pac Allergy 2020; 10:e3. [PMID: 32099825 PMCID: PMC7016320 DOI: 10.5415/apallergy.2020.10.e3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 01/13/2020] [Indexed: 01/19/2023] Open
Abstract
Background A reliable objective tool using as a predictor of asthma control status could assist asthma management. Objective To find the parameters of forced oscillation technique (FOT) as predictors for the future loss of asthma symptom control. Methods Children with well-controlled asthma symptom, aged 6–12 years, were recruited for a 12-week prospective study. FOT and spirometer measures and their bronchodilator response were evaluated at baseline. The level of asthma symptom control was evaluated according to Global Initiative for Asthma. Results Among 68 recruited children, 41 children (60.3%) maintain their asthma control between 2 visits (group C-C), and 27 children (39.7%) lost their asthma control on the follow-up visit (group C-LC). Baseline FOT parameters, including the values of respiratory resistance at 5 Hz (R5), respiratory resistance at 20 Hz (R20), respiratory reactance at 5 Hz, area of reactance, %predicted of R5 and percentage of bronchodilator response (%∆) of R5 and R20 were significantly different between C-C and C-LC groups. In contrast, only %∆ of forced vital capacity, forced expiratory volume in 1 second (FEV1), and FEF25%–75% (forced expiratory flow 25%–75%) were significantly different between groups. Multiple logistic regression analysis revealed that %predicted of R5, %∆R5, %predicted of FEV1 and %∆FEV1 were the predictive factors for predicting the future loss of asthma control. The following cutoff values demonstrated the best sensitivity and specificity for predicting loss of asthma control: %predicted of R5=91.28, %∆R5=21.2, %predicted of FEV1=89.5, and %∆FEV1=7.8. The combination of these parameters predicted the risk of loss of asthma control with area under the curve of 0.924, accuracy of 83.8%. Conclusion Resistance FOT measures have an additive role to spirometric parameter in predicting future loss of asthma control.
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Affiliation(s)
- Piyawut Kreetapirom
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Potjanee Kiewngam
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wanlapa Jotikasthira
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wasu Kamchaisatian
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suwat Benjaponpitak
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wiparat Manuyakorn
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Starczewska-Dymek L, Bozek A, Mielnik M. The sensitivity and specificity of the forced oscillation technique in the diagnosis of bronchoconstriction in children. J Asthma 2019; 58:334-339. [PMID: 31868051 DOI: 10.1080/02770903.2019.1702054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The forced oscillation technique (FOT) is a useful diagnostic respiratory system for children. However, the final value of the FOT in the diagnosis of bronchoconstriction is still open. The aim of the study was to evaluate the sensitivity and specificity of the FOT vs. body plethysmography tests in the measure of bronchoconstriction in asthmatic children. MATERIALS AND METHODS A total of 102 children aged 2 to 6 years diagnosed with early-onset asthma and 52 healthy controls were included in this prospective, randomized study. All asthmatic patients and healthy controls underwent a basic FOT as one measurement, according to the recommendation of the Resmon Pro FOT. Then, the reversibility test was performed 20 min after the administration of 200 mg salbutamol using the FOT and body plethysmography in all patients. RESULTS The mean basic Rrs, Xrs and sRaw in asthmatic patients were, respectively, 11.13 ± 1.28 kPa sL-1, -4.6 ± 1.18 kPa sL-1 and 1.72 ± 0.58 kPa s. Similar parameters were significantly better in the control group (p < 0.05). A total of 73 (71.6%) asthmatic patients had a positive test using the FOT according to Calogero. In 4 (7.7%) patients in the control group, a positive test was obtained. In body plethysmography, similar results were reached, with a positive test in 76 (74.5%) study patients and 5 (9.6%) control patients. CONCLUSIONS A bronchial reversibility test with the use of the FOT is useful for the diagnosis of bronchial asthma, especially with the use of an Rrs parameter, such as the body plethysmography test.
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Affiliation(s)
| | - A Bozek
- Clinical Department of Internal Disease, Dermatology and Allergology in Zabrze, Medical University of Silesia, Katowice, Poland
| | - M Mielnik
- Department of Trauma and Orthopaedics, District Trauma and Orthopaedic Hospital, Piekary Sląskie, Poland
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McDowell KM. Recent Diagnosis Techniques in Pediatric Asthma: Impulse Oscillometry in Preschool Asthma and Use of Exhaled Nitric Oxide. Immunol Allergy Clin North Am 2019; 39:205-219. [PMID: 30954171 DOI: 10.1016/j.iac.2018.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective measures of lung function are important in the diagnosis and management of asthma. Spirometry, the pulmonary function test most widely used in asthma, requires respiratory maneuvers that may be difficult for preschoolers. Impulse oscillometry (IOS) is a noninvasive method of measuring lung function during tidal breathing; hence, IOS is an ideal test for use in preschool asthma. Fractional exhaled nitric oxide (FeNO) levels correspond to eosinophilic inflammation and predict responsiveness to corticosteroids. Basic concepts of IOS, methodology, and interpretation, including available normative values, and recent findings regarding FeNO are reviewed in this article.
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Affiliation(s)
- Karen M McDowell
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 7041, Cincinnati, OH 45229, USA.
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40
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Leocádio RRV, Segundo AKR, Louzada CF. A Sensor for Spirometric Feedback in Ventilation Maneuvers during Cardiopulmonary Resuscitation Training. SENSORS 2019; 19:s19235095. [PMID: 31766452 PMCID: PMC6929026 DOI: 10.3390/s19235095] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/02/2019] [Accepted: 11/03/2019] [Indexed: 12/02/2022]
Abstract
This work proposes adapting an existing sensor and embedding it on mannequins used in cardiopulmonary resuscitation (CPR) training to accurately measure the amount of air supplied to the lungs during ventilation. Mathematical modeling, calibration, and validation of the sensor along with metrology, statistical inference, and spirometry techniques were used as a base for aquiring scientific knowledge of the system. The system directly measures the variable of interest (air volume) and refers to spirometric techniques in the elaboration of its model. This improves the realism of the dummies during the CPR training, because it estimates, in real-time, not only the volume of air entering in the lungs but also the Forced Vital Capacity (FVC), Forced Expiratory Volume (FEVt) and Medium Forced Expiratory Flow (FEF20–75%). The validation of the sensor achieved results that address the requirements for this application, that is, the error below 3.4% of full scale. During the spirometric tests, the system presented the measurement results of (305 ± 22, 450 ± 23, 603 ± 24, 751 ± 26, 922 ± 27, 1021 ± 30, 1182 ± 33, 1326 ± 36, 1476 ± 37, 1618 ± 45 and 1786 ± 56) × 10−6 m3 for reference values of (300, 450, 600, 750, 900, 1050, 1200, 1350, 1500, 1650 and 1800) × 10−6 m3, respectively. Therefore, considering the spirometry and pressure boundary conditions of the manikin lungs, the system achieves the objective of simulating valid spirometric data for debriefings, that is, there is an agreement between the measurement results when compared to the signal generated by a commercial spirometer (Koko brand). The main advantages that this work presents in relation to the sensors commonly used for this purpose are: (i) the reduced cost, which makes it possible, for the first time, to use a respiratory volume sensor in medical simulators or training dummies; (ii) the direct measurement of air entering the lung using a noninvasive method, which makes it possible to use spirometry parameters to characterize simulated human respiration during the CPR training; and (iii) the measurement of spirometric parameters (FVC, FEVt, and FEF20–75%), in real-time, during the CPR training, to achieve optimal ventilation performance. Therefore, the system developed in this work addresses the minimum requirements for the practice of ventilation in the CPR maneuvers and has great potential in several future applications.
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Affiliation(s)
- Rodolfo Rocha Vieira Leocádio
- Department of Control and Automation Engineering (DECAT), Escola de Minas, Universidade Federal de Ouro Preto (UFOP), Morro do Cruzeiro, 35400-000 Ouro Preto, MG, Brazil;
- Department of Pediatric and Adult Clinic (DECPA), Escola de Medicina, Universidade Federal de Ouro Preto (UFOP), Morro do Cruzeiro, 35400-000 Ouro Preto, MG, Brazil;
- Correspondence: ; Tel.: +55-31-98807-3747
| | - Alan Kardek Rêgo Segundo
- Department of Control and Automation Engineering (DECAT), Escola de Minas, Universidade Federal de Ouro Preto (UFOP), Morro do Cruzeiro, 35400-000 Ouro Preto, MG, Brazil;
| | - Cibelle Ferreira Louzada
- Department of Pediatric and Adult Clinic (DECPA), Escola de Medicina, Universidade Federal de Ouro Preto (UFOP), Morro do Cruzeiro, 35400-000 Ouro Preto, MG, Brazil;
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41
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Veneroni C, Dahl MJ, Lavizzari A, Dawson E, Rebentisch A, Studstill S, Bowen S, Albertine KH, Dellaca RL. Non-invasive measurements of respiratory system mechanical properties by the forced oscillation technique in spontaneously breathing, mixed-breed, normal term lambs from birth to five months of age. Physiol Meas 2019; 40:105007. [PMID: 31341100 DOI: 10.1088/1361-6579/ab3493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To provide a non-invasive approach to monitoring lung function in spontaneously breathing lambs, from birth to five months of life, by the forced oscillation technique (FOT). This report describes the experimental set-up, data processing, and identification of normal predicted values of resistance (Rrs) and reactance (Xrs) of the respiratory system, along with normal bronchodilator response for bronchial reversibility testing. APPROACH Rrs and Xrs at 5, 11, and 19 Hz were measured monthly for five months in 20 normal term lambs that breathed spontaneously. In seven lambs, repeated measurements also were made within the first month of life (at 3, 7, 14, and 21 d of life). We determined the repeatability and reproducibility of the measurements and characterized the relationship between lung mechanics and age, sex, and body dimensions, using regression analysis, and measured changes in lung mechanics in response to inhaled bronchodilator. MAIN RESULTS The measurements provided repeatable and reproducible data. Rrs decreased, whereas Xrs increased, with growth from birth through the first two months of life, after which no statistically significant differences were detected. We identified normal value equations for Rrs and Xrs and for each of the measured anthropometric variables. Respiratory system mechanics were not affected by the bronchodilator. SIGNIFICANCE The FOT provides reliable non-invasive measurement of respiratory system mechanics in spontaneously breathing term lambs from birth to five months of age. The methods and normal reference values defined in this study will facilitate testing of the pathophysiological consequences of preterm birth and prolonged respiratory support on respiratory system mechanics.
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Affiliation(s)
- Chiara Veneroni
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano University, Milano, Italy. Co-first and co-last authors. Author to whom any correspondence should be addressed
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42
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Tikkakoski AP, Tikkakoski A, Kivistö JE, Huhtala H, Sipilä K, Karjalainen J, Kähönen M, Lehtimäki L. Association of air humidity with incidence of exercise-induced bronchoconstriction in children. Pediatr Pulmonol 2019; 54:1830-1836. [PMID: 31393065 DOI: 10.1002/ppul.24471] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 07/24/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND The effects of humidity and temperature on results of free running test in children are not known. OBJECTIVE Assess the relation of outdoor air temperature, relative humidity (RH), and absolute humidity (AH) to airway obstruction in children after free running exercise test. METHODS We analyzed all exercise challenge tests with impulse oscillometry in children between January 2012 and April 2015 in the Tampere University Hospital. The associations of AH, RH, and temperature of outdoor air with change in airway resistance were studied using regression analysis and by comparing the frequency of exercise-induced bronchoconstriction (increase ≥40% in resistance at 5 Hz) at different levels of temperature and humidity. RESULTS Overall, 868 children with reliable results were included (mean age: 5.4 years; range: 3.0-14.1). In regression analysis, the relative change in resistance at 5 Hz after exercise was related to temperature (regression coefficient = -0.223, P = .020) and AH (regression coefficient = -0.893, P = .002), but not to RH. If absolute air humidity was <5 g/m3 , exercise-induced bronchoconstriction (EIB) occurred in 17.6% of study subjects and at AH levels ≥10 g/m3 , it occurred in 5.9% of study subjects (P = .008). In multiple regression analysis comparing the effects of temperature and humidity and adjusting for covariates, only AH was independently associated with change in airway resistance (P = .009). CONCLUSION High AH of air is associated with lower incidence of EIB after outdoor exercise test in children. A negative test result at AH ≥10 g/m3 should be interpreted with caution.
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Affiliation(s)
- Anna P Tikkakoski
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Antti Tikkakoski
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Juho E Kivistö
- Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Kalle Sipilä
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | | | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
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Melén E, Guerra S, Hallberg J, Jarvis D, Stanojevic S. Linking COPD epidemiology with pediatric asthma care: Implications for the patient and the physician. Pediatr Allergy Immunol 2019; 30:589-597. [PMID: 30968967 DOI: 10.1111/pai.13054] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 03/22/2019] [Indexed: 12/25/2022]
Abstract
What are the implications of a lower than expected forced expiratory volume in one second (FEV1) in childhood on respiratory health later in adulthood? Lung function is known to track with age, and there is evidence from recent epidemiologic studies that impaired lung function early in life is associated with later chronic airflow limitation, or even chronic obstructive pulmonary disease, COPD. This risk seems particularly strong in subjects with persistent and severe forms of childhood asthma. Can we translate findings from longitudinal cohort studies to individual risk predictions and preventive guidelines in our pediatric care? In this review, we discuss the clinical implementations of recent epidemiological respiratory studies and the importance of preserved lung health across the life course. Also, we evaluate available clinical tools, primarily lung function measures, and profiles of risk factors, including biomarkers, that may help identifying children at risk of chronic airway disease in adulthood. We conclude that translating population level results to the individual patient in the pediatric care setting is not straight forward, and that there is a need for studies specifically designed to evaluate performance of prediction of risk profiles for long-term sequelae of childhood asthma and lung function impairment.
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Affiliation(s)
- Erik Melén
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Stefano Guerra
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona.,ISGlobal, Barcelona, Spain
| | - Jenny Hallberg
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Deborah Jarvis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Sanja Stanojevic
- Translational Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
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44
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Mondal P, Yirinec A, Midya V, Sankoorikal BJ, Smink G, Khokhar A, Abu-Hasan M, Bascom R. Diagnostic value of spirometry vs impulse oscillometry: A comparative study in children with sickle cell disease. Pediatr Pulmonol 2019; 54:1422-1430. [PMID: 31211524 DOI: 10.1002/ppul.24382] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/20/2019] [Accepted: 05/09/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Spirometry is conventionally used to diagnose airway diseases in children with sickle cell disease (C-SCD). However, spirometry is difficult for younger children to perform, is effort dependent, and it provides limited information on respiratory mechanics. Impulse oscillometry (IOS) is an effort-independent pulmonary function test (PFT), which measures total airway resistance (R5Hz) and reactance (AX). IOS could be advantageous without certain limitations of spirometry. AIM To compare the accuracy of IOS vs spirometry in making the diagnosis of asthma and assessing age-related pulmonary changes in C-SCD. STUDY DESIGN Retrospective chart review. SUBJECT SELECTION Fifty-six C-SCD and thirty-six controls (asthmatics without SCD) followed at Penn State with PFTs obtained during the initial pulmonary evaluation. METHODOLOGY We grouped C-SCD into asthmatics and non-asthmatics based on pre-referral diagnosis and compared PFTs between two groups. Receiver operating characteristic (ROC) curve analyses and machine learning tools (XGBoost and artificial neural network) were used to rank the spirometry and IOS measures based on their ability to predict a diagnosis of asthma. Robust linear regression was used to analyze association among height/age with various PFT measures. RESULTS Both ROC and XGBoost indicated that FEF25-75 %, forced expiratory volume in 1 second (FEV1)/forced vital capacity, and R5Hz(%) were the top three predictors for asthma diagnosis. R5Hz(%) and AX had superior bronchodilator response (BDR) than FEV1. IOS parameters had significant association with height/age in C-SCD (possibly due to the stiff lungs) but not in controls. CONCLUSION IOS had advantages over spirometry in C-SCD because it is feasible in early childhood, provides insights into the pulmonary mechanics, and is more sensitive to detect BDR.
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Affiliation(s)
- Pritish Mondal
- Division of Pediatric Pulmonology, Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania
| | - Alison Yirinec
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania
| | - Vishal Midya
- Department of Biostatistics and Bioinformatics, Penn State College of Medicine, Hershey, Pennsylvania
| | - Binu-John Sankoorikal
- Division of Pediatric Pulmonology, Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania
| | - Gayle Smink
- Division of Pediatric Hematology, Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania
| | - Arshjot Khokhar
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania
| | - Mutasim Abu-Hasan
- Division of Pediatric Pulmonology, Department of Pediatrics, University of Florida, Gainesville, Florida
| | - Rebecca Bascom
- Division of Pulmonology and Critical Care, Department of Medicines, Penn State College of Medicine, Hershey, Pennsylvania
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45
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Garcia-Marcos L, Edwards J, Kennington E, Aurora P, Baraldi E, Carraro S, Gappa M, Louis R, Moreno-Galdo A, Peroni DG, Pijnenburg M, Priftis KN, Sanchez-Solis M, Schuster A, Walker S. Priorities for future research into asthma diagnostic tools: A PAN-EU consensus exercise from the European asthma research innovation partnership (EARIP). Clin Exp Allergy 2019; 48:104-120. [PMID: 29290104 DOI: 10.1111/cea.13080] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The diagnosis of asthma is currently based on clinical history, physical examination and lung function, and to date, there are no accurate objective tests either to confirm the diagnosis or to discriminate between different types of asthma. This consensus exercise reviews the state of the art in asthma diagnosis to identify opportunities for future investment based on the likelihood of their successful development, potential for widespread adoption and their perceived impact on asthma patients. Using a two-stage e-Delphi process and a summarizing workshop, a group of European asthma experts including health professionals, researchers, people with asthma and industry representatives ranked the potential impact of research investment in each technique or tool for asthma diagnosis and monitoring. After a systematic review of the literature, 21 statements were extracted and were subject of the two-stage Delphi process. Eleven statements were scored 3 or more and were further discussed and ranked in a face-to-face workshop. The three most important diagnostic/predictive tools ranked were as follows: "New biological markers of asthma (eg genomics, proteomics and metabolomics) as a tool for diagnosis and/or monitoring," "Prediction of future asthma in preschool children with reasonable accuracy" and "Tools to measure volatile organic compounds (VOCs) in exhaled breath."
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Affiliation(s)
- L Garcia-Marcos
- Respiratory and Allergy Units, Arrixaca University Children's Hospital, University of Murcia & IMIB Research Institute, Murcia, Spain
| | | | | | - P Aurora
- Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital for Children, London, UK.,Department of Respiratory, Critical Care and Anaesthesia Unit, University College London (UCL) Great Ormond Street Institute of Child Health, London, UK
| | - E Baraldi
- Women's and Children's Health Department, University of Padua, Padova, Italy
| | - S Carraro
- Women's and Children's Health Department, University of Padua, Padova, Italy
| | - M Gappa
- Children's Hospital & Research Institute, Marienhospital Wesel, Wesel, Germany
| | - R Louis
- Department of Respiratory Medicine, University of Liege, Liege, Belgium
| | - A Moreno-Galdo
- Paediatric Pulmonology Unit, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - D G Peroni
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | - M Pijnenburg
- Paediatrics/Paediatric Respiratory Medicine, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - K N Priftis
- Department of Paediatrics, Athens University Medical School, Attikon General Hospital, Athens, Greece
| | - M Sanchez-Solis
- Respiratory and Allergy Units, Arrixaca University Children's Hospital, University of Murcia & IMIB Research Institute, Murcia, Spain
| | - A Schuster
- Department of Paediatrics, University Hospital, Düsseldorf, Germany
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Díaz Palacios MÁ, Hervás Marín D, Giner Valero A, Colomer Hernández N, Torán Barona C, Hernández Fernández de Rojas D. Correlation between impulse oscillometry parameters and asthma control in an adult population. J Asthma Allergy 2019; 12:195-203. [PMID: 31410030 PMCID: PMC6643487 DOI: 10.2147/jaa.s193744] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/01/2019] [Indexed: 01/27/2023] Open
Abstract
Purpose: Impulse oscillometry (IOS) has been proposed as an alternative test to evaluate the obstruction of small airways and to detect changes in airways earlier than spirometry. In this study, we sought to determine the utility and association of IOS parameters with spirometry and asthma control in an adult population. Patients and methods: Adults 14-82 years of age with asthma were classified into uncontrolled asthma (n=48), partially controlled asthma (n=45), and controlled asthma (n=49) groups, and characterized with fractional exhaled nitric oxide (FENO), IOS, and spirometry in a transversal analysis planned as a one-visit study. The basic parameters evaluated in IOS are resistance at 5 Hz (R5), an index affected by the large and small airway; resistance at 20 Hz (R20), an index of the resistance of large airways; difference between R5 and R20 (R5-R20), indicative of the function of the small peripheral airways; reactance at 5 Hz (X5), indicative of the capacitive reactance in the small peripheral airways; resonance frequency (Fres), the intermediate frequency at which the reactance is null, and reactance area (XA), which represents the total reactance (area under the curve) at all frequencies between 5 Hz to Fres. Results: There were statistical differences between groups in standard spirometry and IOS parameters reflecting small peripheral airways (R5, R10, R5-R20, Fres, XA and X5) (P<0.001). Accuracy of IOS and/or spirometry to discriminate between controlled asthma vs partially controlled asthma and uncontrolled asthma was low (AUC=0.61). Using linear regression models, we found a good association between spirometry and IOS. In order to evaluate IOS as an alternative or supplementary method for spirometry, we designed a predictive model for spirometry from IOS applying a penalized regression model (Lasso). Then, we compared the original spirometry values with the values obtained from the predictive model using Bland-Altman plots, and the models showed an acceptable bias in the case of FEV1/FVC, FEV1%, and FVC%. Conclusion: IOS did not show a discriminative capacity to correctly classify patients according to the degree of asthma control. However, values of IOS showed good association with values of spirometry. IOS could be considered as an alternative and accurate complement to spirometry in adults. In a predictive model, spirometry values estimated from IOS tended to overestimate in low values of "real" spirometry and underestimate in high values.
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Affiliation(s)
| | - David Hervás Marín
- Department of Biostatistics, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Ana Giner Valero
- Department of Allergy, Hospital Universitari La Fe, Valencia, Spain
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47
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Cracco O, Degrugilliers L, Rames C, Bécourt A, Bayat S. Change in capnogram waveform is associated with bronchodilator response and asthma control in children. Pediatr Pulmonol 2019; 54:698-705. [PMID: 30809972 DOI: 10.1002/ppul.24282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/02/2019] [Accepted: 01/20/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Airway hyper-reactivity, inflammation and remodeling contribute to inhomogeneity of ventilation-perfusion ratio VA·/Q· in asthma. Short-term variations in V.A/Q· can cause changes in expired capnographic indices. OBJECTIVES To measure acute changes in the phase 3 slope of the volumetric capnogram after β2-agonist inhalation (ΔSIII), for comparison with airway response based on FEV1 (ΔFEV1), and asthma control. SUBJECTS AND METHODS After ethical approval and informed consent, 72 children aged 6-18 y, followed up for asthma underwent spirometry and capnography before and after β-agonist inhalation through a spacer, using a side-stream rapid infrared analyzer. Asthma control was assessed using the GINA questionnaire. RESULTS Children with positive reversibility tests (defined as ΔFEV1>12%) had a significantly higher ΔSIII (m ± SE: 87.4 ± 41.4) versus those with negative tests (31.3 ± 14.0%, P = 0.001). Uncontrolled asthma was associated with a significantly larger ΔSIII (103.4 ± 64.0%, n = 7) compared to partly controlled (52.0 ± 26.1, n = 24; P = 0.009) and controlled asthma (30.8 ± 16.3, n = 41; P = 0.003). Neither Bohr dead space nor ΔFEV1 were different between asthma control groups. CONCLUSIONS ΔSIII was significantly larger in children with positive response to β2-agonist, and in uncontrolled asthmatics. To our knowledge these are the first data on exhaled CO2 phase III volumetric slope change and asthma control. The observed ΔSIII could be due to an increased ventilation of inhomogeneous peripheral lung units, and merits further evaluation as a potential phenotypic biomarker in asthma.
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Affiliation(s)
- Ophélie Cracco
- Department of Pediatric Pulmonology, Amiens University Hospital, Amiens, France
| | - Loïc Degrugilliers
- Department of Pediatric Intensive Care, Amiens University Hospital, Amiens, France
| | - Cynthia Rames
- Department of Pediatric Pulmonology, Amiens University Hospital, Amiens, France
| | - Arnaud Bécourt
- Department of Pediatric Pulmonology, Amiens University Hospital, Amiens, France
| | - Sam Bayat
- University of Grenoble Alps & Inserm UA7 STROBE Laboratory, Grenoble, France.,Department of Pulmonology and Physiology, Grenoble University Hospital, Grenoble, France
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48
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de Oliveira Jorge P, de Lima J, Chong e Silva D, Medeiros D, Solé D, Wandalsen G. Impulse oscillometry in the assessment of children's lung function. Allergol Immunopathol (Madr) 2019; 47:295-302. [PMID: 29983239 DOI: 10.1016/j.aller.2018.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/21/2018] [Accepted: 03/27/2018] [Indexed: 01/28/2023]
Abstract
PURPOSE To review available evidence in the literature on impulse oscillometry in the assessment of lung function in children with respiratory diseases, especially asthma. DATA COLLECTION Research in the Medline, PubMed, and Lilacs databases, with the keywords forced oscillation, impulse oscillometry, asthma and impulse oscillometry. RESULTS The Impulse Oscillometry System (IOS) allows the measurement of resistance and reactance of airways and is used as a diagnostic resource. A significant association between the findings of the IOS and those of spirometry is observed. In asthma, the IOS has already been used to assess the bronchodilator response and the therapeutic response to different drugs and has shown to be a sensitive technique to evaluate disease control. There are limitations to this assessment, such as children with attention deficit and in some cases it is difficult to interpret the results from a clinical point of view. CONCLUSION The IOS is a useful tool for the measurement of the lung function of children. It is an easy test, although its interpretation is not straightforward.
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Park JH, Lee JH, Kim HJ, Jeong N, Jang HJ, Kim HK, Park CS. Usefulness of impulse oscillometry for the assessment of bronchodilator response in elderly patients with chronic obstructive airway disease. J Thorac Dis 2019; 11:1485-1494. [PMID: 31179091 PMCID: PMC6531754 DOI: 10.21037/jtd.2019.03.34] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Impulse oscillometry (IOS) is a noninvasive and convenient technique to measure both airway resistance and reactance. This study aimed to evaluate whether IOS can be used to measure bronchodilator response (BDR) in elderly patients with asthma and chronic obstructive pulmonary disease (COPD) and also describe the difference between asthma and COPD. METHODS Seventy patients (30 and 40 with asthma and COPD, respectively) over 65 years of age were enrolled. IOS and spirometry measurements were obtained before and after bronchodilator administration. Correlation analysis was used to compare the percentage changes in spirometry and IOS parameters after bronchodilator administration between the asthma and COPD groups. RESULTS The changes in IOS parameters after bronchodilator administration were strongly correlated with changes in forced expiratory volume at 1 second (FEV1) and forced expiratory flow at 25-75% (FEF25-75). However, the percentage changes in IOS parameters failed to discriminate between the asthma and COPD groups. Receiver operating characteristic curve (ROC) analysis of resistance at 5 and 20 Hz (R5-20) at the best cutoff (-15.4% change) showed both high sensitivity and specificity for BDR. CONCLUSIONS IOS serves as a reliable and useful technique for identifying BDR in elderly patients with chronic obstructive airway disease. There was a difference in IOS parameters between the asthma and COPD groups; however, it was difficult to distinguish between both diseases. Further larger studies are required to investigate the real implications of using IOS in the clinical practice.
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Affiliation(s)
- Jin-Han Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jae Ha Lee
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyo-Jung Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Nari Jeong
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hang-Jea Jang
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyun-Kuk Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Chan Sun Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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Leino A, Lukkarinen M, Turunen R, Vuorinen T, Söderlund-Venermo M, Vahlberg T, Camargo CA, Bochkov YA, Gern JE, Jartti T. Pulmonary function and bronchial reactivity 4 years after the first virus-induced wheezing. Allergy 2019; 74:518-526. [PMID: 30144084 PMCID: PMC6387855 DOI: 10.1111/all.13593] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/27/2018] [Accepted: 08/03/2018] [Indexed: 01/12/2023]
Abstract
Background Wheezing illnesses among young children are common and are a risk factor for asthma. However, determinants of childhood bronchial reactivity, a key feature of asthma, are largely unknown. The aim of this study was to determine how patient characteristics during the first severe virus‐induced wheezing episode are associated with pulmonary function at preschool age. Methods Study consisted of 76 children presenting with their first wheezing episode at the ages of 3 to 23 months. At study entry, viral etiology, rhinovirus genome load, atopic and clinical characteristics, and standardized questionnaire were analyzed. At 4‐year follow‐up visit, impulse oscillometry with exercise challenge was performed. Results At study entry, the mean age of the children was 12 months (SD 6.0), 57 (75%) were rhinovirus positive, and 22 (30%) were sensitized. At follow‐up visit four years later, the mean age of the children was 60 months (SD 7.9) and 37 (49%) were using asthma medication regularly (discontinued before testing in 25 [68%] children). Bronchial reactivity (≥35% change in mean crude values of resistance) after exercise challenge or bronchodilation was present in nine (12%) children. Children with atopic sensitization at the time of the first wheezing episode were more often likely to develop bronchial reactivity (odds ratio 8.8, P = 0.03) than the children without sensitization. No other significant associations were found. Conclusions Atopic sensitization at the time of the first severe wheezing episode is an important early risk factor for increased bronchial reactivity at preschool age.
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Affiliation(s)
- Annamari Leino
- Department of Paediatrics and Adolescent Medicine; Turku University Hospital and University of Turku; Turku Finland
| | - Minna Lukkarinen
- Department of Paediatrics and Adolescent Medicine; Turku University Hospital and University of Turku; Turku Finland
- Research Centre of Applied and Preventive Cardiovascular Medicine; University of Turku; Turku Finland
| | - Riitta Turunen
- Department of Paediatrics and Adolescent Medicine; Turku University Hospital and University of Turku; Turku Finland
- Department of Clinical Virology; Turku University Hospital and Department of Virology; Turku University; Turku Finland
| | - Tytti Vuorinen
- Department of Clinical Virology; Turku University Hospital and Department of Virology; Turku University; Turku Finland
| | | | - Tero Vahlberg
- Department of Biostatistics; University of Turku and Turku University Hospital; Turku Finland
| | - Carlos A. Camargo
- Department of Emergency Medicine and Division of Rheumatology, Allergy and Immunology; Department of Medicine; Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts
| | - Yury A. Bochkov
- Department of Pediatrics; School of Medicine and Public Health; University of Wisconsin; Madison Wisconsin
| | - James E. Gern
- Department of Pediatrics; School of Medicine and Public Health; University of Wisconsin; Madison Wisconsin
- Department of Medicine; School of Medicine and Public Health; University of Wisconsin; Madison Wisconsin
| | - Tuomas Jartti
- Department of Paediatrics and Adolescent Medicine; Turku University Hospital and University of Turku; Turku Finland
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