Relating small airways to asthma control by using impulse oscillometry in children

Background Previous reports suggest that the peripheral airways are associated with asthma control. Patient history, although subjective, is used largely to assess asthma control in children because spirometric results are many times normal values. Impulse oscillometry (IOS) is an objective and noni...

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Bibliographic Details
Published in:	Journal of allergy and clinical immunology Vol. 129; no. 3; pp. 671 - 678
Main Authors:	Shi, Yixin, MS, Aledia, Anna S., BS, Tatavoosian, Ahramahzd V., BS, Vijayalakshmi, Shruthi, Galant, Stanley P., MD, George, Steven C., MD, PhD
Format:	Journal Article
Language:	English
Published:	New York, NY Mosby, Inc 01-03-2012 Elsevier Elsevier Limited
Subjects:	Adolescent Airway management Allergy and Immunology Asthma Asthma - diagnosis Asthma - pathology Asthma - physiopathology Asthma - prevention & control Biological and medical sciences Child Children & youth Chronic obstructive pulmonary disease, asthma Colleges & universities control Disease Eradication Feasibility Studies Female Fundamental and applied biological sciences. Psychology Fundamental immunology Hospitals Humans Immunopathology Lung - metabolism Lung - pathology lung function Male Medical sciences Nutrition research Oscillometry pediatric Pneumology Reactance Reporting requirements resistance Respiratory Function Tests - methods Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis Spirometry California Resistance of the respiratory system at 5 Hz Bronchodilator response of FEV 1 Forced vital capacity Difference of R5 and R20 Resonant frequency of reactance pediatric AUC Reactance BDR R20 lung function Area under the curve Reactance of the respiratory system at 5 Hz X5 Impulse oscillometry R5 ROC control Forced expiratory flow at 25% to 75% of forced vital capacity IOS resistance FVC R5-20 Receiver operating characteristic AX Reactance area Fres FEF 25-75 Resistance of the respiratory system at 20 Hz FEF25-75 Human Lung disease Immunopathology Pediatrics Respiratory disease Respiratory system Asthma Resistance Respiratory tract Lung function Immunology Bronchus disease Obstructive pulmonary disease Child Oscillometry
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Summary:	Background Previous reports suggest that the peripheral airways are associated with asthma control. Patient history, although subjective, is used largely to assess asthma control in children because spirometric results are many times normal values. Impulse oscillometry (IOS) is an objective and noninvasive measurement of lung function that has the potential to examine independently both small- and large-airway obstruction. Objective We sought to determine the utility of IOS in assessing asthma control in children. Methods Asthmatic and healthy children (6-17 years) were enrolled in the study. Spirometric and IOS (resistance of the respiratory system at 5 Hz [R5] and 20 Hz [R20], reactance of the respiratory system at 5 Hz [X5], resonant frequency of reactance [Fres], and area under the reactance curve between 5 Hz and Fres [reactance area {AX}]) values were collected in triplicate before and after a bronchodilator was administered. The physicians were blinded to the IOS measurements and assessed asthma control using American Thoracic Society guidelines. Results Small-airway IOS measurements, including the difference of R5 and R20 [R5-20], X5, Fres, and AX, of children with uncontrolled asthma (n = 44) were significantly different from those of children with controlled asthma (n = 57) and healthy children (n = 14), especially before the administration of a bronchodilator. However, there was no difference in large-airway IOS values (R20). No differences were found between children with controlled asthma and healthy children in any of the end points. Receiver operating characteristic analysis showed cut points for baseline R5-20 (1.5 cm H2 O · L−1 · s) and AX (9.5 cm H2 O · L−1 ) that effectively discriminated controlled versus uncontrolled asthma (area under the curve, 0.86 and 0.84) and correctly classified more than 80% of the population. Conclusion Uncontrolled asthma is associated with small-airways dysfunction, and IOS might be a reliable and noninvasive method to assess asthma control in children.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1
ISSN:	0091-6749 1097-6825
DOI:	10.1016/j.jaci.2011.11.002