Finally More Direct Evidence That Impulse Oscillometry Measures Small Airway Disease.
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ABSTRACT:
SUBMITTER: van den Berge M
PROVIDER: S-EPMC6794106 | biostudies-literature | 2019 Oct
REPOSITORIES: biostudies-literature
Publications
Finally More Direct Evidence That Impulse Oscillometry Measures Small Airway Disease.
van den Berge Maarten M Kerstjens Huib A M HAM
American journal of respiratory and critical care medicine 20191001 8
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Project description:Impulse oscillometry (IOS) is a sensitive tool for assessing small airway function in patients with chronic obstructive pulmonary disease (COPD). This study aimed to differentiate between COPD, small airway disease (SAD), and normal groups using IOS, and to evaluate the clinical applicability of IOS. This retrospective cohort study was conducted from January 2020 to February 2022. The eligible population comprised adult patients who simultaneously underwent IOS and pulmonary function tests. The diagnostic value of IOS in differentiating SAD and/or COPD from control was analyzed, and the correlations among IOS parameters, lung function, and radiological assessment results were determined. Among the enrolled 306 patients, 38 (12.4%) had SAD and 134 (43.8%) had COPD. The remainder comprised the control group without COPD and/or SAD. Abnormal airway resistance according to IOS parameters was detected in 17.2% of the patients in the control group, 47.2% of those in the SAD group, and 55.2% of those in the COPD group. Airway resistance estimated by IOS were significantly higher in the SAD and COPD groups than in the control group and correlated with lung function and radiological airway wall thickness. We developed a composite index called the IOS severity index (IOSsi) using IOS parameters that can predict SAD and COPD, and IOSsi showed significantly differentiation of SAD and/or COPD from control. Especially, IOSsi value ≥ 4 was associated with an increased risk of SAD and/or COPD and also with risk for moderate-to-severe exacerbation in patients with COPD. IOS may be a useful tool to differentiate disease status and evaluate disease severity and prognosis in patients with SAD and/or COPD, and a prognostic factor of COPD.
| S-EPMC11564534 | biostudies-literature
Project description:Airways obstruction is frequent in patients with pulmonary hypertension (PH). Small airway disease (SAD) was identified as a major contributor to resistance and symptoms. However, it is easily missed using current diagnostic approaches. We aimed to evaluate more elaborate diagnostic tests such as impulse oscillometry (IOS) and SF₆-multiple-breath-washout (MBW) for the assessment of SAD in PH. Twenty-five PH patients undergoing body-plethysmography, IOS and MBW testing were prospectively included and equally matched to pulmonary healthy and non-healthy controls. Lung clearance index (LCI) and acinar ventilation heterogeneity (Sacin) differed significantly between PH, healthy and non-healthy controls. Likewise, differences were found for all IOS parameters between PH and healthy, but not non-healthy controls. Transfer factor corrected for ventilated alveolar volume (TLCO/VA), frequency dependency of resistance (D5-20), resonance frequency (Fres) and Sacin allowed complete differentiation between PH and healthy controls (AUC (area under the curve) = 1.0). Likewise, PH patients were separated from non-healthy controls (AUC 0.762) by D5-20, LCI and conductive ventilation heterogeneity (Scond). Maximal expiratory flow (MEF) values were not associated with additional diagnostic values. MBW and IOS are feasible in PH patients both providing additional information. This can be used to discriminate PH from healthy and non-healthy controls. Therefore, further research targeting SAD in PH and evaluation of therapeutic implications is justified.
| S-EPMC6306708 | biostudies-literature
Project description:Background and objective: Spirometry is commonly used to assess small airway dysfunction (SAD). Impulse oscillometry (IOS) can complement spirometry. However, discordant spirometry and IOS in the diagnosis of SAD were not uncommon. We examined the association between spirometry and IOS within a large cohort of subjects to identify variables that may explain discordant spirometry and IOS findings. Methods: 1,836 subjects from the ECOPD cohort underwent questionnaires, symptom scores, spirometry, and IOS, and 1,318 subjects were examined by CT. We assessed SAD with R5-R20 > the upper limit of normal (ULN) by IOS and two of the three spirometry indexes (maximal mid-expiratory flow (MMEF), forced expiratory flow (FEF)50%, and FEF75%) < 65% predicted. Multivariate regression analysis was used to analyze factors associated with SAD diagnosed by only spirometry but not IOS (spirometry-only SAD) and only IOS but not spirometry (IOS-only SAD), and line regression was used to assess CT imaging differences. Results: There was a slight agreement between spirometry and IOS in the diagnosis of SAD (kappa 0.322, p < 0.001). Smoking status, phlegm, drug treatment, and family history of respiratory disease were factors leading to spirometry-only SAD. Spirometry-only SAD had more severe emphysema and gas-trapping than IOS-only SAD in abnormal lung function. However, in normal lung function subjects, there was no statistical difference in emphysema and gas-trapping between discordant groups. The number of IOS-only SAD was nearly twice than that of spirometry. Conclusion: IOS may be more sensitive than spirometry in the diagnosis of SAD in normal lung function subjects. But in patients with abnormal lung function, spirometry may be more sensitive than IOS to detect SAD patients with clinical symptoms and CT lesions.
| S-EPMC9257410 | biostudies-literature
Project description:BackgroundStudies on consistency among spirometry, impulse oscillometry (IOS), and histology for detecting small airway dysfunction (SAD) remain scarce. Considering invasiveness of lung histopathology, we aimed to compare spirometry and IOS with chest computed tomography (CT) for SAD detection, and evaluate clinical characteristics of subjects with SAD assessed by these three techniques.MethodsWe collected baseline data from the Early COPD (ECOPD) study. CT-defined SAD was defined as parametric response mapping quantifying SAD (PRMfSAD) ≥ 15%. Spirometry-defined SAD was defined as at least two of maximal mid-expiratory flow (MMEF), forced expiratory flow 50% (FEF50), and forced expiratory flow 75% (FEF75) less than 65% of predicted. IOS-defined SAD was defined as peripheral airway resistance R5 - R20 > 0.07 kPa/L/s. The consistency of spirometry, IOS and CT for diagnosing SAD was assessed using Kappa coefficient. Correlations among the three techniques-measured small airway function parameters were assessed by Spearman correlation analysis.Results2055 subjects were included in the final analysis. There was low agreement in SAD assessment between spirometry and CT (Kappa = 0.126, 95% confidence interval [CI]: 0.106 to 0.146, p < 0.001), between IOS and CT (Kappa = 0.266, 95% CI: 0.219 to 0.313, p < 0.001), as well as among spirometry, IOS, and CT (Kappa = 0.056, 95% CI: 0.029 to 0.082, p < 0.001). The correlation was moderate (|r|: 0.5 to 0.7, p < 0.05) between spirometry and CT-measured small airway function parameters, and weak (|r|< 0.4, p < 0.05) between IOS and CT-measured small airway function parameters. Only spirometry-defined SAD group had more lower lung function (FEV1/FVC: adjusted difference=-10.7%, 95% CI: -13.5% to -7.8%, p < 0.001) and increased airway wall thickness (Pi 10: adjusted difference = 0.3 mm, 95% CI: 0 to 0.6 mm, p = 0.046) than only CT-defined SAD group. Only IOS-defined SAD group had better lung function (FEV1/FVC: adjusted difference = 3.9%, 95% CI: 1.9 to 5.8%, p < 0.001), less emphysema (inspiratory LAA- 950: adjusted difference=-2.1%, 95% CI:-3.1% to -1.1%, P < 0.001; PRMEmph: adjusted difference=-2.3%, 95% CI: -3.2% to -1.4%, p < 0.001), and thicker airway wall (Pi 10: adjusted difference = 0.2 mm, 95% CI: 0.1 mm to 0.4 mm, p = 0.005) than only CT-defined SAD group.ConclusionsThere was low consistency in the assessment of SAD between spirometry and CT, between IOS and CT, as well as among spirometry, IOS, and CT.Clinical trial numberNot applicable.
| S-EPMC11773755 | biostudies-literature
Project description: Not available
| S-EPMC10485984 | biostudies-literature
Project description:Adenosine deaminase-deficient severe combined immunodeficiency (ADA-SCID) is characterized by impaired T-, B- and NK-cell function. Affected children, in addition to early onset of infections, manifest non-immunologic symptoms including pulmonary dysfunction likely attributable to elevated systemic adenosine levels. Lung disease assessment has primarily employed repetitive radiography and effort-dependent functional studies. Through impulse oscillometry (IOS), which is effort-independent, we prospectively obtained objective measures of lung dysfunction in 10 children with ADA-SCID. These results support the use of IOS in the identification and monitoring of lung function abnormalities in children with primary immunodeficiencies.
| S-EPMC4683718 | biostudies-literature
Project description:Impulse oscillometry system (IOS) is a simple, and less invasive method for assessing small to total airway resistance in children. We analyzed the correlation between IOS, spirometry, and plethysmographic parameters performed for the diagnosis of pediatric BO patients. A total of 89 IOS assessments of pediatric BO patients or children without lung disease were included, and the relationship between pulmonary function tests (PFTs) and diagnostic performance was analyzed. R5, R5-20, X5, and AX were statistically significantly worse in the BO group. In general linear correlation analysis, R5% (adjusted β [aβ], -0.59; p < 0.001) and AX % (aβ, -0.9; p < 0.001) showed the strongest correlation with conventional PFT parameters. R5% and AX % also showed the highest correlation with FEF25-75% (aβ, -0.48; p < 0.001 and aβ, -0.83; p < 0.001), and sRaw % (aβ, -0.73; p = 0.003 and aβ, -0.59; p = 0.008, respectively). Multivariate logistic regression analysis showed that R5 Z-score showed the highest ORs with FEV1 (OR = 3.94, p = 0.006), FEF25-75% (OR = 5.96, p = 0.005), and sRaw % (OR = 4.85, p = 0.022). Receiver operating curve analysis suggested AX % and R5% as the most optimal IOS parameters for BO diagnostic performance with the area under the curve of 0.915 and 0.882, respectively. In conclusion, R5 and AX are the parameters that can independently identify the severity of airway obstruction in pediatric BO patients without conventional lung function tests. IOS is an easy-to-perform, and reliable diagnostic method capable of detecting pathological obliteration of the small airways in children with BO.
| S-EPMC9904454 | biostudies-literature
Project description:BackgroundSpirometry confers limited value for identifying small-airway disorders (SADs) in early-stage COPD, which can be detected with impulse oscillometry (IOS) and endobronchial optical coherence tomography (EB-OCT). Whether IOS is useful for reflecting small-airway morphological abnormalities in COPD remains unclear.ObjectivesTo compare the diagnostic value of spirometry and IOS for identifying SADs in heavy-smokers and COPD based on the objective assessment with EB-OCT.MethodsWe recruited 59 COPD patients (stage I, n=17; stage II, n=18; stage III-IV, n=24), 26 heavy-smokers and 21 never-smokers. Assessments of clinical characteristics, spirometry, IOS and EB-OCT were performed. Receiver operation characteristic curve was employed to demonstrate the diagnostic value of IOS and spirometric parameters.ResultsMore advanced staging of COPD was associated with greater abnormality of IOS and spirometric parameters. Resonant frequency (Fres) and peripheral airway resistance (R5-R20) conferred greater diagnostic values than forced expiratory volume in one second (FEV1%) and maximal (mid-)expiratory flow (MMEF%) predicted in discriminating SADs in never-smokers from heavy-smokers (area under curve [AUC]: 0.771 and 0.753 vs 0.570 and 0.558, respectively), and heavy-smokers from patients with stage I COPD (AUC: 0.726 and 0.633 vs 0.548 and 0.567, respectively). The combination of IOS (Fres and R5-R20) and spirometric parameters (FEV1% and MMEF% predicted) contributed to a further increase in the diagnostic value for identifying SADs in early-stage COPD. Small airway wall area percentage (Aw% 7-9), an EB-OCT parameter, correlated significantly with Fres and R5-R20 in COPD and heavy-smokers, whereas EB-OCT parameters correlated with FEV1% and MMEF% in advanced, rather than early-stage, COPD.ConclusionsIOS parameters correlated with the degree of morphologic abnormalities of small airways assessed with EB-OCT in COPD and heavy-smokers. Fres and R5-R20 might be sensitive parameters that reliably reflect SADs in heavy-smokers and early-stage COPD.
| S-EPMC6171757 | biostudies-literature
Project description:BackgroundImpulse oscillometry (IOS) and fractional exhaled nitric oxide (FeNO) are sensitive and non-invasive methods to measure airway resistance and inflammation, although there are limited population-based studies using IOS and FeNO to predict asthma control.ObjectiveThis study aimed to investigate the utility of IOS and FeNO for assessing childhood asthma control in terms of small airway dysfunction and airway inflammation.MethodsThis prospective observational cohort study enrolled 5,018 school children (aged 6-12 years), including 560 asthmatic children and 140 normal participants. FeNO, spirometry, IOS, bronchial dilation test, total IgE, and childhood asthma control test (C-ACT) were measured. FeNO, IOS, spirometry, and C-ACT results were correlated with childhood asthma with and without control.ResultsUncontrolled asthmatic children had abnormal FeNO, IOS, and spirometric values compared with control subjects (P < 0.05). IOS parameters with R5, R5-R20, X5, Ax, △R5, and FeNO can predict lower C-ACT scales by the areas under receiver operating characteristic curves (AUCs) (0.616, 0.625, 0.609, 0.622, 0.625, and 0.714). A combination of FeNO (>20 ppb) with IOS measure significantly increased the specificity for predicting uncontrolled asthma patients compared with FeNO alone (P < 0.01). A multiple regression model showed that small airway parameter (R5-R20) was the strongest risk factor [OR (95% CI): 87.26 (7.67-993.31)] for uncontrolled asthma patients. Poor control with lower C-ACT scales correlated with high FeNO (r = -0.394), R5 (r = -0.106), and R5-R20 (r = -0.129) in asthmatic children (P < 0.05).ConclusionA combined use of FeNO and IOS measurements strongly predicts childhood asthma with or without control.
| S-EPMC9247317 | biostudies-literature
Project description:Although the diagnostic value of impulse oscillometry (IOS) in bronchiectasis for the differential diagnosis of healthy subjects has been researched, the usefulness of each IOS parameter for predicting disease severity in bronchiectasis has not been thoroughly investigated. In addition, the usefulness of IOS in patients with nontuberculous mycobacteria (NTM) infection has not been reported. This study aimed to determine the predictive significance of respiratory impedance and detect the other most significant IOS parameters for predicting disease severity in bronchiectasis patients and to validate the usefulness of IOS in patients with NTM infection. A total of 206 patients with bronchiectasis who attended clinics at the National Hospital Organization Osaka Toneyama Medical Center were included. Chest high-resolution computed tomography, spirometry and IOS were performed. Hospital admissions, mortality and disease severity indices for bronchiectasis (Bronchiectasis Severity Index (BSI), FACED, and E-FACED scores) were calculated to assess disease severity. The patients were divided into subgroups with and without NTM infection, and subgroup analyses were performed. Respiratory reactance, especially resonant frequency (fres), correlated with both BSI and FACED score better than respiratory resistance. Inspiratory but not expiratory impedance was strongly correlated with BSI, FACED and E-FACED scores. Inspiratory fres was the most useful predictor, increasing as the disease became more severe. The usefulness of IOS was almost equivalent in patients both with and without NTM infection. Inspiratory reactance measured by IOS is useful for estimating disease severity in bronchiectasis. Inspiratory fres best predicts disease severity in bronchiectasis patients both with and without NTM infection.
| S-EPMC7553116 | biostudies-literature