Impulse oscillometry: pulmonary function assessment in preschool children

Medeiros, Décio; Castro, Pedro Machado Manhães de; Bianca, Ana Caroline Dela; Sarinho, Emanuel Sávio Cavalcanti; Araújo, João M. M.; Correia, Marco Aurélio de Valois; Rizzo, José Ângelo

doi:10.1080/17476348.2020.1813573

Cited by 7 publications

(16 citation statements)

References 28 publications

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“…IOS presents new perspectives as it can be performed by individuals who are unable to execute deep breathing and forced maneuvers, especially children 15 . In addition to providing more detailed information on the elastance and resistance of the respiratory system.…”

Section: Introductionmentioning

confidence: 99%

“…5,10,12 IOS presents new perspectives as it can be performed by individuals who are unable to execute deep breathing and forced maneuvers, especially children. 15 In addition to providing more detailed information on the elastance and resistance of the respiratory system. Although reference values for IOS are available, 16 data on exercise-induced changes in asthmatic children and young people are scarce, 13 especially in comparison with FEV1 responses, and could contribute to a better understanding of the pathophysiology of EIB.…”

Section: Introductionmentioning

confidence: 99%

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Comparison between impulse oscillometry parameters and spirometry for the diagnosis of exercise‐induced bronchoconstriction in asthmatic children and adolescents

Correia

Filho

Tenório

et al. 2022

Pediatric Pulmonology

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Introduction Impulse oscillometry (IOS) parameters are obtained more easily and effortlessly in comparison to forced expiratory volume in the first second (FEV1). Objective To compare IOS parameters to FEV1 in exercise‐induced bronchoconstriction (EIB) diagnosis. Methods Seventy‐four (60.8% male; 39.2 female) young asthmatics aged between 7 and 17 years (mean 12.6 ± 2.8 years) were evaluated. EIB was defined as a reduction in FEV1 ≥ 10% compared with basal after standardized challenge by treadmill running (TR). IOS parameters and FEV1 were obtained at baseline and 5,15, and 30 min after TR. The area under the receiver operator characteristic curve (AUC) was calculated from the reduction in FEV1 ≥ 10% to evaluate the best psychometric characteristics of IOS parameters. Results Twenty‐four individuals (32.4%) were diagnosed with EIB. A moderate inverse correlation was found between the IOS and FEV1 variables immediately after the TR, with resistance at 5 Hz (R5Hz), resonant frequency (Fres), and reactance area (AX), (r = −0.64, r = −0.53 and r = −0.69, respectively, all with p < 0.05). An increase of 25 kPa/l/s in R5 Hz, of 19k Pa/l/s in AX and 21 Hz in Fres were found to best correlate with EIB diagnosis by FEV1 (sensitivity 67% and specificity 62%, sensitivity 84% and specificity 50%, and sensitivity 84% and specificity 60%, respectively). Conclusion IOS parameters have a significant inverse correlation with FEV1. This study presents cut‐off points for EIB diagnosis for R5Hz, AX, and Fres, however, the findings in IOS parameters should be used and interpreted carefully if the goal is to replace spirometry.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison between impulse oscillometry parameters and spirometry for the diagnosis of exercise‐induced bronchoconstriction in asthmatic children and adolescents

Correia

Filho

Tenório

et al. 2022

Pediatric Pulmonology

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“…Oscillometry was easily performed by preschool children with the overall success rate ranging between 74–98% in studies making it a particularly attractive option ( 69 – 73 ). As a clinical tool oscillometry for preschool children is supported by studies that are able to detect differences in prebronchodilator lung function of preschool children with respiratory symptoms compared to those without respiratory symptoms ( 74 ).…”

Section: Resultsmentioning

confidence: 99%

Lung Function in Preschool Children in Low and Middle Income Countries: An Under-Represented Potential Tool to Strengthen Child Health

Chaya

Zar²,

Gray³

2022

Front. Pediatr.

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BackgroundThe burden of respiratory disease is high in low-middle income countries (LMIC). Pulmonary function tests are useful as an objective measure of lung health and to track progression. Spirometry is the commonest test, but its use is limited in preschool children. Other lung function methods have been developed but their use in LMIC has not been well described.AimTo review the use of preschool lung function testing in children in LMIC, with particular reference to feasibility and clinical applications.MethodsElectronic databases “PubMed”, “Scopus”,” Web of Science”, and “EBSCO host” were searched for publications in low and middle income countries on preschool lung function testing, including spirometry, fractional exhaled nitric oxide (FeNO), oscillometry, interrupter technique, tidal breathing and multiple breath washout (MBW), from 1 January 2011 to 31 January 2022. Papers in English were included and those including only children ≥6 years were excluded.ResultA total of 61 papers from LMIC in Asia, South America, Africa, Eurasia or the Middle East were included. Of these, 40 included spirometry, 7 FeNO, 15 oscillometry, 2 interrupter technique, and 2 tidal breathing. The papers covered test feasibility (19/61), clinical application (46/61) or epidemiological studies (13/61). Lung function testing was successful in preschool children from LMIC. Spirometry was the most technically demanding and success gradually increased with age.ConclusionPreschool lung function testing is under-represented in LMIC for the burden of respiratory disease. These tests have the potential to strengthen respiratory care in LMIC, however access needs to be improved.

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“…Furthermore, it permits to monitor the course of the disease, to assess the response to treatment and to predict exacerbations. 13,[17][18][19][20][21][22][23][24] The role of IOS in preschool children with cough variant asthma (CVA) was recently highlighted in a study conducted by Hu et al 25 Typically, these patients have persistent cough as their principal or only symptom and show pulmonary function testings (usually spirometries) within normal limits and bronchial hyperresponsiveness in bronchial methacholine challenges. [26][27][28] Interestingly, in the aforementioned study, the IOS parameter X5 differed significantly between children with and without CVA, indicating that this condition is characterized by an impairment of the peripheral airways which can be investigated in different aspects by this technique.…”

Section: Introductionmentioning

confidence: 99%

“…13,17,[29][30][31][32][33][34][35][36][37][38][39] Given the diversity of age ranges and protocols, providing a universal definition of BDR is challenging 17,29 ; therefore, the plurality of different cut-offs identified by different authors is not surprising, even taking preschoolers exclusively into account. 17,33,36,40,41 Although the reference values for IOS in healthy children need to be validated in larger populations, a recent ERS technical standard suggests that a change of at least −40% in R5, +50% in X5 and −80% in AX is required to consider as positive the response in either children or adults, based on the distribution of bronchodilator responses (5th percentile) of these populations. 17,18,[34][35][36][42][43][44][45] The objective of the present study was to identify the optimal thresholds to define a positive BDR test with IOS in preschoolers with suspected asthma.…”

Section: Introductionmentioning

confidence: 99%

Impulse oscillometry bronchodilator response in preschool children

Meoli,

Trischler,

Hutter

et al. 2024

Pediatric Pulmonology

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BackgroundIn 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.ObjectiveThe objective of the study was to identify optimal thresholds to define a positive BDR test with IOS in preschoolers with suspected asthma.MethodsChildren 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.ResultsAmong 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.ConclusionThe 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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Impulse oscillometry: pulmonary function assessment in preschool children

Cited by 7 publications

References 28 publications

Comparison between impulse oscillometry parameters and spirometry for the diagnosis of exercise‐induced bronchoconstriction in asthmatic children and adolescents

Comparison between impulse oscillometry parameters and spirometry for the diagnosis of exercise‐induced bronchoconstriction in asthmatic children and adolescents

Lung Function in Preschool Children in Low and Middle Income Countries: An Under-Represented Potential Tool to Strengthen Child Health

Impulse oscillometry bronchodilator response in preschool children

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