Total Respiratory Resistance and Reactance in Patients with Upper Airway Obstruction

Noord, J.A. van; Wellens, W; Clarysse, I.; Cauberghs, M.; Woestijne, K. P. Van de; Demedts, Maurits

doi:10.1378/chest.92.3.475

Cited by 63 publications

(72 citation statements)

References 8 publications

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“…Oscillometric abnormalities may occur in ILD due to interdependence of parenchymal and airway function 58 ; however, this was unlikely in our study since parenchymal disease was not evident on high-resolution CT scan. Additionally, IOS abnormalities may occur because of the upper airway shunt effect.…”

Section: Acknowledgmentsmentioning

confidence: 64%

Lessons From the World Trade Center Disaster

Berger

Reibman

Oppenheimer

et al. 2013

Chest

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Background: The present study (1) characterizes a physiologic phenotype of restrictive dysfunction due to airway injury and (2) compares this phenotype to the phenotype of interstitial lung disease (ILD). Methods: This is a retrospective study of 54 persistently symptomatic subjects following World Trade Center (WTC) dust exposure. Inclusion criteria were reduced vital capacity (VC), FEV 1 /VC . 77%, and normal chest roentgenogram. Measurements included spirometry, plethysmography, diffusing capacity of lung for carbon monoxide (D LCO ), impulse oscillometry (IOS), inspiratory/expiratory CT scan, and lung compliance (n 5 16). Results: VC was reduced (46% to 83% predicted) because of the reduction of expiratory reserve volume (43% Ϯ 26% predicted) with preservation of inspiratory capacity (IC) (85% Ϯ 16% predicted). Total lung capacity (TLC) was reduced, confi rming restriction (73%

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Section: Acknowledgmentsmentioning

confidence: 64%

Lessons From the World Trade Center Disaster

Berger

Reibman

Oppenheimer

et al. 2013

Chest

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“…[23][24][25] or as is seen in patients with COPD, in whom the resistance at 5 Hz is higher than the resistance at 20 Hz. 23,[26][27][28] When forced oscillations are applied to measure the impedance of the respiratory system, part of the air flow generated by the loudspeaker does not enter the lower airways and is lost in motions of the upper airway walls. This process is called an upper airway shunt, which causes changes in the estimation of respiratory impedance.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Central Airway Obstruction Using Impulse Oscillometry Before and After Interventional Bronchoscopy

Handa¹,

Huang

Murgu

et al. 2013

Respir Care

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BACKGROUND: Spirometry is used to physiologically assess patients with central airway obstruction (CAO) before and after interventional bronchoscopy, but is not always feasible in these patients, does not localize the anatomic site of obstruction, and may not correlate with the patient's functional impairment. Impulse oscillometry may overcome these limitations. We assessed the correlations between impulse oscillometry measurements, symptoms, and type of airway narrowing, before and after interventional bronchoscopy, and whether impulse oscillometry parameters can discriminate between fixed and dynamic CAO. METHODS: Twenty consecutive patients with CAO underwent spirometry, impulse oscillometry, computed tomography, dyspnea assessment, and bronchoscopy, before and after interventional bronchoscopy. The collapsibility index (the percent difference in airway lumen diameter during expiration versus during inspiration) was calculated using morphometric bronchoscopic images during quiet breathing. Variable CAO was defined as a collapsibility index of > 50%. Fixed CAO was defined as a collapsibility index of < 50%. The degree of obstruction was analyzed with computed tomography measurements. RESULTS: After interventional bronchoscopy, all impulse oscillometry measurements significantly improved, especially resistance at 5 Hz, which decreased from 0.67 ؎ 0.29kPa/L/s to 0.38 ؎ 0.17kPa/L/s (P < .001), and reactance at 20 Hz, which increased from -0.09 ؎ 0.11 to 0.03 ؎ 0.08 (P < .001). Changes in dyspnea score correlated with resistance at 5 Hz, the difference between the resistance at 5 Hz and the resistance at 20 Hz, and the reactance at 5 Hz, but not with spirometry measurements. The type of obstruction also correlated with dyspnea score, and showed distinct impulse oscillometry measurements. CONCLUSIONS: Impulse oscillometry measurements correlate with symptom improvements after interventional bronchoscopy. Impulse oscillometry might be useful to discriminate variable from fixed central airway obstruction. (University Hospital Medical Information Network, http://www.umin.ac.jp/english, ID000005322).

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“…such as fibrosing alveolitis [64] and kyphoscoliosis or ankylosing spondylitis [62]. Again, this observation can be explained on the basis of the upper airway shunt impedance, which may mask the differences between the alterations in pulmonary mechanics resulting from various respiratory disorders.…”

Section: Diagnostic Capacitymentioning

confidence: 99%

The forced oscillation technique in clinical practice: methodology, recommendations and future developments

Oostveen¹,

MacLeod²,

Lorino³

et al. 2003

European Respiratory Journal

1,083

1,120

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The forced oscillation technique (FOT) is a noninvasive method with which to measure respiratory mechanics. FOT employs small-amplitude pressure oscillations superimposed on the normal breathing and therefore has the advantage over conventional lung function techniques that it does not require the performance of respiratory manoeuvres.The present European Respiratory Society Task Force Report describes the basic principle of the technique and gives guidelines for the application and interpretation of FOT as a routine lung function test in the clinical setting, for both adult and paediatric populations.FOT data, especially those measured at the lower frequencies, are sensitive to airway obstruction, but do not discriminate between obstructive and restrictive lung disorders. There is no consensus regarding the sensitivity of FOT for bronchodilation testing in adults. Values of respiratory resistance have proved sensitive to bronchodilation in children, although the reported cutoff levels remain to be confirmed in future studies.Forced oscillation technique is a reliable method in the assessment of bronchial hyperresponsiveness in adults and children. Moreover, in contrast with spirometry where a deep inspiration is needed, forced oscillation technique does not modify the airway smooth muscle tone. Forced oscillation technique has been shown to be as sensitive as spirometry in detecting impairments of lung function due to smoking or exposure to occupational hazards. Together with the minimal requirement for the subject9s cooperation, this makes forced oscillation technique an ideal lung function test for epidemiological and field studies. Novel applications of forced oscillation technique in the clinical setting include the monitoring of respiratory mechanics during mechanical ventilation and sleep.

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Total Respiratory Resistance and Reactance in Patients with Upper Airway Obstruction

Cited by 63 publications

References 8 publications

Lessons From the World Trade Center Disaster

Lessons From the World Trade Center Disaster

Assessment of Central Airway Obstruction Using Impulse Oscillometry Before and After Interventional Bronchoscopy

The forced oscillation technique in clinical practice: methodology, recommendations and future developments

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