Clinical characteristics of and risk factors for small airway dysfunction detected by impulse oscillometry

Peng, Jieqi; Wu, Fan; Tian, Heshen; Yang, Huajing; Zheng, Yuzhen; Deng, Zhishan; Wang, Zihui; Xiao, Shan; Wen, Xiang; Huang, Peiyu; Lu, Lifei; Dai, Cuiqiong; Zhao, Ningning; Huang, Suyin; Ran, Pixin; Zhou, Yumin

doi:10.1016/j.rmed.2021.106681

Cited by 15 publications

(14 citation statements)

References 31 publications

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“…The baseline characteristics showed airway abnormalities had more clinical symptoms, lower FEV 1 % predicted and more severe airway obstruction than normal airway group. This was consistent with the results of previous studies [5,25]. To our surprise, multivariate analysis results found large airway abnormality assessed by R 20 was associated with occupational exposure.…”

Section: Discussionsupporting

confidence: 93%

Clinical symptoms and radiologic features of airway abnormalities assessed by impulse oscillometry in patients with chronic obstructive pulmonary disease

Peng

et al. 2022

Preprint

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Background: Airway abnormalities assessed by impulse oscillometry (IOS) were common in patients with chronic obstructive pulmonary disease (COPD). However, most studies only used difference from R5 to R20 (R5-R20) > 0.7kPa/L/s to diagnose airway abnormalities, which may ignore the value of other IOS indicators in the diagnosis of airway abnormalities. Our study aimed to comprehensively assess clinical symptoms and radiologic features of airway abnormalities in COPD patients in China.Methods: We enrolled 805 COPD patients from a part of ECOPD cohort, they underwent questionnaires, symptom scores, lung function, IOS and HRCT. The criteria of airway abnormalities were based on standardized IOS reference values. Logistic regression was used to analyze risk factors of airway abnormalities. The associations between acute exacerbation of COPD (AECOPD) in the previous year and airway abnormalities were assessed by Poisson regression. Logistic regression was used to assess the associations between CT imaging and airway abnormalities.Results: The proportion of airway abnormalities evaluated by other indicators increased gradually with COPD severity except for R20. Multivariate logistic analysis showed dyspnea, low FEV1% predicted and airway obstruction were associated with risk of airway abnormalities. Compared with normal airway group, airway abnormalities group had more clinical symptoms (wheeze and dyspnea) and higher mMRC and CAT scores. Airway abnormalities assessed by X5 and AX had more emphysema, gas trapping and higher risk of AECOPD in the previous year.Conclusions: Reactance (X5, AX) assessment of airway abnormalities had more clinical symptoms, emphysema, gas trapping and higher risk of AECOPD in the previous year. be associated with imaging lesions. However, the criteria of airway abnormalities were based on the 3rd quartile values of R rs at 5 Hz (R 5 ) and X 5 in the non-COPD group, and its reliability needed to be further studied. Additionally, some studies only used the difference between R 5 and Rrs at 20 Hz (R 20 ) (R 5 -R 20 ) to assess peripheral airway impairment [7-9] and may ignore the research value of other indicators representing airway abnormalities in chronic respiratory diseases. Therefore, it was necessary to make more appropriate criteria and comprehensively explore the clinical signi cance of airway abnormalities assessed by IOS indexes in COPD.The purpose of this study was to evaluate clinical symptoms and radiologic features of airway abnormalities assessed by standardized IOS reference values [> Upper limit of normal (ULN)/< lower limits of normal (LLN)] in China in COPD patients based on a large prospective cohort to analyze whether airway abnormalities were a COPD phenotype. Methods This was a prospective cohort study of early COPD in Guangdong, China (ECOPD cohort). The speci c research design has been published [10]. Brie y, we continuously recruited subjects from July 2019 to August 2021 in Guangzhou city, Wengyuan, Lianping County, Guangdong Province. Subjects in this study must be ...

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Section: Discussionsupporting

confidence: 93%

Clinical symptoms and radiologic features of airway abnormalities assessed by impulse oscillometry in patients with chronic obstructive pulmonary disease

Peng

et al. 2022

Preprint

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“…Of these, R5–R20 reflects the resistance of small or peripheral airways. Its value > 0.07 Ka/L/s indicated SAD [ 23 ]. The severity of IOS-defined SAD was indicated by all these recorded parameters about airway resistance and reactance.…”

Section: Methodsmentioning

confidence: 99%

The association between small airway dysfunction and aging: a cross-sectional analysis from the ECOPD cohort

Dai

Wang

et al. 2022

Respir Res

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Background Aging has been evidenced to bring about some structural and functional lung changes, especially in COPD. However, whether aging affects SAD, a possible precursor of COPD, has not been well characterized. Objective We aimed to comprehensively assess the relationship between aging and SAD from computed tomography, impulse oscillometry, and spirometry perspectives in Chinese. Methods We included 1859 participants from ECOPD, and used a linear-by-linear association test for evaluating the prevalence of SAD across various age subgroups, and multivariate regression models for determining the impact of age on the risk and severity of SAD. We then repeated the analyses in these subjects stratified by airflow limitation. Results The prevalence of SAD increases over aging regardless of definitional methods. After adjustment for other confounding factors, per 10-yrs increase in age was significantly associated with the risk of CT-defined SAD (OR 2.57, 95% CI 2.13 to 3.10) and the increase in the severity of air trapping (β 2.09, 95% CI − 0.06 to 4.25 for LAA-856), airway reactance (β − 0.02, 95% CI − 0.04 to − 0.01 for X5; β 0.30, 95% CI 0.13 to 0.47 for AX; β 1.75, 95% CI 0.85 to 2.66 for Fres), as well as the decrease in expiratory flow rates (β − 3.95, 95% CI − 6.19 to − 1.71 for MMEF%predicted; β − 5.42, 95% CI − 7.88 to − 2.95 for FEF50%predicted) for SAD. All these associations were generally maintained in SAD defined by IOS or spirometry. After stratification of airflow limitation, we further found that the effect of age on LAA-856 was the most significant among almost all subgroups. Conclusions Aging is significantly associated with the prevalence, increased risk, as well as worse severity of SAD. CT may be a more optimal measure to assess aging-related SAD. The molecular mechanisms for the role of aging in SAD need to be explored in the future. Trialregistration Chinese Clinical Trial Registry ChiCTR1900024643. Registered on 19 July 2019

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“…However, FEV1 is thought to be inadequate to determine obstruction of the smaller airways [ 4 , 5 ]. Some studies suggest that IOS is more sensitive than spirometry for detecting airway obstruction in patients with asthma and COPD [ 1 , 6 , 7 ]. Therefore, IOS is a useful complimentary method in detecting small airway obstruction.…”

Section: Introductionmentioning

confidence: 99%

Long-term variability of impulse oscillometry and spirometry in stable COPD and asthma

Sun

Zhu

et al. 2022

Respir Res

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Background While optimizing spirometry is a challenge for lung function labs, long-term variability if any between IOS (impulse oscillometry) parameters and spirometry is not clearly known in stable COPD (chronic obstructive pulmonary disease) and chronic asthma. The forced oscillation technique is increasingly employed in routine lung function testing. Our aim in this study was to determine the variability in oscillometric parameters between clinic visits over weeks or months in two patient groups during a period of clinical stability. Moreover, the research assessed relationships between IOS parameters long-term variability and COPD severity. Methods We used data from 73 patients with stable COPD and 119 patients with stable asthma at the Shanghai Pulmonary Hospital Affiliated to Tongji University. Patients were included if they had three or more clinic visits where spirometry and IOS were performed during a clinically stable period. Data recorded from the first three visits were used. The standard deviation (SDbv), the coefficient of variation (COV), intraclass correlation coefficient (ICC) and the coefficient of repeatability (COR) were calculated, Wilcoxon Mann–Whitney test was used for data that did not conform to normality of distributions, Kruskal Wallis test was used to compare with multiple groups, post hoc comparison was analyzed by Bonferroni, Spearman correlation coefficients for non-parametric data, the multiple regression analyses to determine the relationship between long-term variability and airflow obstruction. Results (1) The repeatability of IOS resistance parameters with ICC values > 0.8 was high in COPD and asthma. ICC values of IOS resistance parameters were higher than IOS reactance parameters; (2) the repeatability of spirometry parameters with ICC values < 0.8 was lower than IOS resistance parameters in different GOLD (the Global Initiative for Chronic Obstructive Lung Disease) stages, the higher the stage the worse the repeatability; (3) the severity of airflow obstruction was correlated with long-term variability of R5 (R at 5 Hz) (P < 0.05) in GOLD4, not with long-term variability of R20 (R at 20 Hz) (P > 0.05) and R5-R20 (P > 0.05). Conclusion IOS resistance parameters have good long-term repeatability in asthma and COPD. Additionally, repeatability of spirometry parameters is lower than IOS resistance parameters in different GOLD stages.

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Clinical characteristics of and risk factors for small airway dysfunction detected by impulse oscillometry

Cited by 15 publications

References 31 publications

Clinical symptoms and radiologic features of airway abnormalities assessed by impulse oscillometry in patients with chronic obstructive pulmonary disease

Clinical symptoms and radiologic features of airway abnormalities assessed by impulse oscillometry in patients with chronic obstructive pulmonary disease

The association between small airway dysfunction and aging: a cross-sectional analysis from the ECOPD cohort

Long-term variability of impulse oscillometry and spirometry in stable COPD and asthma

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