Clinical Characterization and Predictors of IOS-Defined Small-Airway Dysfunction in Asthma

Cottini, Marcello; Licini, Anita; Lombardi, Carlo; Berti, Alvise

doi:10.1016/j.jaip.2019.10.040

Cited by 56 publications

(60 citation statements)

References 40 publications

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“…Compared with spirometry, the prevalence of SAD is higher when it is recalculated with IOS cutoff values, which has also been confirmed in previous studies [ 10 , 11 , 19 , 24 ]. IOS could detect airway dysfunction that spirometry failed to [ 9 , 26 ].…”

Section: Discussionsupporting

confidence: 80%

“…As the frequency at which reactance is zero, meaning equal and opposite inertial and elastic properties at this frequency [ 23 ], Fres reflects the capacitance and inertial properties of peripheral airways [ 11 ]. Except for the above four parameters, decreases in X5 were also observed in other studies [ 17 , 19 , 24 ] which compared subjects with and without symptoms or SAD. However, X5 is not different between SAD and no SAD group in the present study.…”

Section: Discussionsupporting

confidence: 80%

“…More and more studies [ 9 , 11 , 19 ] found that spirometry was not sensitive to assess small airway function. Xiao et al [ 5 ] found that FEF 25–75% was often within the normal range when FEV 1 /FVC was above 75%.…”

Section: Discussionmentioning

confidence: 99%

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Impulse oscillometry for detection of small airway dysfunction in subjects with chronic respiratory symptoms and preserved pulmonary function

Yan

Yang

et al. 2021

Respir Res

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Background Subjects with chronic respiratory symptoms and preserved pulmonary function (PPF) may have small airway dysfunction (SAD). As the most common means to detect SAD, spirometry needs good cooperation and its reliability is controversial. Impulse oscillometry (IOS) may complete the deficiency of spirometry and have higher sensitivity. We aimed to explore the diagnostic value of IOS to detect SAD in symptomatic subjects with PPF. Methods The evaluation of symptoms, spirometry and IOS results in 209 subjects with chronic respiratory symptoms and PPF were assessed. ROC curves of IOS to detect SAD were analyzed. Results 209 subjects with chronic respiratory symptoms and PPF were included. Subjects who reported sputum had higher R5–R20 and Fres than those who didn’t. Subjects with dyspnea had higher R5, R5–R20 and AX than those without. CAT and mMRC scores correlated better with IOS parameters than with spirometry. R5, R5–R20, AX and Fres in subjects with SAD (n = 42) significantly increased compared to those without. Cutoff values for IOS parameters to detect SAD were 0.30 kPa/L s for R5, 0.015 kPa/L s for R5–R20, 0.30 kPa/L for AX and 11.23 Hz for Fres. Fres has the largest AUC (0.665, P = 0.001) among these parameters. Compared with spirometry, prevalence of SAD was higher when measured with IOS. R5 could detect the most SAD subjects with a prevalence of 60.77% and a sensitivity of 81% (AUC = 0.659, P = 0.002). Conclusion IOS is more sensitive to detect SAD than spirometry in subjects with chronic respiratory symptoms and PPF, and it correlates better with symptoms. IOS could be an additional method for SAD detection in the early stage of diseases.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionsupporting

confidence: 80%

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Impulse oscillometry for detection of small airway dysfunction in subjects with chronic respiratory symptoms and preserved pulmonary function

Yan

Yang

et al. 2021

Respir Res

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“…Small airways, which are defined by an inner diameter <2 mm, represent a "quiet zone" and provide minimal resistance to airflow in normal adult lungs 7 ; however, they are vulnerable to obstruction in asthma 8 . In the diseased state, pulmonary function changes are not detected by standard spirometry until approximately 75% of the small airways are obstructed 9,10 . Therefore, it is crucial for predicting AHR presence in patients with a normal FEV 1 for early stage asthma diagnosis based on small airway function parameters (SAFPs) 11 .…”

Section: Introductionmentioning

confidence: 99%

“…Both SAFPs and FeNO are age dependent 13,14 with older age being an important small‐airway dysfunction (SAD) predictor in patients with asthma 9,15 and being associated with a greater daily dose of inhaled corticosteroid 9 and a worse clinical asthma expression 16 . Moreover, FeNO has been reported to decrease with aging in patients with asthma 17 .…”

Section: Introductionmentioning

confidence: 99%

The value of small airway function parameters and fractional exhaled nitric oxide for predicting positive methacholine challenge test in asthmatics of different ages with FEV₁ ≥ 80% predicted

Hou

Hao

Huang

et al. 2021

Clinical & Translational All

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Background Small airway function parameters (SAFPs) combined with fractional exhaled nitric oxide (FeNO) can predict a positive methacholine challenge test (MCT) for asthma diagnosis. However, their predictive utility in patients with forced expiratory volume in one second (FEV1) ≥80% predicted within different age ranges remains unclear. This study aimed to assess the utility of SAFPs, alone or combined with FeNO, to predict a positive MCT in patients in two age groups (<55 and ≥55 years) with asthma‐suggestive symptoms and FEV1 ≥80% predicted. Methods We enrolled 846 Chinese patients with suspected asthma and standard spirometry, FeNO, and MCT findings. Using the area under the curves (AUCs), the utility of SAFPs, alone or combined with FeNO, for predicting a positive MCT was analyzed in a discovery (n = 534) and validation cohort (n = 312) in both age groups with FEV1 ≥80% predicted. Results In the discovery cohort, the optimal cut‐off values for predicting a positive MCT in patients aged <55 years (74.2% and 74.9% for forced expiratory flow (FEF)50% and FEF25%–75%, respectively) were higher than those in patients aged ≥55 years (65.0% and 62.9% for FEF50%, FEF25%–75%, respectively). However, the optimal FeNO value in patients aged <55 years (43 ppb) was lower than that in patients aged ≥55 years (48 ppb). FeNO combined with SAFPs (FEF50%, FEF25%–75%) significantly increased the AUCs in both groups (≥55 years [0.851 for FEF50% and 0.844 for FEF25%–75%]; <55 years [0.865 for FEF50% and 0.883 for FEF25%–75%]) compared with a single parameter (p < 0.05). These findings were confirmed in the validation cohort. Compared with patients ≥55 years, those aged <55 years had higher and lower optimal cut‐off values for SAFPs and FeNO, respectively. The AUCs of FeNO combined with SAFPs for predicting a positive MCT for asthma diagnosis were significantly higher than those of the individual parameters (p < 0.05) in both age groups. Conclusions There were age‐group differences in the utility of SAFPs combined with FeNO for predicting a positive MCT. Patients with an asthma‐suggestive history and a normal FEV1 should be stratified by age when using SAFPs combined with FeNO to predict a positive MCT.

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Functional Properties of Lower Airway Estimated by Oscillometry: Is Oscillometry Useful for Detecting Lower-Airway Abnormalities?

Kurosawa

2020

Structure-Function Relationships in Various Respiratory Systems

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Clinical Characterization and Predictors of IOS-Defined Small-Airway Dysfunction in Asthma

Cited by 56 publications

References 40 publications

Impulse oscillometry for detection of small airway dysfunction in subjects with chronic respiratory symptoms and preserved pulmonary function

Impulse oscillometry for detection of small airway dysfunction in subjects with chronic respiratory symptoms and preserved pulmonary function

The value of small airway function parameters and fractional exhaled nitric oxide for predicting positive methacholine challenge test in asthmatics of different ages with FEV₁ ≥ 80% predicted

Functional Properties of Lower Airway Estimated by Oscillometry: Is Oscillometry Useful for Detecting Lower-Airway Abnormalities?

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Clinical Characterization and Predictors of IOS-Defined Small-Airway Dysfunction in Asthma

Cited by 56 publications

References 40 publications

Impulse oscillometry for detection of small airway dysfunction in subjects with chronic respiratory symptoms and preserved pulmonary function

Impulse oscillometry for detection of small airway dysfunction in subjects with chronic respiratory symptoms and preserved pulmonary function

The value of small airway function parameters and fractional exhaled nitric oxide for predicting positive methacholine challenge test in asthmatics of different ages with FEV1 ≥ 80% predicted

Functional Properties of Lower Airway Estimated by Oscillometry: Is Oscillometry Useful for Detecting Lower-Airway Abnormalities?

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The value of small airway function parameters and fractional exhaled nitric oxide for predicting positive methacholine challenge test in asthmatics of different ages with FEV₁ ≥ 80% predicted