Impulse oscillometry defined small airway dysfunction in asthmatic patients with normal spirometry: Prevalence, clinical associations, and impact on asthma control

Cottini, Marcello; Bondì, B.; Bagnasco, Diego; Braido, Fulvio; Passalacqua, Giovanni; Licini, Anita; Lombardi, Carlo; Berti, Alvise; Comberiati, Pasquale; Landi, Massimo; Heffler, Enrico; Paoletti, Giovanni

doi:10.1016/j.rmed.2023.107391

Cited by 13 publications

(8 citation statements)

References 59 publications

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“…The IOS parameters, using an interpretation of R5-R20 Hz, are considered good markers of SAD [43]. We found a high prevalence of small airway resistance in EA of 56%, and 45.8% in MGA, 42.1% in PGA, and 25% in NA, but no difference was seen in SAD among phenotypes.…”

Section: Discussionmentioning

confidence: 64%

Asthma Inflammatory Phenotypes: How Can We Distinguish Them?

Plavsic,

Nikolic,

Milenkovic

et al. 2024

JCM

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Background and objectives: induced sputum is used to assess different inflammatory phenotypes in asthma, but is not used routinely. We aimed to determine the proportion of inflammatory asthma phenotypes based on induced sputum, to find biomarkers that can discriminate between phenotypes, and to evaluate biomarkers in patients with and without biological therapy in different inflammatory asthma phenotypes. Materials and Methods: this cross-sectional study investigated clinical characteristics, asthma control tests, skin prick test, impulse oscillometry (IOS), spirometry, induced sputum, biomarkers (IgE, eosinophils, fractional exhaled nitric oxide (FeNO), serum periostin, IL-5, IL-6, IL-8, IL-17A, IL-33) in 80 asthmatics. A total of 17/80 patients were treated with biologics (10 with omalizumab, 7 with benralizumab). Results: a total of 31% of patients had eosinophilic asthma (EA), 30% had mixed granulocytic asthma (MGA), 24% had paucigranulocytic asthma (PGA), and 15% had neutrophilic asthma (NA). The difference was found in blood eosinophils (p = 0.002), the highest observed in EA. The cut-off ≥ 240/μL eosinophils, with 64% sensitivity and 72.7% specificity, identified EA (AUC = 0.743, p = 0.001). A higher IL-8 level was associated with NA (p = 0.025). In 63 non-biologic asthma group, eosinophils were higher in EA than in NA, MGA, and PGA (p = 0.012, p = 0.028, and p = 0.049, respectively). A higher IL-17A was associated with EA without biologics (p = 0.004). A significantly higher IL-5 was found in EA treated with biologics, in comparison with EA without biologics (p = 0.043). The number of leucocytes and neutrophils was higher in MGA without biologics (p = 0.049, p = 0.019), while IL-5, IL-6, and IL-8 levels were higher in MGA treated with biologics (p = 0.012, p = 0.032, p = 0.038, respectively). Conclusions: EA and MGA were the most prevalent asthma phenotypes. Blood eosinophils can identify EA, both in patients with and without biologics. Apart from the clinical profile, a broad spectrum of biomarkers for assessing inflammatory phenotypes is necessary for an adequate therapy approach to patients with asthma.

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Section: Discussionmentioning

confidence: 64%

Asthma Inflammatory Phenotypes: How Can We Distinguish Them?

Plavsic,

Nikolic,

Milenkovic

et al. 2024

JCM

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“… 40 The traditional spirometry was of limited value in assessing peripheral airway injury. 41 In a follow-up study, we will also further evaluate the value of IOS in asthma BDR in preschool children to enrich the clinical prediction model.…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of Impulse Oscillometry Combined with Fractional Expiratory Nitric Oxide Test for Asthma in Preschool Children

Chen,

Xiao,

Liu

et al. 2024

JAA

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Prediction of asthma in preschool children is challenging and lacks objective indicators. The aim is to observe and analyze the variances between impulse oscillometry (IOS) and fractional expiratory nitric oxide (FeNO) in preschool children with wheezing, establish a joint prediction model, and explore the diagnostic value of combining IOS with FeNO in diagnosing asthma among preschool children. Patients and methods:This study enrolled children aged 3-6 years with wheezing between June 2021 and June 2022. They were categorized as asthmatic (n=104) or non-asthmatic (n=109) after a 1-year follow-up. Clinical data, along with IOS and FeNO measurements from both groups, underwent univariate regression and multiple regression analyses to identify predictive factors and develop the most accurate model. The prediction model was built using the stepwise (stepAIC) method. The receiver operating characteristic curve (ROC), calibration curve, Hosmer-Lemeshow test, and decision curve analysis (DCA) were employed to validate and assess the model. Results: During univariate analysis, a history of allergic rhinitis, a history of eczema or atopic dermatitis, and measures including FeNO, R5, X5, R20, Fres, and R5-R20 were found to be associated with asthma diagnosis. Subsequent multivariate analysis revealed elevated FeNO, R5, and X5 as independent risk factors. The stepAIC method selected five factors (history of allergic rhinitis, history of eczema or atopic dermatitis, FeNO, R5, X5) and established a prediction model. The combined model achieved an AUROC of 0.94, with a sensitivity of 0.89 and specificity of 0.88, surpassing that of individual factors. Calibration plots and the HL test confirmed satisfactory accuracy. Conclusion:This study has developed a prediction model based on five factors, potentially aiding clinicians in early identification of asthma risk among preschool children.

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“…Detecting peripheral airways dysfunction may be particularly useful in the evaluation of patients with normal spirometry as demonstrated in several recent studies. In an observational study of asthmatics with normal spirometry, peripheral airways dysfunction was detected by oscillometry in 54.1% of patients while spirometry-defined peripheral airways dysfunction was detected in only 10% of patients [30 ▪ ]. Another study showed oscillometry was more sensitive than spirometry in detecting peripheral airways dysfunction in asthma patients without fixed airway obstruction, while spirometry was superior in detecting peripheral airways dysfunction in patients with fixed airway obstruction [31].…”

Section: Peripheral Airways Dysfunction Symptoms and Response To Trea...mentioning

confidence: 99%

“…The negative association studies may be underpowered as exacerbation risk may only be marginally increased in the presence of peripheral airways dysfunction. Additional studies in adults report oscillometry-measured peripheral airways dysfunction associated with less well controlled asthma [30 ▪ ,33,35], higher mean inhaled corticosteroid use [30 ▪ ], higher short-acting reliever use [33], more exercise-induced asthma symptoms [30 ▪ ], and more asthma-related nocturnal awakenings [30 ▪ ,36]. In children aged 8–16 years old with normal spirometry, the combination of oscillometry and fractional exhaled nitric oxide (FENO) detected inadequate asthma control [37].…”

Section: Peripheral Airways Dysfunction Symptoms and Response To Trea...mentioning

confidence: 99%

The role of oscillometry in asthma

Donohue,

Kaminsky

2024

Current Opinion in Pulmonary Medicine

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Purpose of review Oscillometry is a noninvasive pulmonary function test that has gained significant interest in the evaluation of lung disease. Currently, oscillometry is primarily a research tool, but there is a growing body of evidence supporting its clinical use. This review describes the recent work evaluating the role of oscillometry in the diagnosis and treatment of asthma. Recent findings A large body of observational data supports the ability of oscillometry to distinguish healthy individuals from those with respiratory symptoms or lung disease. Oscillometry may not be as useful as an isolated diagnostic test in asthma, but the combination with other pulmonary function tests may improve its diagnostic ability. Oscillometry can detect peripheral airways dysfunction in asthma, which is associated with symptoms and the risk for exacerbations. To help guide future research, minimal clinically important differences for specific oscillometry variables have been developed. Oscillometry may be useful in monitoring the response to biological therapy and has potential for personalizing treatment for individual patients. Oscillometry also has potential in uncovering unique aspects of the pathophysiology of asthma in obesity. Summary Oscillometry is a promising tool in the diagnosis and management of asthma. More research is needed to support its routine clinical use.

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Impulse oscillometry defined small airway dysfunction in asthmatic patients with normal spirometry: Prevalence, clinical associations, and impact on asthma control

Cited by 13 publications

References 59 publications

Asthma Inflammatory Phenotypes: How Can We Distinguish Them?

Asthma Inflammatory Phenotypes: How Can We Distinguish Them?

Predictive Value of Impulse Oscillometry Combined with Fractional Expiratory Nitric Oxide Test for Asthma in Preschool Children

The role of oscillometry in asthma

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