Interrupter technique versus plethysmography for measurement of respiratory resistance in children with asthma or cystic fibrosis

Oswald‐Mammosser, Monique; Charloux, Anne; Donato, Luigi; Albrech, C.; Speich, J.P.; Lampert, Eliane; Lonsdorfer, J.

doi:10.1002/(sici)1099-0496(200003)29:3<213::aid-ppul10>3.0.co;2-n

Cited by 48 publications

(50 citation statements)

References 22 publications

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“…Until there is international standardisation for Rint,e measurements [20], reference equations are likely to differ according to the equipment and protocol of shutter timing and back extrapolation. In the protocol of the present study, interruptions were programmed at peak tidal expiratory flow, which appears to standardise inflation level [6,9]. The linear model of the present study fits remarkably well with the reference equation of VAN ALTENA and GIMENO [13]:…”

Section: Discussionsupporting

confidence: 63%

“…With this technique, measurements of the resistance of the respiratory system (Rint) can be carried out quickly, with minimal cooperation of the child. Rint measurements have been shown to be reproducible [1,[4][5][6], sufficiently sensitive to detect (sub)clinical airway obstruction [6,7], and to correlate satisfactorily with measurements of airway resistance [4,8,9]. The technique can not only be used as a tool to screen for airway obstruction, but also to assess the responses to bronchodilating and bronchoconstricting agents [1,3,10].…”

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confidence: 99%

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Measurements of interrupter resistance: reference values for children 3–13 yrs of age

Merkus¹,

Arets²,

Joosten³

et al. 2002

Eur Respir J

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The interrupter technique is a convenient and sensitive technique for studying airway function in subjects who cannot actively participate in (forced) ventilatory function tests.Reference values for preschool children exist but are lacking for children w7 yrs. Reference values were obtained for expiratory interrupter resistance (Rint,e) in 208 healthy Dutch Caucasian children 3-13 yrs of age.A curvilinear relationship between Rint,e and height was observed, similar to published airways resistance data measured by plethysmography. No significant differences in cross-sectional trend or level of Rint,e were observed according to sex. It was found that Z-scores could be used to express individual Rint,e values and to describe intra-and interindividual differences based on the reference equation: 10 logRint,e=0.645-0.006686 standing height (cm) kPa?L -1 ?s -1 and residual SD (0.093 kPa?L -1 ?s -1 ).Expiratory interrupter resistance provides a tool for clinical and epidemiological assessment of airway function in a large age range. Eur Respir J 2002; 20: 907-911.

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Section: Discussionsupporting

confidence: 63%

mentioning

confidence: 99%

Measurements of interrupter resistance: reference values for children 3–13 yrs of age

Merkus¹,

Arets²,

Joosten³

et al. 2002

Eur Respir J

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“…This is in accordance with the results reported by Gritti & Barreto, (22) who found the agreement between Rint and airway resistance by plethysmography to be better in patients with mild pulmonary function impairment. In addition, one group of authors (23) showed that the Rint technique tends to underestimate airway resistance in obstructed children with asthma and in those with CF, and that this tendency appears to increase in proportion to the severity of airway obstruction.…”

Section: Discussionmentioning

confidence: 99%

Utilização da técnica de resistência do interruptor na avaliação da resistência das vias aéreas em pacientes com fibrose cística

et al. 2012

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Objective: To measure airway resistance with the interrupter resistance (Rint) technique in patients with cystic fibrosis (CF) and to determine whether Rint values correlate with spirometric parameters, as well as to evaluate the accuracy of the Rint technique in determining the airway response to a bronchodilator. Methods: This was a cross-sectional study involving 38 children and adolescents with CF followed at the Cystic Fibrosis Outpatient Clinic of the São Lucas Hospital, located in the city of Porto Alegre, Brazil. After Rint had been measured, the subjects underwent spirometry. To evaluate bronchodilator response, we repeated the measurements after the use of inhaled albuterol. Results: There was a strong correlation between inverse Rint and FEV 1 (r = 0.8; p < 0.001), and there was a moderate correlation between inverse Rint and FEF 25-75% (r = 0.74; p < 0.001), as well as between inverse Rint and body mass index (r = 0.62; p < 0.001). We used a ROC curve to compare the bronchodilator response, as determined by Rint, with spirometric values. For a Rint cut-off point of −28%, the area under the curve was 0.75, with a sensitivity of 66% and a specificity of 82%. Conclusions: Our findings suggest that Rint correlates well with spirometric parameters, although the Rint technique was not sufficiently accurate to replace spirometry in the evaluation of bronchodilator responses. Keywords:Respiratory function tests; Cystic fibrosis; Spirometry; Airway resistance. ResumoObjetivo: Medir a resistência de vias aéreas utilizando a técnica de resistência do interruptor (Rint) em pacientes com fibrose cística (FC) e correlacioná-la com parâmetros espirométricos, assim como avaliar a acurácia de Rint para determinar a resposta das vias aéreas a um broncodilatador. Métodos: Estudo transversal com 38 crianças e adolescentes com FC acompanhados no Ambulatório de FC do Hospital São Lucas, em Porto Alegre (RS). Após a determinação de Rint, os pacientes foram submetidos à espirometria. Para a avaliação da resposta ao broncodilatador, as medições foram repetidas após o uso de salbutamol inalatório. Resultados: Houve uma forte correlação entre o inverso de Rint e VEF 1 (r = 0,8; p < 0,001) e moderadas correlações entre o inverso de Rint e FEF 25-75% (r = 0,74; p < 0,001) e entre o inverso de Rint e índice de massa corpórea (r = 0,62; p < 0,001). A curva ROC foi utilizada na comparação da resposta ao broncodilatador determinada por Rint com aquela determinada por valores espirométricos. Para um ponto de corte de −28% para Rint, a área sob a curva foi de 0,75, com uma sensibilidade de 66% e uma especificidade de 82%. Conclusões: Nossos achados indicam que Rint apresenta uma boa correlação com parâmetros espirométricos, embora a técnica Rint não tenha sido suficientemente acurada para substituir a espirometria na avaliação da resposta ao broncodilatador.Descritores: Testes de função respiratória; Fibrose cística; Espirometria; Resistência das vias respiratórias.

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“…Airways resistance can then be calculated from the ratio of the mouth pressure (measured immediately after occlusion) to the airflow at the mouth (measured just prior to occlusion) [13]. As equilibration of mouth and alveolar pressure may occur more slowly in obstructed airways, Rint tends to underestimate airways resistance in children with asthma [6,14]. However, in children aged 5 -15 yrs it has been shown to be as sensitive as spirometry in detecting bronchodilator responsiveness [15].…”

mentioning

confidence: 99%

“…Rint can now be measured using portable, affordable equipment [8, 10, 12, 15 -18], hereby providing the potential to assess lung function more easily in children v7 yrs. In the past this was only possible using expensive and complex plethysmographic methods [5,6,14,19,20].…”

mentioning

confidence: 99%

How should airways resistance be measured in young children: mask or mouthpiece?

Child¹,

Clayton²,

Davies³

et al. 2001

Eur Respir J

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The reproducibility and acceptability of airways resistance measurements using the interrupter technique (MicroRint) obtained using a mouthpiece were compared with those using a face mask.Fifty children aged 4 -7 yrs performed four sets of six Rint measurements; two using a mouthpiece and two using a face mask with integral mouthpiece.Complete data were obtained from 45 (90%) children using the mouthpiece and 43 (86%) children using the mask. The two methods were equally repeatable with comparable intraclass correlation coefficients (ICC) and coefficients of variation. Mean Rint values obtained using the mouthpiece were significantly lower than those using the face mask ((mean¡SD) mouthpiece~0.81¡0.18 kPa?L -1 ?s, mask~0.88¡0.24 kPa?L -1 ?s p~0.0002). Although the mean paired differences between the two methods were small (0.07 kPa?L -1 ?s), the ICC and limits of agreement confirmed that the two methods could not be used interchangeably. Sixty-seven per cent of children preferred the face mask but this was more time-consuming (p~0.03). Children did not produce more repeatable results using their preferred method, nor did they improve with practice.Repeatable airway resistance measurements using the interrupter technique can be obtained from young children using either a mouthpiece or a face mask, but there are significant clinical and statistical differences between the results obtained.

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Interrupter technique versus plethysmography for measurement of respiratory resistance in children with asthma or cystic fibrosis

Cited by 48 publications

References 22 publications

Measurements of interrupter resistance: reference values for children 3–13 yrs of age

Measurements of interrupter resistance: reference values for children 3–13 yrs of age

Utilização da técnica de resistência do interruptor na avaliação da resistência das vias aéreas em pacientes com fibrose cística

How should airways resistance be measured in young children: mask or mouthpiece?

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