The predictive value of impulse oscillometry for asthma exacerbations in childhood: A systematic review and meta‐analyses

Ling, Yaoyao; Si, Minghui; Niu, Yufan; Yang, Han; Xu, Yongsheng

doi:10.1002/ppul.25374

Cited by 15 publications

(11 citation statements)

References 35 publications

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“…X 5 and A X reflect the elasticity of the peripheral airways, while X 20 reflects the elasticity of larger, central airways, 27 with the changes observed indicating changes in lung compliance, that may reflect reduced dynamic hyperinflation and gas trapping 28 . Importantly, both X 5 and A X predict asthma exacerbations and loss of asthma control in children with asthma 29 . Airway resistance reflects airway obstruction, 27 and R 5 ‐R 20 is proposed to reflect peripheral airways 27 .…”

Section: Discussionmentioning

confidence: 99%

The effects of increasing fruit and vegetable intake in children with asthma: A randomized controlled trial

Berthon

McLoughlin

Jensen

et al. 2021

Clin Experimental Allergy

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Background A high fruit and vegetable (F&V) diet reduces asthma exacerbations in adults; this has not been examined in children to date. Objective To investigate the effect of a 6‐month, high F&V diet on the time to first asthma exacerbation in children with asthma, in a parallel‐group, randomized, controlled trial. Methods Children (aged 3–11 years) with asthma, history of exacerbations and usual low F&V intake (≤3 serves/day) were randomized to the intervention (high F&V diet) or control group (usual diet) for 6 months. The primary outcome was time to first exacerbation requiring medical intervention. Secondary outcomes included exacerbation rate, lung function, plasma TNF‐α, CRP, and IL‐6, faecal microbiota and peripheral blood mononuclear cell (PBMC) histone deacetylase (HDAC) activity and G‐protein coupled receptor (GPR) 41/43 and HDAC (1–11) expression. Results 67 children were randomized between September 2015 and July 2018. F&V intake (difference in change (∆): 3.5 serves/day, 95% CI: [2.6, 4.4] p < 0.001) and plasma total carotenoids (∆: 0.44 µg/ml [0.19, 0.70] p = 0.001) increased after 6 months (intervention vs control). Time to first exacerbation (HR: 0.81, 95% CI: [0.38, 1.69], p = 0.569; control vs. intervention) and exacerbation rate (IRR: 0.84, [0.47, 1.49], p = 0.553; control vs. intervention) were similar between groups. In per‐protocol analysis, airway reactance z‐scores increased in the intervention versus control group (X5 ∆: 0.76 [0.04, 1.48] p = 0.038, X20 ∆: 0.93 [0.23, 1.64] p = 0.009) and changes in faecal microbiota were observed though there was no difference between groups in systemic inflammation or molecular mechanisms. In the control group, CRP and HDAC enzyme activity increased, while GPR41 expression decreased. No adverse events attributable to the interventions were observed. Conclusion & Clinical Relevance A high F&V diet did not affect asthma exacerbations over the 6‐month intervention, though warrants further investigation as a strategy for improving lung function and protecting against systemic inflammation in children with asthma.

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Section: Discussionmentioning

confidence: 99%

The effects of increasing fruit and vegetable intake in children with asthma: A randomized controlled trial

Berthon

McLoughlin

Jensen

et al. 2021

Clin Experimental Allergy

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“…Small airway disease usually results in the frequency dependence of resistance (Fres), that is, an increased difference between R5 Hz and R20 Hz (R5–20 Hz) and decrease in Xrs. A recent systematic review with meta-analyses showed that R5 Hz, X5 Hz, Fres and reactance area (AX) may predict asthma exacerbations in children [20 ▪▪ ].…”

Section: Impulse Oscillometrymentioning

confidence: 99%

Pulmonary function testing for the diagnosis of asthma in preschool children

Chawes

Elenius

2022

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of reviewTo highlight the recent evidence of the lung function techniques used in preschool children to diagnose asthma. Recent findingsSeveral techniques are available to measure lung function and airway inflammation in preschool children, including spirometry (from age 5 years), impulse oscillometry (>3 years), whole-body plethysmography (>3 years), fractional exhaled nitric oxide (FeNO) (>5 years), multiple breath washout (>3 years), structured light plethysmography (>1-2 years) and impedance pneumography (>1 years). If applicable, measuring forced expiratory volume in 1 s (FEV1) and FEV1/forced vital capacity (FVC) ratio using spirometry is useful (cut-off < 80% predicted or below lower limit of normal [LLN] defined as z-score < À1.64) for diagnosing preschool asthma. For those unable to perform spirometry, whole-body plethysmography (sRaw > 1.6 kPa/s) and impulse oscillometry (Rrs and Xrs at 5 Hz z-score > 2) may be useful. Adding a bronchodilator reversibility test (FEV1 increase > 12%, sRaw decrease > 25-30%, Rrs at 5 Hz decrease > 40%) or a bronchial challenge test, for example, exercise test (FEV1 decrease > 10%), may improve the sensitivity of these tests. Elevated FeNO (>25-35 ppb) is a promising adjunctive test for diagnosing preschool asthma.

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“…The Global Initiative for Asthma (GINA) has made recommendations for early diagnosis and good control based on symptoms and conventional spirometry to improve asthma outcomes (6). Impulse oscillometry (IOS) is an effort-independent method for measuring respiratory system resistance (R) and reactance (X), which is suitable for younger children unable to receive spirometry (7)(8)(9). Increasing evidence shows that IOS indicator with R5 (resistance at 5 Hz) may better predict asthma exacerbations or loss of control in children with asthma (8).…”

Section: Introductionmentioning

confidence: 99%

“…Impulse oscillometry (IOS) is an effort-independent method for measuring respiratory system resistance (R) and reactance (X), which is suitable for younger children unable to receive spirometry (7)(8)(9). Increasing evidence shows that IOS indicator with R5 (resistance at 5 Hz) may better predict asthma exacerbations or loss of control in children with asthma (8).…”

Section: Introductionmentioning

confidence: 99%

“…The spirometry of FEF 25−75% is a marker of early small airway obstruction associated with lung function impairment in early adulthood (4). The IOS-defined small airway dysfunction parameters, R5-R20, X5, and AX (reactance area), are found to be correlated with poor asthma control (8,13,14). However, some evidence shows that spirometry measures are poorly associated with a validated asthma control questionnaire, and thus, the routine use of these small-airway dysfunction markers to detect asthma control is still debated (2,15,16).…”

Section: Introductionmentioning

confidence: 99%

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Small Airway Dysfunction Measured by Impulse Oscillometry and Fractional Exhaled Nitric Oxide Is Associated With Asthma Control in Children

et al. 2022

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BackgroundImpulse oscillometry (IOS) and fractional exhaled nitric oxide (FeNO) are sensitive and non-invasive methods to measure airway resistance and inflammation, although there are limited population-based studies using IOS and FeNO to predict asthma control.ObjectiveThis study aimed to investigate the utility of IOS and FeNO for assessing childhood asthma control in terms of small airway dysfunction and airway inflammation.MethodsThis prospective observational cohort study enrolled 5,018 school children (aged 6–12 years), including 560 asthmatic children and 140 normal participants. FeNO, spirometry, IOS, bronchial dilation test, total IgE, and childhood asthma control test (C-ACT) were measured. FeNO, IOS, spirometry, and C-ACT results were correlated with childhood asthma with and without control.ResultsUncontrolled asthmatic children had abnormal FeNO, IOS, and spirometric values compared with control subjects (P < 0.05). IOS parameters with R5, R5-R20, X5, Ax, △R5, and FeNO can predict lower C-ACT scales by the areas under receiver operating characteristic curves (AUCs) (0.616, 0.625, 0.609, 0.622, 0.625, and 0.714). A combination of FeNO (>20 ppb) with IOS measure significantly increased the specificity for predicting uncontrolled asthma patients compared with FeNO alone (P < 0.01). A multiple regression model showed that small airway parameter (R5-R20) was the strongest risk factor [OR (95% CI): 87.26 (7.67–993.31)] for uncontrolled asthma patients. Poor control with lower C-ACT scales correlated with high FeNO (r = −0.394), R5 (r = −0.106), and R5-R20 (r = −0.129) in asthmatic children (P < 0.05).ConclusionA combined use of FeNO and IOS measurements strongly predicts childhood asthma with or without control.

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The predictive value of impulse oscillometry for asthma exacerbations in childhood: A systematic review and meta‐analyses

Cited by 15 publications

References 35 publications

The effects of increasing fruit and vegetable intake in children with asthma: A randomized controlled trial

The effects of increasing fruit and vegetable intake in children with asthma: A randomized controlled trial

Pulmonary function testing for the diagnosis of asthma in preschool children

Small Airway Dysfunction Measured by Impulse Oscillometry and Fractional Exhaled Nitric Oxide Is Associated With Asthma Control in Children

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