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Menzella F, Antonicelli L, Cottini M, Imeri G, Corsi L, Di Marco F. Oscillometry in severe asthma: the state of the art and future perspectives. Expert Rev Respir Med 2023; 17:563-575. [PMID: 37452692 DOI: 10.1080/17476348.2023.2237872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/07/2023] [Accepted: 07/14/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Approximately 3-10% of people with asthma have severe asthma (SA). Patients with SA have greater impairment in daily life and much higher costs. Even if asthma affects the entire bronchial tree, small airways have been recognized as the major site of airflow limitation. There are several tools for studying small airway dysfunction (SAD), but certainly the most interesting is oscillometry. Despite several studies, the clinical usefulness of oscillometry in asthma is still in question. This paper aims to provide evidence supporting the use of oscillometry to improve the management of SA in clinical practice. AREAS COVERED In the ATLANTIS study, SAD was strongly evident across all severity. Various tools are available for evaluation of SAD, and certainly an integrated use of these can provide complete and detailed information. However, the most suitable method is oscillometry, implemented for clinical routine by using either small pressure impulses or small pressure sinusoidal waves. EXPERT OPINION Oscillometry, despite its different technological implementations is the best tool for determining the impact of SAD on asthma and its control. Oscillometry will also be increasingly useful for choosing the appropriate drug, and there is ample room for a more widespread diffusion in clinical practice.
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Affiliation(s)
| | | | | | - Gianluca Imeri
- Respiratory Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Lorenzo Corsi
- Pulmonology Unit, S. Valentino Hospital, Treviso, Italy
| | - Fabiano Di Marco
- Respiratory Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
- Department of Health Sciences, University of Milan, Bergamo, Italy
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Kaku R, Yoden M, Shiratori T, Hayashi K, Okamoto K, Oshio Y, Nakano Y, Hanaoka J. Perioperative changes in respiratory impedance in lobectomy and their clinical impact. J Thorac Dis 2021; 13:1347-1357. [PMID: 33841928 PMCID: PMC8024863 DOI: 10.21037/jtd-20-3090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Respiratory function declines after lung resection. However, perioperative changes in respiratory impedance and their clinical significance are unclear. The forced oscillation technique can measure respiratory impedance during quiet breathing and possibly early after surgery. We investigated respiratory impedance changes before and after lung lobectomy and examined the correlation of impedance with clinical factors. Methods We prospectively included patients who underwent lobectomy between February 2018 and March 2020 and measured respiratory impedance by forced oscillation preoperatively and postoperative days 1 and 7. We statistically analyzed changes in perioperative forced oscillation measurements and their correlation with clinical factors, including subjective symptoms. The modified British Medical Research Council scale and the chronic obstructive pulmonary disease (COPD) assessment test were used for scoring subjective symptoms. Results Forty-four subjects were included, in whom respiratory impedance could be measured from postoperative day 1. The respective mean values for forced oscillation measurements preoperatively and at postoperative days 1 and 7 were as follows: respiratory resistance, 5 Hz: 2.28, 2.77, and 2.75; respiratory resistance, 20 Hz: 2.00, 2.36, and 2.32; difference in respiratory resistance at 5 and 20 Hz: 0.28, 0.40, and 0.43; respiratory reactance, 5 Hz: -0.31, -0.65, and -0.56; resonant frequency: 7.45, 10.41, and 9.81; and low-frequency reactance area: 1.33, 3.27, and 2.84. These changes were statistically significant (P<0.01). Besides the difference in respiratory resistance at 5 and 20 Hz, all other measurements on postoperative day 7 were relatively weakly correlated with the modified Medical Research Council scale score at this time point (all P<0.05). Respiratory complications correlated with the respiratory resistance difference, respiratory reactance, and resonant frequency on day 7 (R =0.415, -0.421, and 0.441), while the latter also correlated with postoperative hypoxemia on day 1 (R =0.433). Conclusions Respiratory impedance was measurable even early after surgery and significantly changed postoperatively. As the sample size was small and appeared to be biased, assessing respiratory impedance and clinical factors in detail was difficult. Since respiratory impedance is suggested to be associated with clinical factors that affect the postoperative course, it is necessary to accumulate cases and observe them over longer periods.
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Affiliation(s)
- Ryosuke Kaku
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Makoto Yoden
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Takuya Shiratori
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Kazuki Hayashi
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Keigo Okamoto
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Yasuhiko Oshio
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Yasutaka Nakano
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Jun Hanaoka
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
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Bhattarai P, Myers S, Chia C, Weber HC, Young S, Williams AD, Sohal SS. Clinical Application of Forced Oscillation Technique (FOT) in Early Detection of Airway Changes in Smokers. J Clin Med 2020; 9:E2778. [PMID: 32867314 DOI: 10.3390/jcm9092778] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/24/2020] [Accepted: 08/24/2020] [Indexed: 01/31/2023] Open
Abstract
The forced oscillation technique (FOT) is a non-invasive method to assess airway function by emitting oscillatory signals into the respiratory tract during tidal ventilation. This opinion piece discusses the current use, trialled modification and future directions in utilizing FOT as a novel diagnostic tool for early detection of small airway changes in smokers. The published evidence to date has shown that FOT parameters could be a sensitive diagnostic tool to detect early respiratory changes in smokers. Multiple frequencies and the frequency dependence of resistance and reactance can provide the most valuable and early information regarding smoking induced changes in airways. Considering its non-invasiveness, lower level of discomfort to patients than spirometry, feasibility, and cost effectiveness, it could be the first-choice diagnostic technique for detection of early respiratory changes in smokers. The finding of FOT could further be supported and correlated with inflammatory markers.
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Yamamoto Y, Miki K, Matsuki T, Fukushima K, Oshitani Y, Kagawa H, Tsujino K, Yoshimura K, Miki M, Kida H. Evaluation of Exertional Ventilatory Parameters Using Oscillometry in COPD. Int J Chron Obstruct Pulmon Dis 2020; 15:1697-1711. [PMID: 32764915 PMCID: PMC7367741 DOI: 10.2147/copd.s260735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/02/2020] [Indexed: 11/23/2022] Open
Abstract
Background Oscillometry is a tool to measure respiratory impedance that requires minimal patients’ effort. In patients with chronic obstructive pulmonary disease (COPD), the correlation of respiratory impedance at rest with exertional ventilatory parameters, including exercise tolerance, has scarcely been reported. In addition, the utility of oscillometric parameters might differ between the inspiratory and expiratory phases due to airflow obstruction during expiration, but the hypothesis had not been validated. The aim of the present study was to investigate whether oscillometric parameters are associated with exertional ventilatory parameters in patients with COPD. Methods Fifty-five subjects with COPD who attended clinics at the National Hospital Organization Osaka Toneyama Medical Center performed spirometry, oscillometry, and cardiopulmonary exercise testing (CPET) within 2 weeks. The correlations between parameters of spirometry, oscillometry, and CPET were analyzed using Spearman’s rank correlation coefficient, univariate, and multivariate analyses. Results Respiratory reactance had better correlations with the CPET parameters than respiratory resistance. Moreover, inspiratory reactance at rest correlated with the CPET parameters stronger than expiratory reactance. In particular, inspiratory resonant frequency (Fres-ins) correlated with peak oxygen uptake (rS=−0.549, p<0.01) and dead space to tidal volume ratio at peak exercise (rS=0.677, p<0.01) and the best predicted expiratory tidal volume (VT ex) at peak exercise of all the oscillometric parameters (rS=−0.679, p<0.01). However, the correlation between Fres-ins and VT ex at peak exercise became weak in subjects with severe and very severe COPD during exercise. Conclusion Measurement of respiratory reactance is useful for the effortless evaluation of not only exertional ventilatory parameters but exercise tolerance in patients with COPD. The correlation of respiratory impedance with exertional ventilatory parameters can become weak in patients with advanced COPD; thus, the measurement of oscillometry might not be appropriate for evaluating exertional ventilatory parameters of patients with advanced COPD.
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Affiliation(s)
- Yuji Yamamoto
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Keisuke Miki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Takanori Matsuki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Kiyoharu Fukushima
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Yohei Oshitani
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Hiroyuki Kagawa
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Kazuyuki Tsujino
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Kenji Yoshimura
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Mari Miki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Hiroshi Kida
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
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Miyoshi S, Katayama H, Matsubara M, Kato T, Hamaguchi N, Yamaguchi O. Prediction of Spirometric Indices Using Forced Oscillometric Indices in Patients with Asthma, COPD, and Interstitial Lung Disease. Int J Chron Obstruct Pulmon Dis 2020; 15:1565-1575. [PMID: 32669842 PMCID: PMC7335892 DOI: 10.2147/copd.s250080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 06/12/2020] [Indexed: 11/23/2022] Open
Abstract
Background and Objective Spirometry is sometimes difficult to perform in elderly patients and patients with cognitive impairment. Forced oscillometry (FOT) is a simple, noninvasive technique used for measuring respiratory impedance. The aim of this study was to develop regression equations to estimate vital capacity (VC), forced vital capacity (FVC), and forced expiratory volume in 1 s (FEV1.0) on the basis of FOT indices and to evaluate the accuracy of these equations in patients with asthma, chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD). Materials and Methods We retrospectively included data on 683 consecutive patients with asthma (388), COPD (128), or ILD (167) in this study. We generated regression equations for VC, FVC, and FEV1.0 by multivariate linear regression analysis and used them to estimate the corresponding values. We determined whether the estimated data reflected spirometric indices. Results Actual and estimated VC, FVC, and FEV1.0 values showed significant correlations (all r > 0.8 and P < 0.001) in all groups. Biases between the actual data and estimated data for VC, FVC, and FEV1.0 in the asthma group were −0.073 L, −0.069 L, and 0.017 L, respectively. The corresponding values were −0.064 L, 0.027 L, and 0.069 L, respectively, in the COPD group and −0.040 L, −0.071 L, and −0.002 L, respectively, in the ILD group. The estimated data in the present study did not completely correspond to the actual data. In addition, sensitivity for an FEV1.0/FVC ratio of <0.7 and the diagnostic accuracy for the classification of COPD grade using estimated data were low. Conclusion These results suggest that our method is not highly accurate. Further studies are needed to generate more accurate regression equations for estimating spirometric indices based on FOT measurements.
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Affiliation(s)
- Seigo Miyoshi
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
| | - Hitoshi Katayama
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
| | - Minoru Matsubara
- Department of Internal Medicine, Sumitomo Besshi Hospital, Niihama, Ehime 792-8543, Japan
| | - Takahide Kato
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
| | - Naohiko Hamaguchi
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
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Ribeiro CO, Faria ACD, Lopes AJ, de Melo PL. Forced oscillation technique for early detection of the effects of smoking and COPD: contribution of fractional-order modeling. Int J Chron Obstruct Pulmon Dis 2018; 13:3281-3295. [PMID: 30349233 PMCID: PMC6188181 DOI: 10.2147/copd.s173686] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose The aim of the present study was to evaluate the performance of the forced oscillation technique (FOT) for the early diagnosis of the effects of smoking and COPD. The contributions of the integer-order (InOr) and fractional-order (FrOr) models were also evaluated. Patients and methods In total, 120 subjects were analyzed: 40 controls, 40 smokers (20.3±9.3 pack-years) and 40 patients with mild COPD. Results Initially, it was observed that traditional FOT parameters and the InOr and FrOr models provided a consistent description of the COPD pathophysiology. Mild COPD introduced significant increases in the FrOr inertance, damping factor and hysteresivity (P<0.0001). These parameters were significantly correlated with the spirometric parameters of central and small airway obstruction (P<0.0001). The diagnostic accuracy analyses indicated that FOT parameters and InOr modeling may adequately identify these changes (area under the receiver operating characteristic curve – AUC >0.8). The use of FrOr modeling significantly improved this process (P<0.05), allowing the early diagnosis of smokers and patients with mild COPD with high accuracy (AUC >0.9). Conclusion FrOr modeling improves our knowledge of modifications that occur in the early stages of COPD. Additionally, the findings of the present study provide evidence that these models may play an important role in the early diagnosis of COPD, which is crucial for improving the clinical management of the disease.
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Affiliation(s)
- Caroline Oliveira Ribeiro
- Biomedical Instrumentation Laboratory, Institute of Biology and Faculty of Engineering, State University of Rio de Janeiro, Rio de Janeiro, Brazil,
| | - Alvaro Camilo Dias Faria
- Biomedical Instrumentation Laboratory, Institute of Biology and Faculty of Engineering, State University of Rio de Janeiro, Rio de Janeiro, Brazil,
| | - Agnaldo José Lopes
- Pulmonary Function Laboratory, State University of Rio de Janeiro, Rio de Janeiro, Brazil.,Pulmonary Rehabilitation Laboratory, Augusto Motta University Center, Rio de Janeiro, Brazil
| | - Pedro Lopes de Melo
- Biomedical Instrumentation Laboratory, Institute of Biology and Faculty of Engineering, State University of Rio de Janeiro, Rio de Janeiro, Brazil,
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