Abstract
The impulse oscillometry (IOS) is recognized as a complementary method to spirometry in the diagnostics of obstructive pulmonary disorders. The IOS enables to measure total respiratory resistance (R5) and proximal respiratory resistance (R20), with the R5-R20 difference reflecting small airway resistance. This study seeks to evaluate the usefulness of R5-R20, maximal mid-expiratory flow (MMEF), and forced expiratory volume in 3 s/forced vital capacity ratio (FEV3/FVC), in the assessment of small airway obstruction in chronic obstructive pulmonary disease (COPD). One hundred and six COPD patients and 43 control subjects, aged over 55, were investigated. Spirometry and IOS were used to assess pulmonary function. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were evaluated. The findings demonstrate significant reductions in FEV3/FVC and MMEF, and an increase in R5-R20 difference in COPD patients; the changes that depended on the severity of airway obstruction. The sensitivity of R5-R20 in reflecting the MMEF was 84%, specificity 44.2%, PPV 72.4%, and NPV 61.3%. We conclude that the R5-R20 difference is superior to spirometry in the assessment of small bronchi obstruction. A high sensitivity of R5-R20 in reflecting the MMEF makes the IOS method particularly useful for detection of mild lung injury, while a high specificity of the spirometric FEV3/FVC ratio makes it useful to exclude obstruction of small airways. Both methods are thus complimentary.
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References
Allen SC, Baxter M (2009) A comparison of four tests of cognition as predictors of inability to perform spirometry in old age. Age Ageing 38:537–541
Anderson WJ, Lipworth BJ (2012) Relationships between impulse oscillometry, spirometry and dyspnoea in COPD. J R Coll Physicians Edinb 42:111–115
Bellia V, Pistelli R, Catalano F, Antonelli-Incalzi R, Grassi V, Melillo G, Olivieri D, Rengo F (2000) Quality control of spirometry in the elderly. The SA.R.A. study. SAlute Respiration nell’Anziano = Respiratory Health in the Elderly. Am J Respir Crit Care Med 161:1094–1100
Bhattarai B, Ghosh M, Sinha A, Azad MR, Sivasambu B, Saha S, Wan SK, Pokharel S, Vadde R, Oke VV, Schmidt MF, Enriquez D, Quist J, Pandey A, Manhas S (2014) Can the FEV3/FVC ratio be reliably used to screen for lung injury in the absence of obstruction in African American population?. http://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference. Accessed 10 Dec 2016
Cooper CB (2005) Assessment of pulmonary function in COPD. Semin Respir Crit Care Med 26:246–252
Crim C, Celli B, Edwards LD, Wouters E, Coxson HO, Tal-Singer R, Calverley PM (2011) Respiratory system impedance with impulse oscillometry in healthy and COPD subjects: ECLIPSE baseline results. Respir Med 105:1069–1078
De S (2012) Body mass index among patient with chronic obstructive pulmonary diseases. Indian J Physiol Pharmacol 56:353–358
GOLD (2016) Global initiative for chronic obstructive lung disease. http://www.goldcopd.org/guidelines-global-sreategy-for-diagnosis-management.html. Accessed 8 Dec 2016
Guerreiro C, Dionísio P, Ribeiro I, Moreira S, Valença J, Escaleira D, Bárbara C (2015) FEV3/FVC ratio in early detection of airway obstruction. Eur Respir J 46:PA2280. doi:10.1183/13993003.congress-2015.PA2280
Hansen JE, Sun XG, Wasserman K (2006) Discriminating measures and normal values for expiratory obstruction. Chest 129:369–377
Huber JE, Darling M (2011) Effect of Parkinson's disease on the production of structured and unstructured speaking tasks: respiratory physiologic and linguistic considerations. J Speech Lang Hear Res 54:33–46
Janssens JP, Nguyen MC, Herrmann FR, Michel JP (2001) Diagnostic value of respiratory impedance measurements in elderly subjects. Respir Med 95:415–422
Jaranbäck L, Ankerst J, Bjermer L, Tufvesson E (2013) Flow-volume parameters in COPD related to extended measurements of lung volume, diffusion, and resistance. Pulm Med 11:1–10
Johnston R (2013) The FEV3/FVC ratio, a useful tool for assessing early and mild airway obstruction. PFT Blog. Observations, opinions and ideas about pulmonary function testing. http://www.platform.com. Accessed 6 Oct 2013
Kubota M, Shirai G, Nakamori T, Kokubo K, Masuda M, Kobayashi H (2009) Low frequency oscillometry parameters in COPD patients are less variable during inspiration than during expiration. Respir Physiol Neurobiol 166:73–79
Miller MR, Crapo R, Hankinson J (2005) General considerations for lung function testing. Eur Respir J 26:153–161
Morris ZO, Coz A, Starosta D (2013) An isolated reduction of the FEV3/FVC ratio is an indicator of mild lung injury. Chest 144:1117–1123
Oosteveen E, McLeod D, Lorino H (2003) The forced oscillation technique in clinical practice; methodology, recommendations and future developments. Eur Respir J 22:1026–1041
Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R (2005) Interpretative strategies for lung function tests. Eur Respir J 26:948–968
Piorunek T, Kostrzewska M, Cofta S, Batura-Gabryel H, Andrzejczak P, Bogdański P, Wysocka E (2015) Impulse oscillometry in the diagnosis of airway resistance in chronic obstructive pulmonary disease. Adv Exp Med Biol 838:47–52
Schulz H, Flexeder C, Behr J, Heier M, Holle R, Hubner RM, Jörres RA, Nowak D, Peters A, Wichmann HE, Heinrich J, Karrasch S, KORA Study Group (2013) Reference values of impulse oscillometric lung function indices in adults of advanced age. PLoS One 8(5):e63366. doi:10.1371/journal.pone.0063366
Tanaka H, Fujii M, Kitada J (2011) Further examination of COPD. Using spirometry, respiratory function test, and impulse oscillometry. Nihon Rinsho 69:1786–1791
Wilson JT, Hareendran A, Grant M, Baird T, Schulz UG, Muir KW, Bone I (2002) Improving the assessment of outcomes in stroke: use of a structured interview to assign grades on the Modified Rankin Scale. Stroke 33:2243–2246
Winkler J, Hegert-Winkler A, Wirtz H, Schauer J, Kahn T, Hoheisel G (2009) Impulse oscillometry in the diagnosis of the severity of obstructive pulmonary disease. Pneumologie 63:266–275
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The authors are grateful to Dr. Robert Tower for English correction of the manuscript.
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Piorunek, T. et al. (2017). Small Airway Obstruction in Chronic Obstructive Pulmonary Disease: Potential Parameters for Early Detection. In: Pokorski, M. (eds) Respiratory System Diseases. Advances in Experimental Medicine and Biology(), vol 980. Springer, Cham. https://doi.org/10.1007/5584_2016_208
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DOI: https://doi.org/10.1007/5584_2016_208
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