Forced oscillation technique as a predictor for loss of control in asthmatic children

Piyawut Kreetapirom; Potjanee Kiewngam; Wanlapa Jotikasthira; Wasu Kamchaisatian; Suwat Benjaponpitak; Wiparat Manuyakorn

doi:10.5415/apallergy.2020.10.e3

Journal List > Asia Pac Allergy > v.10(1) > 1142165

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kreetapirom, Kiewngam, Jotikasthira, Kamchaisatian, Benjaponpitak, and Manuyakorn: Forced oscillation technique as a predictor for loss of control in asthmatic children

Original Article

Asia Pac Allergy 2020;10(1):e3.

Published online: 4 January 2020

DOI: https://doi.org/10.5415/apallergy.2020.10.e3

Forced oscillation technique as a predictor for loss of control in asthmatic children

Piyawut Kreetapirom, Potjanee Kiewngam, Wanlapa Jotikasthira, Wasu Kamchaisatian, Suwat Benjaponpitak, Wiparat Manuyakorn^*

Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

^*Correspondence to Wiparat Manuyakorn Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchatewi, Bangkok 10400, Thailand. Tel: +66-2-201-1760 Fax: +66-2-345-7068 E-mail: mwiparat@hotmail.com

Received 15 June 2019 Accepted 13 January 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

A reliable objective tool using as a predictor of asthma control status could assist asthma management.

Objective

To find the parameters of forced oscillation technique (FOT) as predictors for th future loss of asthma symptom control.

Methods

Children with well-controlled asthma symptom, aged 6–12 years, were recruited for a 12-week prospective study. FOT and spirometer measures and their bronchodilator response were evaluated at baseline. The level of asthma symptom control was evaluated according to Global Initiative for Asthma.

Results

Among 68 recruited children, 41 children (60.3%) maintain their asthma control between 2 visits (group C-C), and 27 children (39.7%) lost their asthma control on the follow-up visit (group C-LC). Baseline FOT parameters, including the values of respiratory resistance at 5 Hz (R5), respiratory resistance at 20 Hz (R20), respiratory reactance at 5 Hz, area of reactance, %predicted of R5 and percentage of bronchodilator response (%∆) of R5 and R20 were significantly different between C-C and C-LC groups. In contrast, only %∆ of forced vital capacity, forced expiratory volume in 1 second (FEV₁), and FEF_25%–75% (forced expiratory flow 25%–75%) were significantly different between groups. Multiple logistic regression analysis revealed that %predicted of R5, %∆R5, %predicted of FEV₁ and %∆FEV₁ were the predictive factors for predicting the future loss of asthma control. The following cutoff values demonstrated the best sensitivity and specificity for predicting loss of asthma control: %predicted of R5=91.28, %∆R5=21.2, %predicted of FEV₁=89.5, and %∆FEV₁=7.8. The combination of these parameters predicted the risk of loss of asthma control with area under the curve of 0.924, accuracy of 83.8%.

Conclusion

Resistance FOT measures have an additive role to spirometric parameter in predicting future loss of asthma control.

Keywords: Resistance, Reactance, Spirometry, Frequency of resonance, Asthma

References

1. Global Initiative for Asthma. Global strategy for asthma management and prevention (2018 update) [Internet]. Fontana (WI): Global Initiative for Asthma;2018. [cited 2018 May 1]. Available from:. http://ginasthma.org.

2. Puranitee P, Kamchaisatian W, Manuyakorn W, Vilaiyuk S, Laecha O, Pattanaprateep O, Benjaponpitak S. Direct medical cost of Thai pediatric asthma management: a pilot study. Asian Pac J Allergy Immunol. 2015; 33:296–300.

3. Bateman ED, Reddel HK, Eriksson G, Peterson S, Ostlund O, Sears MR, Jenkins C, Humbert M, Buhl R, Harrison TW, Quirce S, O'Byrne PM. Overall asthma control: the relationship between current control and future risk. J Allergy Clin Immunol. 2010; 125:600–8.

4. Zeiger RS, Yegin A, Simons FE, Haselkorn T, Rasouliyan L, Szefler SJ, Chipps BE. TENOR Study Group. Evaluation of the National Heart, Lung, and Blood Institute guidelines impairment domain for classifying asthma control and predicting asthma exacerbations. Ann Allergy Asthma Immunol. 2012; 108:81–7.

5. Carroll WD, Wildhaber J, Brand PL. Parent misperception of control in childhood/adolescent asthma: the Room to Breathe survey. Eur Respir J. 2012; 39:90–6.

6. Cabral AL, Vollmer WM, Barbirotto RM, Martins MA. Exhaled nitric oxide as a predictor of exacerbation in children with moderate-to-severe asthma: a prospective, 5-month study. Ann Allergy Asthma Immunol. 2009; 103:206–11.

7. Farah CS, King GG, Brown NJ, Downie SR, Kermode JA, Hardaker KM, Peters MJ, Berend N, Salome CM. The role of the small airways in the clinical expression of asthma in adults. J Allergy Clin Immunol. 2012; 129:381–7.

8. Bisgaard H, Klug B. Lung function measurement in awake young children. Eur Respir J. 1995; 8:2067–75.

9. Schulze J, Smith HJ, Fuchs J, Herrmann E, Dressler M, Rose MA, Zielen S. Methacholine challenge in young children as evaluated by spirometry and impulse oscillometry. Respir Med. 2012; 106:627–34.

10. Brashier B, Salvi S. Measuring lung function using sound waves: role of the forced oscillation technique and impulse oscillometry system. Breathe (Sheff). 2015; 11:57–65.

11. Schulze J, Biedebach S, Christmann M, Herrmann E, Voss S, Zielen S. Impulse oscillometry as a predictor of asthma exacerbations in young children. Respiration. 2016; 91:107–14.

12. Heffler E, Crimi C, Campisi R, Sichili S, Nicolosi G, Porto M, Intravaia R, Sberna ME, Liuzzo MT, Crimi N. Bronchodilator response as a marker of poor asthma control. Respir Med. 2016; 112:45–50.

13. Ferrer Galván M, Javier Alvarez Gutiérrez F, Romero Falcón A, Romero Romero B, Sáez A, Medina Gallardo JF. Is the bronchodilator test an useful tool to measure asthma control? Respir Med. 2017; 126:26–31.

14. Pride NB. Assessment of changes in airway calibre I. Tests of forced expiration. Br J Clin Pharmacol. 1979; 8:193–203.

15. Oostveen E, MacLeod D, Lorino H, Farré R, Hantos Z, Desager K, Marchal F. ERS Task Force on Respiratory Impedance Measurements. The forced oscillation technique in clinical practice: methodology, recommendations and future developments. Eur Respir J. 2003; 22:1026–41.

16. Marotta A, Klinnert MD, Price MR, Larsen GL, Liu AH. Impulse oscillometry provides an effective measure of lung dysfunction in 4-year-old children at risk for persistent asthma. J Allergy Clin Immunol. 2003; 112:317–22.

17. Song TW, Kim KW, Kim ES, Park JW, Sohn MH, Kim KE. Utility of impulse oscillometry in young children with asthma. Pediatr Allergy Immunol. 2008; 19:763–8.

18. Heijkenskjöld Rentzhog C, Janson C, Berglund L, Borres MP, Nordvall L, Alving K, Malinovschi A. Overall and peripheral lung function assessment by spirometry and forced oscillation technique in relation to asthma diagnosis and control. Clin Exp Allergy. 2017; 47:1546–54.

19. Manoharan A, Anderson WJ, Lipworth J, Lipworth BJ. Assessment of spirometry and impulse oscillometry in relation to asthma control. Lung. 2015; 193:47–51.

20. Skylogianni E, Douros K, Anthracopoulos MB, Fouzas S. The forced oscillation technique in paediatric respiratory practice. Paediatr Respir Rev. 2016; 18:46–51.

21. Fuhlbrigge AL, Kitch BT, Paltiel AD, Kuntz KM, Neumann PJ, Dockery DW, Weiss ST. FEV(1) is associated with risk of asthma attacks in a pediatric population. J Allergy Clin Immunol. 2001; 107:61–7.

22. Pongracic JA, Krouse RZ, Babineau DC, Zoratti EM, Cohen RT, Wood RA, Khurana Hershey GK, Kercsmar CM, Gruchalla RS, Kattan M, Teach SJ, Johnson CC, Bacharier LB, Gern JE, Sigelman SM, Gergen PJ, Togias A, Visness CM, Busse WW, Liu AH. Distinguishing characteristics of difficult-to-control asthma in inner-city children and adolescents. J Allergy Clin Immunol. 2016; 138:1030–41.

Table 1.

Baseline characteristics

Variable	C-C group (n = 41)	C-LC group (n = 27)	p value
Sex			0.74
Male	26 (63.4)	19 (70.4)
Female	15 (36.6)	8 (29.6)
Age (yr)	9.93 ± 1.85	8.93 ± 2.0	0.04
Height (cm)	137.07 ± 13.44	128.37 ± 13.45	0.01
Weight (kg)	37.59 ± 13.99	31.78 ± 13.81	0.10
Aeroallergen sensitization	31 (75.6)	22 (81.5)	0.79
Allergic rhinitis	3 (85.4)	22 (81.5)	0.81
Tobacco exposure	8 (19.5)	5 (18.5)	0.08
Age of asthma diagnosis (yr)	5.83 ± 2.71	4.96 ± 2.02	0.16
Duration of asthma (yr)	3.86 ± 2.13	3.71 ± 1.99	0.77
Inhaled corticosteroid dosage (µg)^*	218.79 ± 185.15	203 ± 140.72	0.95

Values are presented as number (%) or mean ± standard deviation.

C-C group, group of children who maintained their level of asthma well-controlled; C-LC group, group of children who lost their level of asthma well-controlled at the end of the study.

^* Beclomethasone equivalent dose/day.

Table 2.

Comparison forced oscillation technique measures between C-C and C-LC groups

Variable	C-C group	C-LC group	p value
Prebronchodilator
R5 (cmH₂ O/L/sec)	6.98 ± 2.11	9.98 ± 2.42	<0.001
R5 (% predicted)	89.28 ± 18.44	114.91 ± 23.39	<0.001
R20 (cmH₂ O/L/sec)	5.83 ± 1.52	7.82 ± 1.61	<0.001
R20 (% predicted)	118.84 ± 38.85	126.56 ± 34.27	0.405
X5 (cmH₂ O/L/sec)	−0.63 ± 0.47	−0.93 ± 0.61	0.03
X5 (% predicted)	27.95 ± 21.70	27.46 ± 20.53	0.9
ALX	2.54 ± 2.22	4.19 ± 4.04	0.03
Bronchodilator response
∆R5 (%)	12.92 ± 10.48	30.28 ± 11.32	<0.001
∆R20 (%)	13.96 ± 10.4	24.65 ± 11.52	<0.001
∆ALX (%)	14.58 ± 62.45	26.43 ± 64.4	0.45

Values are presented as mean ± standard deviation.

C-C group, group of children who maintained their level of asthma well-controlled; C-LC group, group of children who lost their level of asthma well-controlled at the end of the study.

R5, resistance at 5 Hz; R20, respiratory resistance at 20 Hz; X5, respiratory reactance at 5 Hz; ALX, area of reactance; ∆, percentage of bronchodilator response.

Table 3.

Comparison spirometric measures between C-C and C-LC groups

Variable	C-C group	C-LC group	p value
Prebronchodilator
FVC (% predicted)	92.5 ± 10.0	98.7 ± 16.6	0.06
FEV₁ (% predicted)	89.7 ± 13.3	96 ± 19.4	0.11
FEV₁/FVC (%)	88.5 ± 6.6	87.6 ± 5.5	0.58
FEF_25%–75% (% predicted)	95 ± 29.3	92.3 ± 29.3	0.71
Bronchodilator response
∆FVC (%)	1.3 ± 5.9	4.3 ± 4.5	0.03
∆FEV₁ (%)	3.7 ± 5.9	7.9 ± 5.4	0.004
∆FEV₁/FVC (%)	2.4 ± 3.4	3.5 ± 3.4	0.18
∆FEF_25%–75% (%)	15.1 ± 15.4	23.3 ± 15.9	0.04

Values are presented as mean ± standard deviation.

C-C group, group of children who maintained their level of asthma well-controlled; C-LC group, group of children who lost their level of asthma well-controlled at the end of the study.

FVC, forced vital capacity; FEV₁, forced expiratory volume in 1 second; FEF_25%-75%, forced expiratory flow 25%–75%; ∆, percentage of bronchodilator response.

Table 4.

Logistic regression to predict loss of asthma control

Predictor variable	Regression coefficient	AUC (95% CI)	p value
R5 (% predicted)	0.059	0.810 (0.700–0.920)	<0.001
R5 (% predicted)	0.049	0.859 (0.770–0.950)	<0.001
∆R5 (%)	0.069	–	–
∆FEV₁ (%)	0.278	0.910 (0.840–0.980)	<0.001
R5 (% predicted)	0.044	–	–
∆R5 (%)	0.124	–	–
FEV₁ (% predicted)	0.059	0.924 (0.860–0.990)	<0.001
∆FEV₁ (%)	0.302	–	–
₁ R5 (% predicted)	0.045	–	–
∆R5 (%)	0.144	–	–

AUC, area under the curve; CI, confidence interval; R5, resistance at 5 Hz; FEV₁, forced expiratory volume in 1 second.

Table 5.

Cutoff points in predicting of loss of asthma symptom control on a follow-up visit

Variable	Cutoff points	AUC (95% CI)	Sensitivity	Specificity	p value
FOT parameters
R5 (% predicted)	91.28	0.812 (0.702–0.922)	0.821	0.56	<0.001
R20 (% predicted)	122.23	0.55 (0.41–0.69)	0.59	0.52	0.48
X5 (% predicted)	21.16	0.47 (0.33–0.61)	0.48	0.44	0.72
Spirometric parameters
FVC (% predicted)	96.4	0.60 (0.44–0.75)	0.52	0.66	0.176
FEV₁ (% predicted)	89.5	0.54 (0.387–0.699)	0.52	0.52	0.55
FEV₁/FVC (%)	88.99	0.43 (0.29–0.57)	0.52	0.44	0.32
FEF_25%–75% (% predicted)	91.65	0.46 (0.32–0.60)	0.48	0.59	0.57
Postbronchodilator response
∆R5 (%)	21.2	0.79 (0.68–0.90)	0.70	0.70	<0.001
∆R20 (%)	24.8	0.74 (0.62–0.86)	0.52	0.90	<0.001
∆FVC (%)	2.75	0.67 (0.54–0.80)	0.70	0.59	0.018
∆FEV₁ (%)	7.8	0.69 (0.57–0.81)	0.52	0.76	0.008
∆FEV₁/FVC (%)	3	0.59 (0.45–0.72)	0.52	0.63	0.21
∆FEF_25%–75% (%)	15.2	0.65 (0.52–0.79)	0.70	0.57	0.035

FOT, forced oscillation technique; AUC, area under the curve; CI, confidence interval; R5, resistance at 5 Hz; R20, respiratory resistance at 20 Hz; X5, respiratory reactance at 5 Hz; FVC, forced vital capacity; FEV₁, forced expiratory volume in 1 second; FEF_25%-75%, forced expiratory flow 25%–75%; ∆, percentage of bronchodilator response.

TOOLS

Similar articles