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

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

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 FEF25%–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.

References

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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
  FEF25%–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
  ∆FEF25%–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; FEF25%-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
  FEF25%–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
  ∆FEF25%–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; FEF25%-75%, forced expiratory flow 25%–75%; ∆, percentage of bronchodilator response.

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