Peripheral airways dysfunction measured by oscillometry differentiates asthma from inducible laryngeal obstruction

• Published in: Respiratory medicine Vol. 236; p. 107905
• Main Authors: Donohue, Patrick, Connolly, Margaret, D'Alfonso, Marcus, Jackson, Gerriann, Grasso, Liane C., Cai, Xueya, O'Connell Ferster, Ashley P., Schneider, G Todd, Khurana, Sandhya, Georas, Steve N.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.01.2025
• Subjects: Adult; Aged; Airway Obstruction - diagnosis; Airway Obstruction - physiopathology; Airway Resistance - physiology; Asthma; Asthma - diagnosis; Asthma - physiopathology; Diagnosis, Differential; Female; Humans; Inducible laryngeal obstruction; Male; Middle Aged; Oscillometry; Oscillometry - methods; Physiology; Respiratory Function Tests - methods; Vocal cord dysfunction; Vocal Cord Dysfunction - diagnosis; Vocal Cord Dysfunction - physiopathology; R5Stdev; EILO; Vocal cord dysfunction; R5-R20; ILO; Physiology; Z5; X5; R5max-R5min; BMI; R5; PVFM; IQR; Asthma; ACT; FVC; Inducible laryngeal obstruction; R5inspiratory; VCD; AX; ICS; FEV1; R5inspiratiory-R5expiratory; Oscillometry; COPD
• ISSN: 0954-6111; 1532-3064; 1532-3064
• DOI: 10.1016/j.rmed.2024.107905

Inducible laryngeal obstruction (ILO, also called vocal cord dysfunction) can be difficult to distinguish clinically from asthma. Limited studies have explored the use of respiratory oscillometry to detect changes unique to ILO, but more study is needed to determine if routine oscillometry can differentiate these two clinical entities. Determine if impedance variables measured on routine oscillometry over tidal breathing vary between individuals with asthma and ILO. Subjects with asthma and ILO were recruited to participate in a single-center, observational study at the University of Rochester Medical Center. Oscillometry measurements were obtained over tidal breathing according to technical standards. Exploratory oscillometry variables were analyzed, as well as standard oscillometry variables including measures of peripheral airways dysfunction. 25 subjects (12 with asthma and 13 with ILO) were recruited and included in the analysis. Measures of peripheral airways dysfunction including frequency dependence of resistance (R5-R20), area under the reactance curve (AX), and reactance at 5 Hz (X5) were significantly more abnormal in asthma subjects compared to ILO subjects (p = 0.039, p = 0.008, and p = 0.0327 respectively). Resistance at 5 Hz (R5) was not statistically different between asthma and ILO (p = 0.301). Exploratory variables, including inspiratory impedance and the standard deviation of impedance, were not significantly different between asthma and ILO. Measures of peripheral airways dysfunction by oscillometry were significantly different in subjects with asthma compared to ILO and more significant in subjects with poor asthma control. There were no exploratory oscillometry variables that were significantly different between ILO and asthma. •Oscillometry has potential to detect inducible laryngeal obstruction.•Without symptom triggers, oscillometry may miss inducible laryngeal obstruction.•Peripheral airways dysfunction implies asthma over inducible laryngeal obstruction.