The case for impulse oscillometry in the management of asthma in children and adults

• Published in: Annals of allergy, asthma, & immunology Vol. 118; no. 6; pp. 664 - 671
• Main Authors: Galant, Stanley P., MD, Komarow, Hirsh D., MD, Shin, Hye-Won, PhD, Siddiqui, Salman, PhD, Lipworth, Brian J., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2017
• Subjects: Adrenal Cortex Hormones - therapeutic use; Adult; Allergy and Immunology; Asthma - diagnosis; Asthma - drug therapy; Asthma - physiopathology; Bronchial Provocation Tests; Child; Humans; Oscillometry - methods; Reference Values; Spirometry
• ISSN: 1081-1206; 1534-4436
• DOI: 10.1016/j.anai.2017.04.009

Abstract Objective To provide a clinical rationale for including impulse oscillometry (IOS) as a part of standard office-based asthma assessment. Data Sources PubMed and Google search, limited to English language and human disease, with the keywords IOS and asthma. Study Selections Articles included in this review were based on the expert opinion and previous publications by the authors. Results In children, IOS was more useful than spirometry in identifying asthma and uncontrolled asthma and predicting loss of control and exacerbations. IOS predicts young children at risk for loss of lung function with age and the potential for early intervention to prevent further sequelae. In adults, peripheral airway impairment detected by IOS or spirometry (ie, forced expiratory flow between 25% and 75%) commonly occurs across severity, and each measure may be complementary in predicting loss of control even with normal forced expiratory volume in 1 second. Extrafine inhaled corticosteroids with or without long-acting β-agonists proved superior to standard particle aerosols in improving IOS-detected peripheral airway obstruction. Our data also suggest that currently available commercial reference values for lung resistance at 5 Hz and lung reactance at 5 Hz are applicable across diverse populations, but further studies are needed. Conclusion The findings of this review suggest that IOS can add value to traditional clinical and spirometric assessment and thus improve management of asthma in children and adults, as well as have the potential to detect early dysfunction of the peripheral airways, which may result in better outcomes.