Impulse oscillometry versus spirometry in a long-term study of controller therapy for pediatric asthma

Gary L. Larsen, Wayne Morgan, Gregory P. Heldt, David Mauger, Susan J. Boehmer, Vernon Chinchilli, Robert F. Lemanske, Fernando Martinez, Robert C. Strunk, Stanley J. Szefler, Robert S. Zeiger, Lynn M. Taussig, Leonard B. Bacharier, Theresa W. Guilbert, Shelley Radford, Christine A. Sorkness

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

Background: Determination of the benefits and limitations of specific physiologic tests has not been well studied in long-term clinical pediatric trials. Objective: We sought to determine the utility of impulse oscillometry in a long-term comparison of 3 controller regimens in children with persistent asthma. Methods: Children 6 to 14 years of age with mild-to-moderate persistent asthma were characterized with oscillometry and spirometry before entry into a clinical trial and then serially during 48 weeks of therapy with either an inhaled corticosteroid, a combination inhaled corticosteroid with a long-acting β-agonist, or a leukotriene receptor antagonist. Results: The FEV1/forced vital capacity ratio, as well as the forced expiratory flow from 25% to 75% of forced vital capacity in terms of spirometric parameters and the reactance area (XA) from impulse oscillometry, appeared to complement information provided by FEV1 when comparing the tests and factors that appeared to predict a response to treatment. XA was unique in that it, as distinct from spirometric variables, reflected ongoing improvement during the latter part of the trial. In general, improvements in XA during the latter part of the study occurred independently of indices of atopy and the level of airway responsiveness. Conclusion: Assessment of respiratory mechanics over time with oscillometry might offer additional insights into the response of asthmatic patients to therapy. In particular, the pattern of improvement seen in XA over the course of therapy suggests this test might detect alterations in airway mechanics not reflected by spirometry. The possibility that changes in XA reflect ongoing improvement in small airway function deserves additional study.

Original languageEnglish (US)
JournalJournal of Allergy and Clinical Immunology
Volume123
Issue number4
DOIs
StatePublished - Jan 1 2009

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Oscillometry
Spirometry
Asthma
Pediatrics
Vital Capacity
Adrenal Cortex Hormones
Clinical Trials
Respiratory Mechanics
Leukotriene Antagonists
Therapeutics
Mechanics

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology

Cite this

Larsen, Gary L. ; Morgan, Wayne ; Heldt, Gregory P. ; Mauger, David ; Boehmer, Susan J. ; Chinchilli, Vernon ; Lemanske, Robert F. ; Martinez, Fernando ; Strunk, Robert C. ; Szefler, Stanley J. ; Zeiger, Robert S. ; Taussig, Lynn M. ; Bacharier, Leonard B. ; Guilbert, Theresa W. ; Radford, Shelley ; Sorkness, Christine A. / Impulse oscillometry versus spirometry in a long-term study of controller therapy for pediatric asthma. In: Journal of Allergy and Clinical Immunology. 2009 ; Vol. 123, No. 4.
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abstract = "Background: Determination of the benefits and limitations of specific physiologic tests has not been well studied in long-term clinical pediatric trials. Objective: We sought to determine the utility of impulse oscillometry in a long-term comparison of 3 controller regimens in children with persistent asthma. Methods: Children 6 to 14 years of age with mild-to-moderate persistent asthma were characterized with oscillometry and spirometry before entry into a clinical trial and then serially during 48 weeks of therapy with either an inhaled corticosteroid, a combination inhaled corticosteroid with a long-acting β-agonist, or a leukotriene receptor antagonist. Results: The FEV1/forced vital capacity ratio, as well as the forced expiratory flow from 25{\%} to 75{\%} of forced vital capacity in terms of spirometric parameters and the reactance area (XA) from impulse oscillometry, appeared to complement information provided by FEV1 when comparing the tests and factors that appeared to predict a response to treatment. XA was unique in that it, as distinct from spirometric variables, reflected ongoing improvement during the latter part of the trial. In general, improvements in XA during the latter part of the study occurred independently of indices of atopy and the level of airway responsiveness. Conclusion: Assessment of respiratory mechanics over time with oscillometry might offer additional insights into the response of asthmatic patients to therapy. In particular, the pattern of improvement seen in XA over the course of therapy suggests this test might detect alterations in airway mechanics not reflected by spirometry. The possibility that changes in XA reflect ongoing improvement in small airway function deserves additional study.",
author = "Larsen, {Gary L.} and Wayne Morgan and Heldt, {Gregory P.} and David Mauger and Boehmer, {Susan J.} and Vernon Chinchilli and Lemanske, {Robert F.} and Fernando Martinez and Strunk, {Robert C.} and Szefler, {Stanley J.} and Zeiger, {Robert S.} and Taussig, {Lynn M.} and Bacharier, {Leonard B.} and Guilbert, {Theresa W.} and Shelley Radford and Sorkness, {Christine A.}",
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Larsen, GL, Morgan, W, Heldt, GP, Mauger, D, Boehmer, SJ, Chinchilli, V, Lemanske, RF, Martinez, F, Strunk, RC, Szefler, SJ, Zeiger, RS, Taussig, LM, Bacharier, LB, Guilbert, TW, Radford, S & Sorkness, CA 2009, 'Impulse oscillometry versus spirometry in a long-term study of controller therapy for pediatric asthma', Journal of Allergy and Clinical Immunology, vol. 123, no. 4. https://doi.org/10.1016/j.jaci.2008.10.036

Impulse oscillometry versus spirometry in a long-term study of controller therapy for pediatric asthma. / Larsen, Gary L.; Morgan, Wayne; Heldt, Gregory P.; Mauger, David; Boehmer, Susan J.; Chinchilli, Vernon; Lemanske, Robert F.; Martinez, Fernando; Strunk, Robert C.; Szefler, Stanley J.; Zeiger, Robert S.; Taussig, Lynn M.; Bacharier, Leonard B.; Guilbert, Theresa W.; Radford, Shelley; Sorkness, Christine A.

In: Journal of Allergy and Clinical Immunology, Vol. 123, No. 4, 01.01.2009.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impulse oscillometry versus spirometry in a long-term study of controller therapy for pediatric asthma

AU - Larsen, Gary L.

AU - Morgan, Wayne

AU - Heldt, Gregory P.

AU - Mauger, David

AU - Boehmer, Susan J.

AU - Chinchilli, Vernon

AU - Lemanske, Robert F.

AU - Martinez, Fernando

AU - Strunk, Robert C.

AU - Szefler, Stanley J.

AU - Zeiger, Robert S.

AU - Taussig, Lynn M.

AU - Bacharier, Leonard B.

AU - Guilbert, Theresa W.

AU - Radford, Shelley

AU - Sorkness, Christine A.

PY - 2009/1/1

Y1 - 2009/1/1

N2 - Background: Determination of the benefits and limitations of specific physiologic tests has not been well studied in long-term clinical pediatric trials. Objective: We sought to determine the utility of impulse oscillometry in a long-term comparison of 3 controller regimens in children with persistent asthma. Methods: Children 6 to 14 years of age with mild-to-moderate persistent asthma were characterized with oscillometry and spirometry before entry into a clinical trial and then serially during 48 weeks of therapy with either an inhaled corticosteroid, a combination inhaled corticosteroid with a long-acting β-agonist, or a leukotriene receptor antagonist. Results: The FEV1/forced vital capacity ratio, as well as the forced expiratory flow from 25% to 75% of forced vital capacity in terms of spirometric parameters and the reactance area (XA) from impulse oscillometry, appeared to complement information provided by FEV1 when comparing the tests and factors that appeared to predict a response to treatment. XA was unique in that it, as distinct from spirometric variables, reflected ongoing improvement during the latter part of the trial. In general, improvements in XA during the latter part of the study occurred independently of indices of atopy and the level of airway responsiveness. Conclusion: Assessment of respiratory mechanics over time with oscillometry might offer additional insights into the response of asthmatic patients to therapy. In particular, the pattern of improvement seen in XA over the course of therapy suggests this test might detect alterations in airway mechanics not reflected by spirometry. The possibility that changes in XA reflect ongoing improvement in small airway function deserves additional study.

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