Effects of respiratory timing and cheek support on resistance measurements, before and after bronchodilation in asthmatic children using the interrupter technique

Abstract

The interrupter technique (Rint) is a noninvasive method for assessing respiratory resistance. The aims of this study were to assess whether upper airway support affects the measurement of Rint, if inspiratory or expiratory Rint were most reproducible, and which method of assessing Rint correlated best with spirometry results and was the most sensitive for identifying bronchodilator response. Twenty-four asthmatic children with a mean age of 10.3 years (range, 7-16 years) were included in the study. Rint measurements were obtained in inspiration and expiration with cheeks supported and unsupported. Spirometry was then performed. Rint and spirometry measurements were repeated after the inhalation of 600 mcg of salbutamol. The mean Rint supported inspiratory (0.708 KPa/l/sec) and expiratory (0.729 KPa/l/sec) values were significantly higher than the unsupported values (inspiratory, 0.622 KPa/l/sec; expiratory, 0.584 KPa/l/sec), P < 0.05 and P < 0.001, respectively. The reproducibility of Rint was not different whether cheeks were supported or not, or whether the measurements were carried out during inspiration or expiration. Cheek support improved the correlation with all the lung function results, both in inspiratory and expiratory measurements. The best correlations, however, were found for the inspiratory supported Rint results. The most sensitive method to ascertain bronchodilator response (BD) was the inspiratory supported Rint measurement, as 83.3% of children were identified as having a positive response to bronchodilator therapy as defined by a reduction of twice the coefficient of variation of the measurement. In conclusion, cheek support increases Rint but does not impact on reproducibility, though it improves the correlation with spirometric indices. Rint with cheek support on inspiration correlates best with spirometric indices and appears to be the most sensitive measure of response to bronchodilators.