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

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 beta-agonist, or a leukotriene receptor antagonist.

Results: The FEV(1)/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 FEV(1) 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.

FIG 1

Changes in FEV₁ (A), FEV₁/ FVC (B), FEF_25–75 (C), and XA (D) over time are displayed for three treatment groups as both mean data at each measurement point (dashed lines) and as a regression model with a change point at 12 weeks (solid lines). The statistical analyses using the regression model are summarized in Tables I and II. Over the first 12 weeks of therapy, the slopes for FEV₁, FEV₁/ FVC, and FEF_25–75 were significant in a positive direction for combination and fluticasone therapy. However, for these spirometric parameters, the pattern over the last period of therapy (12–48 weeks) was different with all slopes close to zero. Conversely, XA significantly improved in the fluticasone group during the latter period as reflected by the negative slope for change in XA.