Bronchodilator Response Assessed by the Forced Oscillation Technique Identifies Poor Asthma Control With Greater Sensitivity Than Spirometry

Alice M Cottee¹, Leigh M Seccombe², Cindy Thamrin³, Gregory G King⁴, Matthew J Peters⁵, Claude S Farah⁶

Affiliations

¹ Department of Respiratory Medicine, Concord Repatriation General Hospital, Concord, NSW, Australia; Woolcock Emphysema Centre and Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, Glebe, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia. Electronic address: alice.cottee@sydney.edu.au.
² Department of Respiratory Medicine, Concord Repatriation General Hospital, Concord, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
³ Woolcock Emphysema Centre and Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, Glebe, NSW, Australia.
⁴ Woolcock Emphysema Centre and Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, Glebe, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Respiratory Medicine, Royal North Shore Hospital, NSW, Australia.
⁵ Department of Respiratory Medicine, Concord Repatriation General Hospital, Concord, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health Sciences, Macquarie University, North Ryde, NSW, Australia.
⁶ Department of Respiratory Medicine, Concord Repatriation General Hospital, Concord, NSW, Australia; Woolcock Emphysema Centre and Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, Glebe, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health Sciences, Macquarie University, North Ryde, NSW, Australia.

PMID: 31982392
PMCID: PMC7268434
DOI: 10.1016/j.chest.2019.12.035

Bronchodilator Response Assessed by the Forced Oscillation Technique Identifies Poor Asthma Control With Greater Sensitivity Than Spirometry

Alice M Cottee et al. Chest. 2020 Jun.

. 2020 Jun;157(6):1435-1441.

doi: 10.1016/j.chest.2019.12.035. Epub 2020 Jan 23.

Authors

Alice M Cottee¹, Leigh M Seccombe², Cindy Thamrin³, Gregory G King⁴, Matthew J Peters⁵, Claude S Farah⁶

Affiliations

¹ Department of Respiratory Medicine, Concord Repatriation General Hospital, Concord, NSW, Australia; Woolcock Emphysema Centre and Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, Glebe, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia. Electronic address: alice.cottee@sydney.edu.au.
² Department of Respiratory Medicine, Concord Repatriation General Hospital, Concord, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
³ Woolcock Emphysema Centre and Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, Glebe, NSW, Australia.
⁴ Woolcock Emphysema Centre and Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, Glebe, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Respiratory Medicine, Royal North Shore Hospital, NSW, Australia.
⁵ Department of Respiratory Medicine, Concord Repatriation General Hospital, Concord, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health Sciences, Macquarie University, North Ryde, NSW, Australia.
⁶ Department of Respiratory Medicine, Concord Repatriation General Hospital, Concord, NSW, Australia; Woolcock Emphysema Centre and Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, Glebe, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health Sciences, Macquarie University, North Ryde, NSW, Australia.

PMID: 31982392
PMCID: PMC7268434
DOI: 10.1016/j.chest.2019.12.035

Abstract

Background: Persistent bronchodilator response (BDR) following diagnosis of asthma is an underrecognized treatable trait, associated with worse lung function and asthma control. The forced oscillation technique (FOT) measures respiratory system impedance, and BDR cutoffs have been proposed for healthy adults; however, the relevance in asthma is unknown. We compared BDR cutoffs, using FOT and spirometry, in asthma and the relationship with asthma control.

Methods: Data from patients with asthma who withheld bronchodilator medication for at least 8 h before a tertiary airway clinic visit were reviewed. All subjects performed FOT and spirometry before and after salbutamol administration, and completed the Asthma Control Test. FOT parameters examined included respiratory system resistance (R5) and reactance (X5) at 5 Hz, and area under the reactance curve (AX). BDR was defined by standard recommendations for spirometry and based on the 95th percentile of BDR in healthy adults for FOT.

Results: Fifty-two subjects (18 men; mean age, 53 ± 18 years) were included. BDR was identified more frequently by FOT than spirometry (54% vs 27% of subjects). BDR assessed by X5 and AX, but not R5, was associated with spirometric BDR (χ², P < .01) and correlated with asthma control (X5: r_s = -0.36, P < .01; AX: r_s = 0.34, P = .01). BDR measured by reactance parameters identified more subjects with poor asthma control than did spirometry (AX, 69% vs spirometry, 41%).

Conclusions: BDR assessed by FOT can identify poor asthma control. Reactance parameters were more sensitive in identifying poor asthma control than spirometry, supporting the use of FOT to complement spirometry in the clinical management of asthma.

Keywords: asthma control; bronchodilator response; forced oscillation technique; symptoms.

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Figures

**Figure 1**
Comparison between bronchodilator response (BDR) identified by spirometry and forced oscillation technique (FOT). Shown are the following: cutoff for identifying BDR by spirometry (blue line) and FOT (orange line); subjects with (blue circles) or without (red circles) BDR in FEV₁ and/or FVC as assessed by spirometry; region of BDR concordance between spirometry and FOT (orange-shaded areas); Cohen’s κ; change in parameter after bronchodilator administration (postbronchodilator minus prebronchodilator) (Δ). Spirometric BDR is defined as ≥ 200 mL and ≥ 12% improvement in FEV₁ and/or FVC.

**Figure 2**
Association between the presence of BDR and asthma control. Shown are the following: cutoff for poor asthma control (Asthma Control Test score < 20) (blue line); cutoff for BDR by spirometry or FOT (orange line); subjects with spirometric BDR (blue circles) or no spirometric BDR (red circles) in FEV₁ and/or FVC; region of concordance between BDR and poor asthma control (orange-shaded areas); Spearman’s correlation (r_s); change in parameter after bronchodilator administration (postbronchodilator minus prebronchodilator) (Δ). Spirometric BDR is defined as ≥ 200 mL and ≥ 12% improvement in FEV₁ and/or FVC. ACT = Asthma Control Test; AX = area under the reactance curve, between 5 Hz and resonant frequency; R5 = resistance at 5 Hz; X5 = reactance at 5 Hz. See Figure 1 legend for expansion of other abbreviations.

See this image and copyright information in PMC

Comment in

Criteria for Airway Oscillometry Reversibility in Asthma.
Lipworth B, Chan R, Kuo CR. Lipworth B, et al. Chest. 2020 Sep;158(3):1282-1283. doi: 10.1016/j.chest.2020.03.048. Chest. 2020. PMID: 32892863 No abstract available.
Response.
Cottee AM, Seccombe LM, Thamrin C, King GG, Peters MJ, Farah CS. Cottee AM, et al. Chest. 2020 Sep;158(3):1283-1284. doi: 10.1016/j.chest.2020.03.047. Chest. 2020. PMID: 32892864 No abstract available.
Regression Artifacts: Bronchodilator Response and Regression to the Mean.
Eliasson O. Eliasson O. Chest. 2020 Dec;158(6):2697-2698. doi: 10.1016/j.chest.2020.06.087. Chest. 2020. PMID: 33280751 No abstract available.
Response.
Cottee AM, Seccombe LM, Thamrin C, King GG, Peters MJ, Farah CS. Cottee AM, et al. Chest. 2020 Dec;158(6):2698-2699. doi: 10.1016/j.chest.2020.07.044. Chest. 2020. PMID: 33280752 No abstract available.

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Bronchodilator Response Assessed by the Forced Oscillation Technique Identifies Poor Asthma Control With Greater Sensitivity Than Spirometry

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Bronchodilator Response Assessed by the Forced Oscillation Technique Identifies Poor Asthma Control With Greater Sensitivity Than Spirometry

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