A portable device based on the interrupter technique to measure bronchodilator response in schoolchildren

Abstract

A new device for measuring airway resistance following brief airflow interruption (Microlab 4000; Micromedical Ltd, UK) was evaluated in 25 asthmatic school children in comparison with well-established methods. Airway resistance was measured during brief airflow interruption (Rint), before and after administration of salbutamol 200 micrograms by metered-dose inhaler, and in the spirometric parameters, forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF), and total respiratory system resistance at 6 Hz (Rrs,6) measured by the forced oscillation technique (FOT). The sensitivity index (SI) (mean change/baseline standard deviation) was calculated for each subject. At baseline, interrupter conductance, the reciprocal of Rint, correlated well with FEV1 (r = 0.837; p < 0.001) and PEF (r = 0.773; p < 0.001), and Rint correlated highly with Rrs,6 (r = 0.942; p < 0.001). The median intrasubject coefficient of variation of the interrupter method was higher than the FOT or either spirometric parameter; Rint 11%, Rrs,6 9%, FEV1 5% and PEF 5%. However, the sensitivity to detect change after bronchodilator, expressed as the median SI, did not differ significantly between measurements: Rint 3.5, Rrs,6 3.6, FEV1 2.4 and PEF 3.0. A significant response (SI > 2) was shown by the interrupter in 22 of the subjects compared with 16 by FEV1. The interrupter technique is useful for assessing changes in airway calibre in asthmatic school children, with a sensitivity at least as good as standard methods. Such a device could be of particular value in those too young to perform spirometry.