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May 6, 2020 / in Scientific Article

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: rs = –0.36, P < .01; AX: rs = 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.

The articles include uses of tremoflo products or describes research devices that may not have been cleared by FDA
Keywords
Asthma control, bronchodilator response, forced oscillation technique, symptoms
Source

Cottee AM, Seccombe LM, Thamrin C, King GG, Peters MJ, Farah CS. Bronchodilator response assessed using the forced oscillation technique identifies poor asthma control with greater sensitivity than spirometry. Chest. 2020.

Other resources of interest

June 9, 2022
Longitudinal monitoring of asthma in the clinic using respiratory oscillometry
Asthma guidelines emphasize the importance of assessing lung function and symptoms. The forced oscillation technique (FOT) and its longitudinal relationship with spirometry and symptoms are unresolved. We examined concordance between longitudinal spirometry, FOT and symptom control, and determined FOT limits of agreement in stable asthma.
June 9, 2022
Criteria for Airway Oscillometry Reversibility in Asthma
We read with interest the article in the June 2020 issue of CHEST from Cottee et al,1 examining 52 patients with asthma, which concluded that bronchodilator response to albuterol 400 mg using forced oscillation technique (airway oscillometry [AO]) with Thorasys Tremoflo was more sensitive than spirometry at identifying poor disease control with the asthma control test.1 This pattern was observed for reactance area (AX) and reactance at 5Hz but not for resistance at 5Hz (R5).
May 2, 2022
Regional Airway Heterogeneity in Asthma
In an issue of CHEST (September 2020), Karakioulaki et al1 reinforced mounting evidence for the presence of regionally heterogeneous airway abnormalities in patients with asthma by showing histopathologic airway differences across lung lobes on endobronchial biopsy. At the lobar level, airway smooth muscle cell mass and the distance between the basement membrane and airway smooth muscle were significantly different across lobes. Airway smooth muscle cell mass was greater in lower lobes compared with upper lobes, and, although specific interlobar differences were not measured, the right upper lobe notably exhibited the least amount of airway smooth muscle mass.
June 9, 2022
Longitudinal monitoring of asthma in the clinic using respiratory oscillometry
Asthma guidelines emphasize the importance of assessing lung function and symptoms. The forced oscillation technique (FOT) and its longitudinal relationship with spirometry and symptoms are unresolved. We examined concordance between longitudinal spirometry, FOT and symptom control, and determined FOT limits of agreement in stable asthma.
June 9, 2022
Criteria for Airway Oscillometry Reversibility in Asthma
We read with interest the article in the June 2020 issue of CHEST from Cottee et al,1 examining 52 patients with asthma, which concluded that bronchodilator response to albuterol 400 mg using forced oscillation technique (airway oscillometry [AO]) with Thorasys Tremoflo was more sensitive than spirometry at identifying poor disease control with the asthma control test.1 This pattern was observed for reactance area (AX) and reactance at 5Hz but not for resistance at 5Hz (R5).
May 2, 2022
Regional Airway Heterogeneity in Asthma
In an issue of CHEST (September 2020), Karakioulaki et al1 reinforced mounting evidence for the presence of regionally heterogeneous airway abnormalities in patients with asthma by showing histopathologic airway differences across lung lobes on endobronchial biopsy. At the lobar level, airway smooth muscle cell mass and the distance between the basement membrane and airway smooth muscle were significantly different across lobes. Airway smooth muscle cell mass was greater in lower lobes compared with upper lobes, and, although specific interlobar differences were not measured, the right upper lobe notably exhibited the least amount of airway smooth muscle mass.
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