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Clinical application of oscillometry in respiratory diseases: an impulse oscillometry registry

Xiaolin Liang, Jinping Zheng, Yi Gao, Zhe Zhang, Wen Han, Jing Du, Yong Lu, Li Chen, Tao Wang, Jinming Liu, Gang Huang, Bingrong Zhao, Guihua Zhao, Xuhua Zhang, Yi Peng, Xin Chen, Ning Zhou
ERJ Open Research 2022 8: 00080-2022; DOI: 10.1183/23120541.00080-2022
Xiaolin Liang
1National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Jinping Zheng
1National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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  • ORCID record for Jinping Zheng
Yi Gao
1National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Zhe Zhang
1National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Wen Han
2Dept of Respiratory and Critical Care Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
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Jing Du
3Dept of Respiratory and Critical Care, West China Hospital, Sichuan University, Chengdu, China
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Yong Lu
4Dept of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Li Chen
5Dept of Respiratory Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Tao Wang
6Dept of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Jinming Liu
7Dept of Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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Gang Huang
8Key Laboratory of Respiratory Disease of Zhejiang Province, Dept of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Bingrong Zhao
9Dept of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
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Guihua Zhao
10Dept of Cardiopulmonary function, Henan Provincial People's Hospital, Zhengzhou, China
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Xuhua Zhang
11Dept of Pulmonary Function Test, Ningxia Medical University General Hospital, Yinchuan, China
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Yi Peng
12Dept of Respiratory Medicine, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Xin Chen
13Dept of Respiratory and Critical Care Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, China
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Ning Zhou
14Dept of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
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  • Article
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  • FIGURE 1
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    FIGURE 1

    Study flowchart. ERS: European Respiratory Society.

  • FIGURE 2
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    FIGURE 2

    Comparisons of the z-scores of oscillometric parameters between different groups. R5: resistance at 5 Hz; R20: resistance at 20 Hz; X5: reactance at 5 Hz; fres: resonant frequency; AX: reactance area; ILD: interstitial lung disease; UAO: upper airway obstruction; ULN: upper limit of normal (1.645); LLN: lower limit of normal (−1.645). ns: nonsignificant between-group difference (p>0.05); other between-group differences without this notation were all significant (p<0.05).

  • FIGURE 3
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    FIGURE 3

    Equations of the z-scores of oscillometric parameters predicted by the forced expiratory volume in 1 s (FEV1) z-score. The solid lines represent medians and the shaded areas 95% confidence intervals. R5: resistance at 5 Hz; R20: resistance at 20 Hz; X5: reactance at 5 Hz; ILD: interstitial lung disease; UAO: upper airway obstruction.

  • FIGURE 4
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    FIGURE 4

    Diagnostic performances of oscillometric and spirometric parameters in diagnosing respiratory diseases (interstitial lung disease (ILD)+asthma+COPD+bronchiectasis+upper airway obstruction (UAO) versus healthy) and airway obstructive diseases (asthma+COPD+bronchiectasis+UAO versus healthy+ILD). R5: resistance at 5 Hz; AX: reactance area; fres: resonant frequency; X5: reactance at 5 Hz; R20: resistance at 20 Hz; FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity.

Tables

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  • Supplementary Materials
  • TABLE 1

    Anthropometrics and spirometric parameters of the analysed population

    HealthyILDAsthmaCOPDBronchiectasisUAO
    Subjects, N56727478168810940
    Females, n (%)300 (52.9)124 (45.3)441 (56.5)58 (8.4)66 (60.6)19 (47.5)
    Age, years38.3±14.357.4±11.645.9±12.963.2±8.652.9±11.154.5±14.9
    Height, cm164.3±8.3161.6±8.0162.2±8.2165.2±7.0160.0±8.4160.7±7.5
    Weight, kg62.9±11.164.8±10.963.7±12.562.7±11.558.0±12.161.7±10.7
    BMI, kg·m−223.2±3.124.7±3.324.1±3.722.9±3.622.5±3.723.8±3.3
    FEV1, L#3.32±0.722.15±0.642.39±0.831.5±0.641.93±0.742.11±0.85
    FEV1 z-score#0.291±0.914−1.766±1.664−1.784±1.902−4.12±1.796−2.506±1.942−2.034±2.34
    FVC, L#3.96±0.872.71±0.843.52±0.953.02±0.802.84±0.863.22±0.84
    FVC z-score#0.310±0.978−1.800±1.753−0.225±1.442−1.517±1.690−1.363±1.482−0.407±1.526
    FEV1/FVC#83.8±5.580.1±8.767.2±13.048.5±12.867.2±14.164.2±16.0
    FEV1/FVC z-score#−0.047±0.7910.01±1.507−2.572±2.16−4.849±2.047−2.329±2.382−2.882±2.948
    MMEF, L·s−1¶3.45±1.061.89±0.881.63±0.970.59±0.391.21±0.891.76±0.82
    MMEF z-score¶0.153±0.993−0.904±1.347−1.917±1.172−2.901±0.552−2.094±1.304−1.399±1.067
    PEF, L·s−1#8.02±1.935.12±2.196.08±1.984.00±2.217.03±1.944.08±2.27
    PEF z-score#0.378±0.995−1.212±1.537−2.653±1.311−0.233±1.349−1.623±1.464−2.658±1.661

    Data are presented as mean±sd unless otherwise stated. ILD: interstitial lung disease; UAO: upper airway obstruction; BMI: body mass index; FEV­1: forced expiratory volume in 1 s; FVC: forced vital capacity; MMEF: maximum mid-expiratory flow; PEF: peak expiratory flow. #: 11 data were missing from this analysis; ¶: 177 data were missing from this analysis.

    • TABLE 2

      Intercepts and slopes of the predictive equations of oscillometric parameters (ln z-scores) estimated by the linear mixed model analysis

      ln(5+R5 z-score)ln(5+R20 z-score)ln(5+R5−R20 z-score)ln(42+X5 z-score)
      Estimate (95% CI)p-value#Estimate (95% CI)p-value#Estimate (95% CI)p-value#Estimate (95% CI)p-value#
      Intercept
       Healthy1.67 (1.60–1.73)<0.0011.66 (1.59–1.72)<0.0011.76 (1.70–1.82)<0.0013.73 (3.71–3.75)<0.001
       ILD1.68 (1.63–1.74)0.5551.64 (1.59–1.69)0.4631.71 (1.64–1.77)0.0813.71 (3.67–3.75)0.095
       Asthma1.71 (1.68–1.75)0.0141.70 (1.67–1.73)0.0081.73 (1.69–1.78)0.2153.77 (3.74–3.79)<0.001
       COPD1.66 (1.61–1.72)0.9331.74 (1.69–1.79)0.0011.56 (1.49–1.62)<0.0013.89 (3.85–3.93)0.412
       Bronchiectasis1.61 (1.52–1.70)0.1821.59 (1.51–1.67)0.0911.65 (1.55–1.75)0.0273.78 (3.72–3.85)0.095
       UAO2.29 (2.17–2.42)<0.0012.08 (1.97–2.19)<0.0012.21 (2.07–2.35)<0.0013.68 (3.60–3.77)0.007
      Slope (against FEV1 z-score)
       Healthy−0.0514
      (−0.0788– −0.0240)
      <0.001−0.0309
      (−0.0532– −0.0086)
      0.006−0.0619
      (−0.0956– −0.0282)
      <0.0010.0175
      (−0.0039–0.0390)
      0.1081
       ILD−0.0639
      (−0.0956– −0.0322)
      0.439−0.0159
      (−0.0438–0.0121)
      0.292−0.1005
      (−0.1364– −0.0648)
      0.0360.0214
      (−0.0019–0.0447)
      0.743
       Asthma−0.1391
      (−0.1661– −0.1121)
      <0.001−0.0672
      (−0.0909– −0.0435)
      0.003−0.1427
      (−0.1734– −0.1121)
      <0.0010.0638
      (0.0440–0.0837)
      <0.001
       COPD−0.1333
      (−0.1610– −0.1056)
      <0.001−0.0337
      (−0.0579– −0.0095)
      0.821−0.1951
      (−0.2266– −0.1636)
      <0.0010.0972
      (0.0769–0.1175)
      <0.001
       Bronchiectasis−0.1370
      (−0.1737– −0.1003)
      <0.001−0.0887
      (−0.0242– −0.1207)
      0.121−0.1532
      (−0.1948– −0.1116)
      <0.0010.0657
      (0.0389–0.0925)
      <0.001
       UAO−0.1072
      (−0.1526– −0.0618)
      0.016−0.0309
      (−0.0708–0.0089)
      0.998−0.1492
      (−0.2007– −0.0977)
      0.0010.1646
      (0.1316–0.1975)
      <0.001

      R5: resistance at 5 Hz; R20: resistance at 20 Hz; X­5: reactance at 5 Hz; ILD: interstitial lung disease; UAO: upper airway obstruction; FEV1: forced expiratory volume in 1 s. #: p-values of the healthy groups were derived from the comparisons with zero; p-values of disease groups were derived from the comparisons with the healthy group.

      • TABLE 3

        Comparisons of the diagnostic values between R5 and spirometric parameters

        AUC (95% CI)p-valueCut-offSensitivitySpecificity
        Respiratory diseases
         R5 z-score0.807 (0.790–0.824)<0.01>1.42662.4%90.3%
         FEV1 z-score0.900 (0.888–0.912)<0.01≤ −1.11274.0%95.4%
         FEV1/FVC z-score0.861 (0.847–0.875)<0.01≤ −1.41070.5%97.4%
        Obstructive airway diseases
         R5 z-score0.788 (0.770–0.806)<0.01>1.42666.7%81.5%
         FEV1 z-score0.820 (0.803–0.837)<0.01≤ −1.06976.2%75.2%
         FEV1/FVC z-score0.922 (0.912–0.933)<0.01≤ −1.40180.72%94.5%
        UAO
         R20 z-score0.895 (0.852–0.938)<0.01>2.30087.5%79.0%
         FEV1 z-score0.509 (0.420–0.598)0.84≤ −0.23082.1%26.6%
         0.557 (0.473–0.640)0.18≤ −0.59587.2%32.2%
         PEF z-score0.728 (0.657–0.799)<0.01≤−0.83589.47%47.87%

        AUC: area under the curve; respiratory diseases: interstitial lung disease+asthma+COPD+bronchiectasis+upper airway obstruction (UAO) versus healthy; R5: resistance at 5 Hz; FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; obstructive airway diseases: asthma+COPD+bronchiectasis+UAO versus healthy+ILD; R20: resistance at 20 Hz; PEF: peak expiratory flow.

        • TABLE 4

          z-scores of oscillometric parameters corresponded to forced expiratory volume in 1 s (FEV1) z-score −2.5 and −4

          R5 z-scoreR20 z-scoreR5−R20 z-scoreX5 z-score
          FEV1 z-score−2.5−4−2.5−4−2.5−4−2.5−4
          Healthy1.0241.5060.6560.9251.7872.448−2.129−3.162
          ILD2.8594.6821.4752.1623.0895.02−5.2−8.558
          Asthma2.3744.0061.1961.5182.7375.367−3.606−8.815
          COPD1.3181.9540.350.4792.0723.223−3.146−4.374
          Bronchiectasis2.0223.6240.6321.1292.6084.573−4.683−8.185
          UAO7.93210.1883.6454.0558.20911.52−15.639−21.406
          Average of asthma+COPD+bronchiectasis2.4184.1042.8114.987−4.496−8.519

          R5: resistance at 5 Hz; R20: resistance at 20 Hz; X5: reactance at 5 Hz; ILD: interstitial lung disease; UAO: upper airway obstruction.

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          Clinical application of oscillometry in respiratory diseases: an impulse oscillometry registry
          Xiaolin Liang, Jinping Zheng, Yi Gao, Zhe Zhang, Wen Han, Jing Du, Yong Lu, Li Chen, Tao Wang, Jinming Liu, Gang Huang, Bingrong Zhao, Guihua Zhao, Xuhua Zhang, Yi Peng, Xin Chen, Ning Zhou
          ERJ Open Research Oct 2022, 8 (4) 00080-2022; DOI: 10.1183/23120541.00080-2022

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          Clinical application of oscillometry in respiratory diseases: an impulse oscillometry registry
          Xiaolin Liang, Jinping Zheng, Yi Gao, Zhe Zhang, Wen Han, Jing Du, Yong Lu, Li Chen, Tao Wang, Jinming Liu, Gang Huang, Bingrong Zhao, Guihua Zhao, Xuhua Zhang, Yi Peng, Xin Chen, Ning Zhou
          ERJ Open Research Oct 2022, 8 (4) 00080-2022; DOI: 10.1183/23120541.00080-2022
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