Reference Values of Impulse Oscillometric Lung Function Indices in Adults of Advanced Age

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Abstract

Background

Impulse oscillometry (IOS) is a non-demanding lung function test. Its diagnostic use may be particularly useful in patients of advanced age with physical or mental limitations unable to perform spirometry. Only few reference equations are available for Caucasians, none of them covering the old age. Here, we provide reference equations up to advanced age and compare them with currently available equations.

Methods

IOS was performed in a population-based sample of 1990 subjects, aged 45–91 years, from KORA cohorts (Augsburg, Germany). From those, 397 never-smoking, lung healthy subjects with normal spirometry were identified and sex-specific quantile regression models with age, height and body weight as predictors for respiratory system impedance, resistance, reactance, and other parameters of IOS applied.

Results

Women (n = 243) showed higher resistance values than men (n = 154), while reactance at low frequencies (up to 20 Hz) was lower (p<0.05). A significant age dependency was observed for the difference between resistance values at 5 Hz and 20 Hz (R5–R20), the integrated area of low-frequency reactance (AX), and resonant frequency (Fres) in both sexes whereas reactance at 5 Hz (X5) was age dependent only in females. In the healthy subjects (n = 397), mean differences between observed values and predictions for resistance (5 Hz and 20 Hz) and reactance (5 Hz) ranged between −1% and 5% when using the present model. In contrast, differences based on the currently applied equations (Vogel & Smidt 1994) ranged between −34% and 76%. Regarding our equations the indices were beyond the limits of normal in 8.1% to 18.6% of the entire KORA cohort (n = 1990), and in 0.7% to 9.4% with the currently applied equations.

Conclusions

Our study provides up-to-date reference equations for IOS in Caucasians aged 45 to 85 years. We suggest the use of the present equations particularly in advanced age in order to detect airway dysfunction.

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Most cited references 24

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Statistical methods for assessing agreement between two methods of clinical measurement.

J Bland, D Altman (1986)

In clinical measurement comparison of a new measurement technique with an established one is often needed to see whether they agree sufficiently for the new to replace the old. Such investigations are often analysed inappropriately, notably by using correlation coefficients. The use of correlation is misleading. An alternative approach, based on graphical techniques and simple calculations, is described, together with the relation between this analysis and the assessment of repeatability.

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Physiology of obesity and effects on lung function.

Cheryl M Salome, Gregory G King, Norbert Berend (2010)

In obese people, the presence of adipose tissue around the rib cage and abdomen and in the visceral cavity loads the chest wall and reduces functional residual capacity (FRC). The reduction in FRC and in expiratory reserve volume is detectable, even at a modest increase in weight. However, obesity has little direct effect on airway caliber. Spirometric variables decrease in proportion to lung volumes, but are rarely below the normal range, even in the extremely obese, while reductions in expiratory flows and increases in airway resistance are largely normalized by adjusting for lung volumes. Nevertheless, the reduction in FRC has consequences for other aspects of lung function. A low FRC increases the risk of both expiratory flow limitation and airway closure. Marked reductions in expiratory reserve volume may lead to abnormalities in ventilation distribution, with closure of airways in the dependent zones of the lung and ventilation perfusion inequalities. Greater airway closure during tidal breathing is associated with lower arterial oxygen saturation in some subjects, even though lung CO-diffusing capacity is normal or increased in the obese. Bronchoconstriction has the potential to enhance the effects of obesity on airway closure and thus on ventilation distribution. Thus obesity has effects on lung function that can reduce respiratory well-being, even in the absence of specific respiratory disease, and may also exaggerate the effects of existing airway disease.

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The forced oscillation technique in clinical practice: methodology, recommendations and future developments.

, K Desager, E Oostveen … (2003)

The forced oscillation technique (FOT) is a noninvasive method with which to measure respiratory mechanics. FOT employs small-amplitude pressure oscillations superimposed on the normal breathing and therefore has the advantage over conventional lung function techniques that it does not require the performance of respiratory manoeuvres. The present European Respiratory Society Task Force Report describes the basic principle of the technique and gives guidelines for the application and interpretation of FOT as a routine lung function test in the clinical setting, for both adult and paediatric populations. FOT data, especially those measured at the lower frequencies, are sensitive to airway obstruction, but do not discriminate between obstructive and restrictive lung disorders. There is no consensus regarding the sensitivity of FOT for bronchodilation testing in adults. Values of respiratory resistance have proved sensitive to bronchodilation in children, although the reported cutoff levels remain to be confirmed in future studies. Forced oscillation technique is a reliable method in the assessment of bronchial hyperresponsiveness in adults and children. Moreover, in contrast with spirometry where a deep inspiration is needed, forced oscillation technique does not modify the airway smooth muscle tone. Forced oscillation technique has been shown to be as sensitive as spirometry in detecting impairments of lung function due to smoking or exposure to occupational hazards. Together with the minimal requirement for the subject's cooperation, this makes forced oscillation technique an ideal lung function test for epidemiological and field studies. Novel applications of forced oscillation technique in the clinical setting include the monitoring of respiratory mechanics during mechanical ventilation and sleep.

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Author and article information

Contributors

Stefan Karrasch: On behalf of : for the KORA Study Group

Henrik Watz: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, USA )

ISSN (Electronic): 1932-6203

Publication date Collection: 2013

Publication date (Electronic): 15 May 2013

Volume: 8

Issue: 5

Electronic Location Identifier: e63366

Affiliations

[1 ]Institute of Epidemiology I, Helmholtz Zentrum München, Munich, Germany

[2 ]Department of Internal Medicine V, Comprehensive Pneumology Center Munich, Ludwig-Maximilians-University, Munich, Germany

[3 ]Institute of Epidemiology II, Helmholtz Zentrum München, Munich, Germany

[4 ]Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Munich, Germany

[5 ]Division of Respiratory Medicine and Thoracic Oncology, Department of Medicine, Innenstadt, Ludwig-Maximilians-University, Munich, Germany

[6 ]Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-University, Munich, Germany

[7 ]Institute of Medical Data Management, Biometrics and Epidemiology, Ludwig-Maximilians-University, Munich, Germany

[8 ]Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany

[9 ]Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Munich, Germany

Pulmonary Research Institute at LungClinic Grosshansdorf, United States of America

Author notes

* E-mail: schulz@ 123456helmholtz-muenchen.de

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: HS JB MH RH RMH RAJ DN AP HEW JH SK. Performed the experiments: HS CF RH AP HEW JH SK. Analyzed the data: HS CF RH AP HEW JH SK. Contributed reagents/materials/analysis tools: HS CF SK. Wrote the paper: HS CF SK. Critical revision of the manuscript: JB MH RH RMH RAJ DN AP HEW JH.

Article

Publisher ID: PONE-D-13-05691

DOI: 10.1371/journal.pone.0063366

PMC ID: 3655177

PubMed ID: 23691036

SO-VID: 3575151c-2e03-4e8b-9563-5393ff65ed6d

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 7 February 2013

Date accepted : 30 March 2013

Page count

Pages: 10

Funding

The KORA research platform (KORA, Cooperative Research in the Region of Augsburg) was initiated and financed by the Helmholtz Zentrum München - German Research Center for Environmental Health, which is funded by the German Federal Ministry of Education and Research and by the State of Bavaria. The KORA-Age project was financed by the German Federal Ministry of Education and Research (BMBF FKZ 01ET0713 and 01ET1003A) as part of the ‘Health in old age’ program. Further support was provided by the Competence Network ASCONET, subnetwork COSYCONET (FKZ 01GI0882). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Reference Values of Impulse Oscillometric Lung Function Indices in Adults of Advanced Age

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Abstract

Background

Methods

Results

Conclusions

Related collections

PLOS Climate

Most cited references 24

Statistical methods for assessing agreement between two methods of clinical measurement.

Physiology of obesity and effects on lung function.

The forced oscillation technique in clinical practice: methodology, recommendations and future developments.

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