Detection of changes in respiratory mechanics due to increasing degrees of airway obstruction in asthma by the forced oscillation technique

Forced expiratory airflows and volumes are often used to assess the airway obstruction in asthmatics. However, forced maneuvers may change bronchial tone and modify airway patency. The aim of this study was to determine whether the Forced Oscillation Technique (FOT), which does not require forced manoeuvres, may be useful to describe the changes in respiratory mechanics in progressive asthma. This study involved 25 healthy and 84 asthmatics, including patients with normal spirometric exam (NE), mild moderate and severe obstruction. Resistive data were interpreted using the respiratory system resistance extrapolated at 0 Hz (R0), the mean respiratory resistance (Rm), and the resistance/frequency slope (S). Reactance data were interpreted by its mean values (Xm), the dynamic compliance (Crs,dyn), and resonant frequency (fr). Receiver operating characteristics curves were used to determine the sensitivity (Se) and specificity (Sp) of FOT parameters in identifying asthma. There were not statistically significant differences between the control and NE groups. Comparing the control and mild groups, significant increases of R0 (P < 0.0007), Rm (P < 0.003), and S (P < 0.003) were observed. In reactive parameters, a significant reduction in Crs,dyn (P < 0.04) was observed, white Xm and fr presented significant increases (P < 0.0007 and P < 0.006, respectively). Comparison between mild and moderate groups showed non-significant modifications in all of the parameters, except for Xm (P < 0.02). In the late stages (moderate to severe obstruction), all of the resistive parameters, as well as the reactive ones Xm (P < 0.007) and Crs,dyn (P < 0.03), presented statistically significant modifications. Among the studied parameters, the effects of airway obstruction in asthma seem to be well described by R0, Rm, S and Xm, which were in close agreement with physiological fundamentals. The best parameters for detecting asthma were R0 (Se = 81%, Sp = 76%), S (Se = 78%, Sp = 72%) and Xm (Se = 81%, Sp = 80%). In conclusion, the results of this study suggest that the FOT can be proposed as an alternative method for the assessment of the respiratory mechanics in asthmatic patients, representing a promising solution to the problem of effort dependence. (c) 2006 Elsevier Ltd. All rights reserved.