Use of the forced oscillation technique to assess airway obstruction and reversibility in children

The forced oscillation technique (FOT) is particularly attractive in a pediatric setting as it requires only passive cooperation from the child. We assessed the sensitivity and specificity of this method for detecting airway obstruction and its reversibility in 313 children (3 to 16 yr of age) with asthma or chronic nocturnal cough. Baseline and postbronchodilator (n = 251) resistance were measured (R-0) with the FOT. Baseline R-0 was normalized for height and weight [Ro(SD)]. In children able to perform forced expiratory maneuvers (n = 181), R-0(SD) was independently correlated with FEV1 (p < 0.02) and maximal expiratory flow at 50% (MEF50) (p < 0.004). The optimal R-0(SD) cutoff: value given by receiver operating characteristic (ROC) curves to discriminate between children with baseline FEV1 < 80% or greater than or equal to 80% of predicted values yielded 84% sensitivity and 73% specificity. Postbronchodilator changes in R-0(SD) [Delta R-0(SD)] were mostly correlated to changes in MEF50. The optimal Delta R-0(SD) cutoff value to discriminate between children with the presence or absence of significant reversibility in FEV1 yielded 69% sensitivity and 78% specificity. In children unable to perform forced expiratory maneuvers (n = 132), this Delta R-0(SD) cutoff clearly identified a subgroup of young children with high R-0 values at baseline, that returned to normal after bronchodilation. We conclude that FOT measurements allow reliable evaluation of bronchial obstruction and its reversibility in asthmatic children over 3 yr old.