IMPULSE OSCILLOMETRY FOR DIAGNOSIS OF EARLY CHANGES IN THE RESPIRATORY SYSTEM FUNCTIONAL STATE IN PATIENTS WITH MILD ASTHMA

Currently, the analysis of respiratory function of lungs at suspicion of obstructive pulmonary diseases is recommended to start with spirometry as the most sensitive method of obstruction detection. However, data on informative value and specificity of a method are contradictory. To obtain reliable results good cooperation of the patient and health professionals is necessary. Impulse oscillometry is a noninvasive method of general respiratory resistance assessment, which does not require forced exhalations. The sensitivity and specificity of this method remain undecided as well as the obtained parameter interpretation. The objective of this work was to study opportunities of impulse oscillometry in diagnostics of early respiratory dysfunctions of ist most informative indicators correlating with parameters of spirometry and body plethysmography.

Materials and methods. Patients with the established diagnosis of mild asthma (n=68) were examined. In 71% of patients, obstructive respiratory dysfunction was revealed. In the control group (n=41) there were no abnormalities.

Results. In most of patients with revealed via spirometry and body plethysmography obstructive disturbances the increase in indicators of absolute frequency dependence of the resistive component of the respiratory impedance at the oscillation frequency of 5 and 20 Hz (Rrs5-Rrs20) and the reactance area (AX). Increase in Rrs5-Rrs20 was revealed in 48 (71%) patients and the increase in AX was observed in 44 (65%) of the surveyed, patients with 42 (61%) patients without the increase of reactance (Xrs5) and resistance (Rrs5).

Conclusion. The absolute frequency dependence of Rrs5-Rrs20 and AX are the most informative parameters of impulse oscillometry. In some patients the IOM findings were more significant in comparison with spirometry ones.

1. Nunes C., Pereira A.M., Morais-Almeida M. Asthma costs and social impact. Asthma Research and Practice. 2017; 3: 1. DOI: 10.1186/s40733-016-0029-3.

2. Morbidity of the whole population of Russia in 2017: Statistical materials. P.I. M.: The Russian Federation Ministry of Health, Department of Monitoring, Analysis and Strategic Health Development, Federal State Budgetary Institution «Central Research Institute for Health Organization and Informatization» of the Russia Health Ministry. 2018; 97-99 [In Russian].

3. Dusser D., Montani D., Chanez P., et al. Mild asthma: an expert review on epidemiology, clinical characteristics and treatment recommendations. Allergy. 2007; 6 (62): 591–604. DOI:10.1111/j.1398-9995.2007.01394.x.

4. Pribylova N.N., Pribylov S.A., Mahova O.Ju. Prevalence, features of the clinical course and treatment, phenotypes of bronchial asthma in the Kursk region according to the register. Modern Problems of Science and Education. 2016; 5: 120 [In Russian].

5. Arhipov V.V., Belousov D.Ju., Lazareva N.B., et al. Bronchial asthma — problem study. Good Clinical Practice. 2006; 3:31 [In Russian].

6. Mineev V.N. Sorokina L.N., Njoma M.A. Polymorphism of a protein gene STAT6 and bronchial asthma. Kazan medical journal. 2009; 9 (3): 102-103 [In Russian].

7. Namazova L.S., Ogorodova L.M., Geppe N.A., et al. Bronchial asthma. Pediatric Pharmacology. 2006; 3 (2):12-25 [In Russian].

8. Beilby J. Asthma monitoring in primary care: time to gather more robust evidence. Primary Care Respiratory Journal. 2012; 21:1-7. DOI: 10.4104/pcrj.2012.00005.

9. Boulay M.E., Boulet L.P. Discordance between asthma control clinical, physiological and inflammatory parameters in mild asthma. Respiratory Medicine. 2013; 107(4): 511–518. DOI:10.1016/j.rmed.2012.12.015.

10. Shi Y., Aledia A.S., Galant S.P., et al. Peripheral airway impairment measured by oscillometry predicts loss of asthma control in children. The Journal of Allergy and Clinical Immunology. 2013; 131(3): 718-723. DOI: 10.1016/j.jaci.2012.09.022.

11. Santos K. dos, Kviecinski M.R., Silva J. da. Diagnosis of asthma: the challenge goes on. The Journal of Asthma: Official Journal of the Association for the Care of Asthma. 2016; 53(2): 113. DOI:10.3109/02770903.2015.1060610.

12. Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2017.

13. Wanger J., Clausen J.L., Coates A. et al. Standardisation of the measurement of lung volumes. European Respiratory Journal. 2005; 26 (3): 511-522. DOI: 10.1183/09031936.05.00035005.

14. Maclntyre N., Crapo R.O., Viegi G. et al. Standardisation of the single-breath determination of carbon monoxide uptake in the lung. European Respiratory Journal. 2005; 26 (4): 720-735. DOI: 10.1183/09031936.05.00034905.

15. Smith H.J., Reinhold P., Goldman M.D. Forced oscillation technique and impulse oscillometry. In: Gosselink R., Stam H., eds. Lung function testing. Sheffield, UK: European Respiratory Society. 2005; 72—105.

16. Savushkina O.I., Chernjak A.V. Pulmonary function tests: from theory to practice. M.: STROM. 2017; 192 p. [In Russian].

17. Nekljudova GV, Chernjak AV. Impulse oscillometry in the evaluation of the provocative test. Collection of abstracts of the 15th Respiratory diseases National Congress. Moscow, November 29 — December 2, 2005. Pulmonology. 2005, application: 213 (785) [In Russian].

18. Chernjak A.V., Amelina E.L. Use of a impulse osсillometry for patients with a mucoviscidosis. Pulmonology. 2005; 2: 84-88 [In Russian].

19. Chuchalin A.G., Aĭ sanov Z.R., Chikina S.Ju., et al. Federal clinical guidelines of the Russian respiratory society on the use of the spirometry method. Pulmonology. 2014; 6:11-24 [in Russian].

20. Winkler J., Hagert-Winkler A., Wirtz H., et al. [Die moderne impulsoszillometrie im Spektrum lungenfunktioneller Messmethoden]. Pneumologie. 2009; 63 (8): 461469. DOI: 10.1055/S-0029-1214938 [In German].

21. Chernjak A.V., Kameneva M.Ju., Krjukov E.V., et al. Possibilities of impulse oscillometry in the diagnosis of airway obstruction of mild severity. Pulmonology. 2018; 28 (4): 391-398 [In Russian].

22. Pellegrino R., Viegi G., Brusasco V. et al. Interpretative strategies for lung function tests. European Respiratory Journal. 2005; 26: 948-968.

23. Chuchalin A.G. Bronchial asthma and asthma-like states. Russian Medical Journal. 2002; 5: 232 [in Russian].

24. Cowie R.L., Underwood M.F., FieldCan S.K. Asthma symptoms do not predict spirometry. Canadian Respiratory Journal. 2007; 6 (4): 339-342 DOI: 10.1155/2007/816132.

25. Kirjuhina L.D., Kameneva M.Ju., Novikova L.N. Opportunities of impulse oscillometry in the diagnosis of a restrictive variant of ventilation disorders. Medical sciences. 2017; 59 (5): 136-141 [In Russian].

26. Sobko E.A., Ishchenko O.P., Demko I.V., et al. Evaluation of the clinical and functional status in patients with bronchial asthma. Siberian Medical Review. 2010; 3: 75-79 [In Russian].