The intra-breath changes of reactance at low frequency in impulse oscillometry: differentiating obstructive airway disease and Interstitial Lung Disease

Abstract

Background

Impulse Oscillometry (IOS) helps understanding the mechanical properties of the respiratory system. Evaluating its role in distinguishing Obstructive Airway Disease (OAD) from Restrictive Lung Disease (RLD) remains underexplored.

Methods

We included the consecutive patients of both OAD (asthma and COPD), ILD (representing RLD) observing guideline recommendations and a cohort of ‘healthy’ subjects (asymptomatic, no disease clinico-radiologically and on spirometry). They underwent spirometry and impulse oscillometry concurrently on the same sitting. The comparison between the three groups included IOS derived R5, R10, R15, R20, R5-10, R5-15, R5-20, R10-20, X5, Rin5 (R5 inspiration), Rex5 (R5 expiration), Xin5 (X5 inspiration) and Xex5 (X5 expiration), Fres and AX. We proposed Δintrabreath-X5 (Xin5-Xex5) and a ‘reactance variance index’ (RVI) [(Xin5-Xex5)/Xex5 × 100] in the effort. Those showing highly significant difference (p ≤ 0.0001) were analysed with the ROC curves to determine the best differentiating values.

Results

We included 104 OAD (COPD: 53, Asthma: 51), 75 RLDs and 43 healthy controls. Multiple resistance (R5, R5-10, R5-15, R5-20, and Rex5 Xex5) and reactance related (X5, Fres and AX) parameters displayed significant difference (p < 0.0001). The Xex5 and R5 turned out to be the best discriminators, with areas under the curve of 0.9244 and 0.9292, showing sensitivities of 88.57% and 85.85%, and specificities of 95.35% and 100%, respectively, using cut-off values of -2.49 and 5.04 in differentiating OAD from healthy subjects. Of the resistance factors (R5, R10, R15, R20, R5-15, R5-20, R-in-5) significantly differed between ILD and healthy cohorts; the R5 had the highest discriminating power (sensitivity of 64% and specificity of 100% to differentiate them. The Δintrabreath-X5 could best distinguish ILD from OAD with 88.06% sensitivity and 80.95% specificity, closely followed by Xin5/Xex5 and the RVI.

Conclusion

IOS can acceptably distinguish OAD from ILD using Δintrabreath-X5. The observation demands further validation.