Relating small airways to asthma control by using impulse oscillometry in children.

Relating small airways to asthma control by using impulse oscillometry in children.
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DOI:
10.1016/j.jaci.2011.11.002
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发表时间:
2012-03
期刊:
The Journal of allergy and clinical immunology
影响因子:
--
通讯作者:
George SC
George SC
中科院分区:
其他
文献类型:
--
作者:
Shi Y;Aledia AS;Tatavoosian AV;Vijayalakshmi S;Galant SP;George SC

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先前的报告表明,外周气道与哮喘控制有关。患者的病史,虽然主观的,主要用于评估儿童哮喘控制,因为肺功能测定是正常的许多倍。脉冲呼吸测量法(IOS)是一种客观的非侵入性肺功能测量方法,它有可能独立地检查小气道阻塞和大气道阻塞。确定IOS在评估儿童哮喘控制中的效用。哮喘和健康儿童(6-17岁)入组研究。在给予支气管扩张剂之前和之后,一式三份地收集肺量测定和IOS(分别为5和20 Hz下的电阻R5和R20、5 Hz下的电抗X5、共振频率Fres和5 Hz与Fres之间的电抗曲线下面积AX)。医生对IOS测量结果不知情,并使用ATS指南评估哮喘控制。未控制哮喘儿童(n=44)的小气道IOS测量值(包括R5-20、X5、Fres和AX)与控制哮喘儿童(n=57)和健康儿童(n=14)的测量值有显著差异,尤其是在使用支气管扩张剂之前。然而,大气道IOS(R20)无差异。哮喘控制组和健康儿童在任何终点上均无差异。ROC分析显示,基线R5-20(1.5 cmH 2 O·L-1·s)和AX(9.5 cmH 2 O·L-1)的临界点可有效区分控制与未控制的哮喘(AUC=0.86和0.84),并正确分类超过80%的人群。未控制的哮喘与小气道功能障碍有关,IOS可能是评估儿童哮喘控制的可靠的无创方法。
Previous reports suggest that peripheral airways are associated with asthma control. Patient history, although subjective is used largely to assess asthma control in children because spirometry is many times normal. Impulse oscillometry (IOS) is an objective non-invasive measurement of lung function, which has the potential to examine independently both small and large airway obstruction. To determine the utility of IOS in assessing asthma control in children. Asthmatic and healthy children (6–17 yrs) were enrolled in the study. Spirometry and IOS (resistance at 5 and 20 Hz, R5 and R20, respectively, reactance at 5 Hz, X5, resonant frequency, Fres, and area under the reactance curve between 5 Hz and Fres, AX) were collected in triplicate before and after a bronchodilator was administered. The physicians were blinded to the IOS measurements and assessed asthma control using ATS guidelines. Small airway IOS measurements, including R5-20, X5, Fres and AX, of children with uncontrolled asthma (n=44) were significantly different from those of controlled asthmatic (n=57) and healthy (n=14) children, especially prior to the administration of a bronchodilator. However, there was no difference in large airway IOS (R20). No differences were found between controlled asthmatic and healthy children in any of the endpoints. ROC analysis showed cut-points for baseline R5-20 (1.5 cmH2O·L−1·s) and AX (9.5 cmH2O·L−1) that effectively discriminated controlled versus uncontrolled asthma (AUC=0.86 and 0.84), and correctly classified more than 80% of the population. Uncontrolled asthma is associated with small airways dysfunction, and IOS may be a reliable non-invasive method to assess asthma control in children.
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