Accuracy of forced oscillation technique to assess lung function in geriatric COPD population

Hoi Nam Tse, Cee Zhung Steven Tseng, King Ying Wong, Kwok Sang Yee, Lai Yun Ng, Hoi Nam Tse, Cee Zhung Steven Tseng, King Ying Wong, Kwok Sang Yee, Lai Yun Ng

Abstract

Introduction: Performing lung function test in geriatric patients has never been an easy task. With well-established evidence indicating impaired small airway function and air trapping in patients with geriatric COPD, utilizing forced oscillation technique (FOT) as a supplementary tool may aid in the assessment of lung function in this population.

Aims: To study the use of FOT in the assessment of airflow limitation and air trapping in geriatric COPD patients.

Study design: A cross-sectional study in a public hospital in Hong Kong. ClinicalTrials.gov ID: NCT01553812.

Methods: Geriatric patients who had spirometry-diagnosed COPD were recruited, with both FOT and plethysmography performed. "Resistance" and "reactance" FOT parameters were compared to plethysmography for the assessment of air trapping and airflow limitation.

Results: In total, 158 COPD subjects with a mean age of 71.9±0.7 years and percentage of forced expiratory volume in 1 second of 53.4±1.7 L were recruited. FOT values had a good correlation (r=0.4-0.7) to spirometric data. In general, X values (reactance) were better than R values (resistance), showing a higher correlation with spirometric data in airflow limitation (r=0.07-0.49 vs 0.61-0.67), small airway (r=0.05-0.48 vs 0.56-0.65), and lung volume (r=0.12-0.29 vs 0.43-0.49). In addition, resonance frequency (Fres) and frequency dependence (FDep) could well identify the severe type (percentage of forced expiratory volume in 1 second <50%) of COPD with high sensitivity (0.76, 0.71) and specificity (0.72, 0.64) (area under the curve: 0.8 and 0.77, respectively). Moreover, X values could stratify different severities of air trapping, while R values could not.

Conclusion: FOT may act as a simple and accurate tool in the assessment of severity of airflow limitation, small and central airway function, and air trapping in patients with geriatric COPD who have difficulties performing conventional lung function test. Moreover, reactance parameters were better than resistance parameters in correlation with air trapping.

Keywords: air trapping; airflow limitation; chronic obstructive pulmonary disease.

Figures

Figure 1
Figure 1
Correlation between FEV1 and various FOT parameters. Notes: (A) FDep, (B) R6, (C) R20, (D) RAvr, (E) Fres, (F) X6, (G) X20, and (H) XAvr. *P<0.05. Abbreviations: FDep, frequency dependence; FEV1, forced expiratory volume in 1 second; FOT, forced oscillation technique; Fres, resonance frequency; R6, resistance at 6 Hz; R20, resistance at 20 Hz; RAvr, average resistance; X6, reactance at 6 Hz; X20, reactance at 20 Hz; XAvr, average reactance.
Figure 2
Figure 2
Correlation between FEF25–75% and various FOT parameters. Notes: (A) FDep, (B) R6, (C) R20, (D) RAvr, (E) Fres, (F) X6, (G) X20, and (H) XAvr. *P<0.05. Abbreviations: FDep, frequency dependence; FOT, forced oscillation technique; Fres, resonance frequency; R6, resistance at 6 Hz; R20, resistance at 20 Hz; RAvr, average resistance; X6, reactance at 6 Hz; X20, reactance at 20 Hz; XAvr, average reactance.
Figure 3
Figure 3
Correlation between RV/TLC ratio and various FOT parameters. Notes: (A) FDep, (B) R6, (C) R20, (D) RAvr, (E) Fres, (F) X6, (G) X20, and (H) XAvr. *P<0.05. Abbreviations: FDep, frequency dependence; FOT, forced oscillation technique; Fres, resonance frequency; R6, resistance at 6 Hz; R20, resistance at 20 Hz; RAvr, average resistance; RV, residual volume; TLC, total lung capacity; X6, reactance at 6 Hz; X20, reactance at 20 Hz; XAvr, average reactance.
Figure 4
Figure 4
Different “resistance” and “reactance” parameters in various GOLD stages (stages 1–4). Notes: (A) Resistance (R6, R20, RAvr); (B) FDep; (C) reactance (X6, X20, XAvr); and (D) Fres. *P<0.05. Outliers are displayed as various symbols to represent the different groups. Abbreviations: FDep, frequency dependence; Fres, resonance frequency; GOLD, Global Initiative for Chronic Obstructive Lung Disease; NS, not significant; R6, resistance at 6 Hz; R20, resistance at 20 Hz; RAvr, average resistance; X6, reactance at 6 Hz; X20, reactance at 20 Hz; XAvr, average reactance.
Figure 5
Figure 5
ROC curves for various FOT parameters in prediction of severe type of patients with COPD (%FEV1 <50%). Notes: (A) Fres, (B) X6, (C) X20, (D) XAvr, (E) FDep, (F) R6, (G) R20, and (H) RAvr. Abbreviations: AUC, area under the curve; FDep, frequency dependence; FEV1, forced expiratory volume in 1 second; FOT, forced oscillation technique; Fres, resonance frequency; R6, resistance at 6 Hz; R20, resistance at 20 Hz; RAvr, average resistance; ROC, receiver operating characteristic; X6, reactance at 6 Hz; X20, reactance at 20 Hz; XAvr, average reactance.
Figure 5
Figure 5
ROC curves for various FOT parameters in prediction of severe type of patients with COPD (%FEV1 <50%). Notes: (A) Fres, (B) X6, (C) X20, (D) XAvr, (E) FDep, (F) R6, (G) R20, and (H) RAvr. Abbreviations: AUC, area under the curve; FDep, frequency dependence; FEV1, forced expiratory volume in 1 second; FOT, forced oscillation technique; Fres, resonance frequency; R6, resistance at 6 Hz; R20, resistance at 20 Hz; RAvr, average resistance; ROC, receiver operating characteristic; X6, reactance at 6 Hz; X20, reactance at 20 Hz; XAvr, average reactance.
Figure 6
Figure 6
Different “resistance” and “reactance” parameters in various degrees of air trapping (grades 1–3). Notes: (A) Resistance (R6, R20, RAvr); (B) FDep; (C) reactance (X6, X20, XAvr); and (D) Fres. *P<0.05. Outliers are displayed as various symbols to represent the different groups. Abbreviations: FDep, frequency dependence; Fres, resonance frequency; NS, not significant; R6, resistance at 6 Hz; R20, resistance at 20 Hz; RAvr, average resistance; X6, reactance at 6 Hz; X20, reactance at 20 Hz; XAvr, average reactance.

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Source: PubMed

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