Lung disease burden assessment by oscillometry in a systematically disadvantaged urban population experiencing homelessness or at-risk for homelessness in Ottawa, Canada from a prospective observational study

Abstract

Rationale: Oscillometry is an emerging technique that offers some advantages over spirometry as it does not require forced exhalation and may detect early changes in respiratory pathology. Obstructive lung disease disproportionately impacts people experiencing homelessness with a high symptoms burden, yet oscillometry is not studied in this population.

Objectives: To assess lung disease and symptom burden using oscillometry in people experiencing homelessness or at-risk of homelessness using a community-based participatory action research approach (The Bridge Model™).

Methods: Of 80 recruited, 55 completed baseline oscillometry, 64 completed spirometry, and all completed patient-reported outcomes with demographics, health, and respiratory symptom related questionnaires in the Participatory Research in Ottawa: Management and Point-of-Care for Tobacco Dependence project. Using a two-tail t-test, we compared mean oscillometry values for airway resistance (R5-20), reactance area under the curve (Ax) and reactance at 5 Hz (X5) amongst individuals with fixed-ratio method (FEV1/FVC ratio < 0.70) and LLN (FEV1/FVC ratio ≤ LLN) spirometry diagnosed chronic obstructive pulmonary disease (COPD). We compared mean oscillometry parameters based on participants' COPD assessment test (CAT) scores using ANOVA test.

Results: There was no significant difference between the pre- and post- bronchodilator values of R5-20 and Ax for the fixed ratio method (p = 0.63 and 0.43) and the LLN method (p = 0.45 and 0.36). There was a significant difference in all three of the oscillometry parameters, R5-20, Ax and X5, based on CAT score (p = 0.009, 0.007 and 0.05, respectively). There was a significant difference in R5-20 and Ax based on the presence of phlegm (p = 0.03 and 0.02, respectively) and the presence of wheeze (p = 0.05 and 0.01, respectively). Oscillometry data did not correlate with spirometry data, but it was associated with CAT scores and correlated with the presence of self-reported symptoms of phlegm and wheeze in this population.

Conclusions: Oscillometry is associated with respiratory symptom burden and highlights the need for future studies to generate more robust data regarding the use of oscillometry in systematically disadvantaged populations where disease burden is disproportionately higher than the general population.

Trial registration: ClinicalTrails.gov-NCT03626064, Retrospective registered: August 2018, https://ichgcp.net/clinical-trials-registry/NCT03626064.

Keywords: Asthma; COPD; Community-based research; Homelessness; Lung function; Patient engagement.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1

Mean R5–20, Ax and X5 values based on the COPD assessment test (CAT) score. Mean oscillometry values are reported for R5–20, Ax and X5 based on the CAT Score. R5–20 is a measure of small airway resistance. Ax is a measure of the area under the reactance curve. X5 is a measure of airway elastance. CAT score is classified as low (< 10), medium (10–20), high (21–30) and very high (> 30). p Values were generated using the ANOVA test. p Values for R5–20, Ax and X5 based on CAT score were 0.009, 0.007, and 0.05, respectively. Sample size based on CAT score group were as follows, low n = 10, medium n = 29, high n = 15, and very high n = 5