Spirometry and Impulse Oscillometry in Preschool Children: Acceptability and Relationship to Maternal Smoking in Pregnancy

Abstract

Background: Comparisons of the technical acceptability of spirometry and impulse oscillometry (IOS) and clinical correlations of the measurements have not been well studied in young children. There are no large studies focused on African American and Hispanic children.

Objectives: We sought to (1) compare the acceptability of spirometry and IOS in 3- to 5-year-old children and (2) examine the relationship of maternal smoking during pregnancy to later lung function.

Methods: Spirometry and IOS were attempted at 4 sites from the Urban Environmental and Childhood Asthma Study birth cohort at ages 3, 4, and 5 years (472, 471, and 479 children, respectively). We measured forced expiratory flow in 0.5 s (forced expiratory volume in 0.5 seconds [FEV0.5]) with spirometry and area of reactance (AX), resistance and reactance at 5 Hz (R5 and X5, respectively) using IOS.

Results: Children were more likely to achieve acceptable maneuvers with spirometry than with IOS at age 3 (60% vs 46%, P < .001) and 5 years (89% vs 84%, P = .02). Performance was consistent among the 4 study sites. In children without recurrent wheeze, there were strong trends for higher FEV0.5 and lower R5 and AX over time. Maternal smoking during pregnancy was associated with higher AX at ages 4 and 5 years (P < .01 for both years). There was no significant difference in FEV0.5 between children with and without in utero exposure to smoking.

Conclusion: There is a higher rate of acceptable maneuvers with spirometry compared with IOS, but IOS may be a better indicator of peripheral airway function in preschool children.

Keywords: African American; Epidemiology; Forced oscillation technique; Hispanic; Pediatric pulmonary function testing; Wheezing.

Conflict of interest statement

Potential Conflicts of Interest:

M. Kattan reports personal fees from Novartis Pharma. L. B. Bacharier has consultant arrangements with Aerocrine, GlasoSmithKline, Genentech/Novartis, Cephalon, Teva, and Boehringer Ingelheim; has received personal fees from Merck, DBV Technologies, AstraZeneca, WebMD/Medscape, Sanofi, Vectura, and Circassia. G. T. O’Connor has received a grant from Janssen Pharmaceuticals and has consultant arrangements with AstraZeneca. R. Cohen and R. Sorkness have nothing to disclose. W. Morgan reports grants from the Cystic Fibrosis Foundation; personal fees from Genentech, Cystic Fibrosis Foundation, American College of Chest Physicians, and American Thoracic Society. J. Gergen, K. F. Jaffee, and C. M. Visness have nothing to disclose. R. A. Wood has received grants from the NIH, DBV, Aimmune, Astellas, and HAL-Allergy; has consultant arrangements with Stallergenes; and receives royalties from UpToDate. G. R. Bloomberg and S. Doyle have nothing to disclose. R. Burton has consultancy arrangements with eResearch Technologies (ERT). J. E. Gern has received personal fees from Janssen, Regeneron, and PReP Biosciences; and has received travel support from Boehringer Ingelheim.

Copyright © 2018 American Academy of Allergy, Asthma & Immunology. All rights reserved.

Figures

Figure 1

The number of children who attended a clinic visit (darkest shade of blue), attempted to perform a pulmonary function test (middle shade of blue) and had an acceptable pulmonary function test (lightest shade of blue) at ages 3, 4 and 5 years. The number of participants attending, attempting, and completing an acceptable test are shown on top of each stacked bar. Percentages of acceptable spirometry maneuvers were higher than percentages of acceptable IOS measurements at ages 3 and 5 (p

Figure 2

R5 (kPa/l/s), X5 (kPa/l/s), and AX (kPa/l) and FEV0.5 (L) plotted by height (cm) in URECA children without recurrent wheeze. Each point indicates a raw pulmonary measurement for an associated height. Regression line is plotted from an unadjusted linear model. Spirometry and Impulse Oscillometry in Preschool Children: