Impulse oscillometry versus spirometry in a long-term study of controller therapy for pediatric asthma - 15/08/11
, Wayne Morgan, MD g, Gregory P. Heldt, MD e, David T. Mauger, PhD d, Susan J. Boehmer, MA d, Vernon M. Chinchilli, PhD d, Robert F. Lemanske, MD c, Fernando Martinez, MD g, Robert C. Strunk, MD b, Stanley J. Szefler, MD a, Robert S. Zeiger, MD, PhD e, f, Lynn M. Taussig, MD a, Leonard B. Bacharier, MD b, Theresa W. Guilbert, MD c, Shelley Radford g, †, Christine A. Sorkness, PharmD cChildhood Asthma Research and Education Network of the National Heart, Lung, and Blood Institute
Reprint requests: Gary L. Larsen, MD, Department of Pediatrics, National Jewish Health, 1400 Jackson St, Denver, CO 80206.Abstract |
Background |
Determination of the benefits and limitations of specific physiologic tests has not been well studied in long-term clinical pediatric trials.
Objective |
We sought to determine the utility of impulse oscillometry in a long-term comparison of 3 controller regimens in children with persistent asthma.
Methods |
Children 6 to 14 years of age with mild-to-moderate persistent asthma were characterized with oscillometry and spirometry before entry into a clinical trial and then serially during 48 weeks of therapy with either an inhaled corticosteroid, a combination inhaled corticosteroid with a long-acting β-agonist, or a leukotriene receptor antagonist.
Results |
The FEV1/forced vital capacity ratio, as well as the forced expiratory flow from 25% to 75% of forced vital capacity in terms of spirometric parameters and the reactance area (XA) from impulse oscillometry, appeared to complement information provided by FEV1 when comparing the tests and factors that appeared to predict a response to treatment. XA was unique in that it, as distinct from spirometric variables, reflected ongoing improvement during the latter part of the trial. In general, improvements in XA during the latter part of the study occurred independently of indices of atopy and the level of airway responsiveness.
Conclusion |
Assessment of respiratory mechanics over time with oscillometry might offer additional insights into the response of asthmatic patients to therapy. In particular, the pattern of improvement seen in XA over the course of therapy suggests this test might detect alterations in airway mechanics not reflected by spirometry. The possibility that changes in XA reflect ongoing improvement in small airway function deserves additional study.
Le texte complet de cet article est disponible en PDF.Key words : Pediatric asthma, impulse oscillometry, spirometry, therapy of asthma
Abbreviations used : CARE, eNO, FEF25-75, Fres, FVC, IOS, NHLBI, PACT, R5, R10, XA
Plan
| Supported by grants U10HL064287, 5U10HL064288, 5U10HL064295, 5U10HL064305, and 5U10HL064307 from the National Heart, Lung, and Blood Institute. This study was carried out in part in the General Clinical Research Centers at National Jewish Medical and Research Center (M01 RR00051), Washington University School of Medicine (M01 RR00036), and the University of Wisconsin (MO1 RR03186). |
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| Disclosure of potential conflict of interest: G. L. Larsen is on the Asthma Advisory Board for Genentech and receives grant support from the National Institutes of Health. V. M. Chinchilli receives grant support from the National Heart, Lung, and Blood Institute. R. F. Lemanske is on the speakers’ bureau for Merck, is a consultant for GlaxoSmithKline, and receives grant support from the National Heart, Lung, and Blood Institute. F. Martinez is on the Advisory Boards for Merck and MedImmune, receives lecture fees from Merck and Pfizer, and is a consultant for GlaxoSmithKline and Pfizer. S. J. Szefler is a consultant for AstraZeneca, GlaxoSmithKline, Aventis, Genentech, and Merck and receives grant support from the National Institutes of Health; the National Heart, Lung, and Blood Institute; and Ross Pharmaceuticals. R. S. Zeiger is a consultant for Aerocrine, AstraZeneca, Dynavax, Genentech, Merck, Novartis, and GlaxoSmithKline and receives grant support from Sanofi-Aventis, Teva Pharmaceuticals, Merck, AstraZeneca, GlaxoSmithKline, and Genentech. L. B. Bacharier receives honoraria from AstraZeneca, Genentech, GlaxoSmithKline, Merck, and Aerocrine and is on the Advisory Board for Schering-Plough. T. W. Guilbert receives honoraria from GlaxoSmithKline, AstraZeneca, the Peerpoint Medical Education Institute, Merck, Schering-Plough, Genentech/Novartis, and Antidote; receives grant support from Altus Pharmaceuticals, Inspire Pharmaceuticals, the National Institutes of Health, and the National Heart, Lung, and Blood Institute; and is a member of the American Lung Association, American Thoracic Society, and American Academy of Pediatrics. C. A. Sorkness is a consultant and on the speakers’ bureau for GlaxoSmithKline and receives grant support from Pharmaxis. The rest of the authors have declared that they have no conflict of interest. |
Vol 123 - N° 4
P. 861 - avril 2009 Retour au numéro
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