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Peripheral airways dysfunction measured by oscillometry differentiates asthma from inducible laryngeal obstruction - 02/01/25

Doi : 10.1016/j.rmed.2024.107905 
Patrick Donohue a, b, , Margaret Connolly c , Marcus D'Alfonso a , Gerriann Jackson d , Liane C. Grasso d , Xueya Cai e , Ashley P. O'Connell Ferster f , G Todd Schneider d , Sandhya Khurana a, b , Steve N. Georas a, b
a Division of Pulmonary and Critical Care Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY, 14642, USA 
b Mary Parkes Center for Asthma, Allergy & Pulmonary Care, 400 Red Creek Drive, Suite 110, Rochester, NY, 14623, USA 
c Division of Pulmonary, Critical Care, and Sleep Medicine, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD, 21201, USA 
d Department of Otolaryngology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY, 14642, USA 
e Department of Biostatistics and Computational Biology, 265 Crittenden Boulevard, CU 420630, Rochester, NY, 14642, USA 
f Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA 

Corresponding author. Pulmonary and Critical Care, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA.Pulmonary and Critical CareUniversity of Rochester Medical Center601 Elmwood AveRochesterNY14642USA

Abstract

Background

Inducible laryngeal obstruction (ILO, also called vocal cord dysfunction) can be difficult to distinguish clinically from asthma. Limited studies have explored the use of respiratory oscillometry to detect changes unique to ILO, but more study is needed to determine if routine oscillometry can differentiate these two clinical entities.

Objective

Determine if impedance variables measured on routine oscillometry over tidal breathing vary between individuals with asthma and ILO.

Methods

Subjects with asthma and ILO were recruited to participate in a single-center, observational study at the University of Rochester Medical Center. Oscillometry measurements were obtained over tidal breathing according to technical standards. Exploratory oscillometry variables were analyzed, as well as standard oscillometry variables including measures of peripheral airways dysfunction.

Results

25 subjects (12 with asthma and 13 with ILO) were recruited and included in the analysis. Measures of peripheral airways dysfunction including frequency dependence of resistance (R5-R20), area under the reactance curve (AX), and reactance at 5 Hz (X5) were significantly more abnormal in asthma subjects compared to ILO subjects (p = 0.039, p = 0.008, and p = 0.0327 respectively). Resistance at 5 Hz (R5) was not statistically different between asthma and ILO (p = 0.301). Exploratory variables, including inspiratory impedance and the standard deviation of impedance, were not significantly different between asthma and ILO.

Conclusion

Measures of peripheral airways dysfunction by oscillometry were significantly different in subjects with asthma compared to ILO and more significant in subjects with poor asthma control. There were no exploratory oscillometry variables that were significantly different between ILO and asthma.

El texto completo de este artículo está disponible en PDF.

Highlights

Oscillometry has potential to detect inducible laryngeal obstruction.
Without symptom triggers, oscillometry may miss inducible laryngeal obstruction.
Peripheral airways dysfunction implies asthma over inducible laryngeal obstruction.

El texto completo de este artículo está disponible en PDF.

Keywords : Oscillometry, Asthma, Inducible laryngeal obstruction, Vocal cord dysfunction, Physiology

Abbreviations : ILO, VCD, PVFM, R5, R5-R20, AX, X5, R5inspiratory, R5inspiratiory-R5expiratory, R5max-R5min, R5Stdev, ACT, ICS, BMI, FEV1, FVC, IQR, Z5, EILO, COPD


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