A study of the use of impulse oscillometry in the evaluation of children with asthma: Analysis of lung parameters, order effect, and utility compared with spirometry

Background The ability to objectively measure lung function in children is critical in the assessment and treatment of asthma in this age group. We thus determined the effectiveness of impulse oscillometry (IOS) as a non‐invasive technique to assess lung function in children and in comparison to spirometry for sensitivity and specificity, testing variability, and the order effect of sequential testing of IOS and spirometry. Methods One hundred seventeen children sequentially evaluated in a pediatric clinic and under medical care for disease, were asked to perform IOS and spirometry. The utility of IOS and spirometry in differentiating children that had asthma versus those children who did not was then analyzed. Results In the primary analysis (n = 117), bronchodilator response using IOS distinguished asthmatics from non‐asthmatics, P = 0.0008 for R10. Receiver–operator characteristic curve (ROC) analysis of R10 bronchodilator response at the best cut‐off (−8.6% change) correctly identified 77% of patients with asthma and excluded 76% of non‐asthmatics. Amongst those children able to perform spirometry (asthmatics, n = 66; non‐asthmatics, n = 16), FEV1 did not reveal a difference between these two groups, while area of reactance (AX) did distinguish these groups (P = 0.0092). Sequential testing of IOS and then spirometry (n = 47) showed a significant decrement in lung function as determined by IOS following performance of spirometry (P = 0.0309). Conclusion In the diagnosis and management of children with lung disease, IOS is a non‐invasive approach that easily and objectively measures lung impedance and should be considered as both an adjunct, and in some situations, an alternative to standard spirometry. Pediatr Pulmonol. 2012; 47:18–26. © 2010 Wiley Periodicals, Inc.