Related Experiment Video
Updated: Jun 24, 2026
Employing the Forced Oscillation Technique for the Assessment of Respiratory Mechanics in Adults
Published on: February 9, 2022
Application of a shortened inhaled adenosine-5'-monophosphate challenge in young children using the forced
Graham L Hall1, Catherine Gangell2, Takayoshi Fukushima3
1Department of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, WA, Australia; School of Paediatric and Child Health, Centre for Child Health Research, University of Western Australia, Perth, WA, Australia; Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, WA, Australia.
Insights
A shortened Adenosine-5'-monophosphate (AMP) challenge is a reliable method for assessing allergic airway inflammation in children. This method, using the forced oscillation technique (FOT), is comparable to standard protocols and highly repeatable.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Respiratory Physiology
Background:
- Adenosine-5'-monophosphate (AMP) serves as an indirect agent to evaluate allergic airway inflammation.
- The forced oscillation technique (FOT) is well-suited for pediatric respiratory assessments, including inhaled challenge studies.
- This study investigates the agreement and repeatability of a shortened AMP challenge protocol using FOT in children.
Purpose of the Study:
- To assess the agreement between a shortened and a standard AMP challenge protocol.
- To determine the repeatability of the shortened AMP challenge protocol.
- To utilize the forced oscillation technique (FOT) as the primary outcome measure for AMP challenges in children.
Main Methods:
- Eighteen children underwent both shortened and standard AMP challenges; 20 children completed repeated shortened AMP challenges.
- Nebulized AMP was inhaled for 2 minutes, with wheezing, oxygen saturation (Spo2), and FOT measurements recorded.
- Testing ceased at maximum dose or upon detecting wheeze, Spo2 < 90%, or increased respiratory resistance.
Main Results:
- A high concordance of 94% was observed between shortened and standard AMP protocols.
- Repeated shortened AMP protocols showed 100% concordance.
- Excellent agreement in provocation concentrations (PCs) was found, with intraclass correlation coefficients of 0.94 for both protocols.
Conclusions:
- A shortened AMP challenge is comparable to the standard protocol for young children.
- The shortened AMP challenge using FOT demonstrates high repeatability.
- Further research is needed to establish the clinical utility of the shortened AMP challenge in pediatric populations.
Background:
Adenosine-5'-monophosphate (AMP) is an indirect challenge agent thought to reflect allergic airway inflammation. The forced oscillation technique (FOT) is ideal for use in young children and is suitable for inhaled challenge studies in patients who are in this age group. We assessed the agreement between a shortened and a standard AMP challenge and the repeatability of the shortened AMP challenge using FOT as a primary outcome variable.
Methods:
Eighteen children completed a shortened and a standard AMP challenge, and 20 children completed repeated shortened AMP challenges. The children inhaled nebulized AMP tidally for 2 min, following which the presence of wheeze and pulse oximetric saturation (Spo(2)) was recorded prior to FOT measurement. Testing continued until the maximum dose was reached or until wheeze, a decrease in Spo(2) to < 90%, or an increase in respiratory resistance at 8 Hz of 2.0 hPa/s/L or 30% was noted. Concordance was assessed as a binary response, and agreement in provocation concentrations (PCs) causing a response was assessed with intraclass correlations.
Results:
There was a high degree of concordance between the shortened and standard AMP protocols (94%) and repeated shortened AMP protocols (100%). The mean log(10) PCs displayed a high degree of agreement for both AMP protocols, with intraclass correlation coefficients of 0.94 (95% confidence interval, 0.85 to 0.98) and 0.94 (95% confidence interval, 0.82 to 0.98), respectively.
Conclusions:
We demonstrated that a shortened AMP challenge that can be applied to young children is comparable to the standard AMP challenge and is highly repeatable. Further studies in young children to assess the clinical role of a shortened AMP challenge using FOT are required.
Related Concept Videos
01:17Assessment of apical pulse
Assessing the apical pulse is a critical nursing procedure, particularly indicated for:
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management