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Cut-points for response to mannitol challenges using the forced oscillation technique.

Melissa A McClean1, Christopher Htun, Gregory G King

  • 1Woolcock Institute of Medical Research, Glebe, NSW, Australia. mmcclean@mail.usyd.edu.au

Respiratory Medicine
|November 6, 2010
PubMed
Summary
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The forced oscillation technique (FOT) provides sensitive and repeatable measurements of airway hyperresponsiveness to mannitol challenges. Adjusting for lung volume did not impact the accuracy or repeatability of these respiratory measurements.

Area of Science:

  • Respiratory Physiology
  • Pulmonary Medicine
  • Diagnostic Techniques

Background:

  • Airway hyperresponsiveness is a key feature of asthma.
  • The forced oscillation technique (FOT) measures respiratory system impedance.
  • Established cut-points for FOT in mannitol challenges are lacking, and lung volume effects are unknown.

Purpose of the Study:

  • To determine cut-points for FOT variables (Grs, Xrs) in mannitol challenges.
  • To assess the impact of lung volume adjustments on FOT measurements.
  • To evaluate the repeatability of FOT compared to FEV(1) in detecting airway hyperresponsiveness.

Main Methods:

  • 15 non-asthmatic and 52 asthmatic subjects underwent mannitol challenges.
  • Respiratory system conductance (Grs) and reactance (Xrs) were measured using FOT.

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  • Dose-response slopes (DRS) were analyzed, with and without inspiratory capacity (IC) adjustment, using ROC analysis.

    • Main Results:

    • Both Grs and Xrs (DRSGrs, DRSXrs) detected positive mannitol challenges (p < 0.0001).
    • Adjustment for IC did not significantly alter the detection ability or repeatability of DRSGrs or DRSXrs.
    • FOT cut-points were established: 27% fall in Grs or 0.93 cm H(2)O/L/s decrease in Xrs at 635 mg mannitol.

    Conclusions:

    • FOT measurements of Grs and Xrs are sensitive and repeatable for assessing mannitol-induced airway hyperresponsiveness.
    • Adjusting FOT variables for lung volume does not improve their diagnostic utility or repeatability.
    • FOT offers a valuable, lung-volume-independent method for evaluating airway responsiveness.