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Conducting Respiratory Oscillometry in an Outpatient Setting

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Published on: April 8, 2022

Are we overlooking persistent small airways dysfunction in community-managed asthma?

William J Anderson¹, Emma Zajda, Brian J Lipworth

¹Asthma and Allergy Research Group, University of Dundee, Scotland, United Kingdom.

Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology

|August 28, 2012

Summary

Small airways dysfunction persists in asthma patients despite standard treatment. Extra-fine inhaled corticosteroids may improve airway resistance in early treatment steps, warranting further study.

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Area of Science:

Pulmonology
Respiratory Medicine
Asthma Research

Background:

Small airways dysfunction is a key feature of asthma.
Its persistence in patients on standard community treatment is not well understood.
Impulse oscillometry (IOS) offers sensitive assessment of small airways function.

Purpose of the Study:

To evaluate the extent of small airways dysfunction in a diverse group of asthma patients managed in the community.
To compare small airways function across different asthma treatment intensity levels.

Main Methods:

Analysis of primary care referral data for 378 persistent asthma patients.
Assessment using spirometry and impulse oscillometry (IOS).
Comparison of patients across British Thoracic Society asthma treatment steps 2, 3, and 4.

Main Results:

Patients on step 4 showed significantly higher resistance (F(res), R5-R20) and lower lung function (FEV1, FEF25-75) compared to step 2.
High prevalence of abnormal peripheral airway resistance (R5-R20) was observed across all treatment steps (64.6% to 69.9%).
Extra-fine inhaled corticosteroids (ICS) in step 2 patients reduced total airway resistance (R5) compared to standard ICS, without affecting FEV1.

Conclusions:

Asthma patients exhibit persistent small airways dysfunction even with current guideline-based treatments (steps 2-4).
Extra-fine particle ICS show potential in reducing airway resistance at step 2.
Further prospective research is needed to determine if extra-fine ICS, with or without long-acting beta-agonists (LABA), can improve long-term asthma control by enhancing small airways function.