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Updated: Aug 11, 2025

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Minimal clinically important difference for impulse oscillometry in adults with asthma.

Mustafa Abdo1, Anne-Marie Kirsten2, Erika von Mutius3,4

  • 1LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany m.abdo@lungenclinic.de.

The European Respiratory Journal
|February 9, 2023
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Summary

This study establishes minimal clinically important differences (MCIDs) for impulse oscillometry (IOS) measures like frequency dependence of resistance (FDR) and area of reactance (AX) in asthma patients. These IOS MCIDs predict improvements in patient-reported outcomes, offering valuable insights beyond traditional lung function tests.

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Area of Science:

  • Pulmonary Medicine
  • Respiratory Physiology

Background:

  • Impulse oscillometry (IOS) offers effort-independent assessment of small airway function in asthma.
  • Minimal clinically important differences (MCIDs) for IOS measures are currently lacking.
  • This study aims to define MCIDs for frequency dependence of resistance (FDR) and area of reactance (AX) in asthma patients.

Purpose of the Study:

  • To establish statistically derived and clinically validated MCIDs for IOS measures (FDR and AX) in adult asthma patients.
  • To compare the predictive value of IOS-derived MCIDs against the established MCID for forced expiratory volume in 1-second (FEV1) for patient-reported outcomes.

Main Methods:

  • Impulse oscillometry (IOS) was performed at baseline and 1-year follow-up in 235 adult patients with mild-to-severe asthma.
  • A two-step approach involving distribution-based methods and validation against patient-reported outcome measures (PROMs) including AQLQ, ACQ-7, and ACT was used.
  • Multivariable analyses investigated MCIDs for FDR and AX as predictors of PROM improvements.

Main Results:

  • Proposed MCIDs were defined as a decline of ≥0.06 kPa·L⁻¹·s⁻¹ for FDR and ≥0.65 kPa·L⁻¹ for AX.
  • Patients exceeding both FDR and AX MCIDs demonstrated greater improvements in all PROMs compared to those who did not.
  • MCIDs for FDR and AX were independent predictors of MCIDs for all PROMs, with FDR MCID showing stronger prediction than FEV1 MCID.

Conclusions:

  • This study provides the first MCIDs for IOS-derived measures in adult asthma patients.
  • Small airway function, assessed by IOS, represents a distinct and important endpoint in asthma management.
  • IOS-derived MCIDs offer valuable clinical insights that complement or surpass traditional measures like FEV1.