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Updated: Feb 6, 2026
Conducting Respiratory Oscillometry in an Outpatient Setting
Published on: April 8, 2022
Reversible Airway Obstruction on Impulse Oscillometry in Preschool Children with Bronchopulmonary Dysplasia
Daniela Bullard Elias1, Raouf Amin2, Daniel Ignatiuk2
1Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Insights
Impulse oscillometry system (IOS) can assess lung function in preschool children with bronchopulmonary dysplasia (BPD). This method reveals abnormal airway resistance and reactance that responds to bronchodilators, offering a feasible alternative to spirometry.
Area of Science:
- Pediatric Pulmonology
- Respiratory Physiology
- Medical Technology Assessment
Background:
- Bronchopulmonary dysplasia (BPD) significantly impacts lung function in young children.
- Traditional spirometry is challenging to perform in preschool-aged children, limiting objective lung function assessment.
- Impulse oscillometry system (IOS) offers a non-invasive method for evaluating respiratory mechanics.
Purpose of the Study:
- To evaluate the feasibility and utility of the impulse oscillometry system (IOS) for assessing lung function in children aged 3-6 years with BPD.
- To determine bronchodilator reversibility using IOS in this pediatric population.
- To correlate IOS findings with clinical data and respiratory symptoms.
Main Methods:
- Retrospective review of IOS data from 73 children (3-6 years old) diagnosed with BPD.
- Analysis of lung function parameters including resistance and reactance.
- Abstraction of clinical data, including modified Saint-George Respiratory Questionnaire (SGRQ) scores.
Main Results:
- IOS was acceptable and repeatable in 52.4% of the analyzed reports.
- 78% of IOS reports indicated abnormal lung function, with elevated resistance (R7, R7-20) and decreased reactance (AX, Fres, X7).
- Lung function parameters normalized post-albuterol administration, and improvements were noted with inhaled corticosteroid/long-acting-beta-agonist therapy. The cohort exhibited increased morbidity per SGRQ scores.
Conclusions:
- IOS is a feasible technique for assessing lung function in preschool children with BPD, a population difficult to test with spirometry.
- IOS effectively identifies abnormal lung function, characterized by increased airway resistance and decreased reactance, which is responsive to bronchodilators.
- IOS provides objective data on respiratory health changes and treatment response in young children with BPD, aiding in early medical intervention.
Objective:
To assess lung function and bronchodilator reversibility via the impulse oscillometry system (IOS) in 3- to 6-year-old children with bronchopulmonary dysplasia, a population historically difficult to evaluate via spirometry.
Study Design:
A retrospective review of IOS in 3- to 6-year-old children was conducted. Clinical data were abstracted from electronic medical records, including a modified St George's Respiratory Questionnaire scored according to symptoms, activity, and impact.
Results:
We analyzed 103 IOS reports in 73 patients (median age 4.1 years; IQR 3.5-5.0); of these, 52.4% were acceptable and repeatable. At least 1 parameter was abnormal in 78% of reports, including elevated resistance with median z scores for R7 (1.8; IQR 0.9-2.8) and R7-20 (1.4; IQR 0.8-2.2) and decreased reactance with median AX (2.6; IQR 0.8-3.3), Fres (1.4 IQR; 0.6-2.4), and X7 (-2.4 IQR; -3.7 to -1.4]). Median z scores for the cohort normalized after the administration of albuterol. Improved resistance and reactance were observed on clinic follow-up IOS in children treated with inhaled corticosteroid/long-acting beta-agonists. The cohort had increased morbidity, with total St George's Respiratory Questionnaire score of 12.1 (IQR 7.6-25.6), symptom score of 32.5 (IQR 17.2-46.8), activity score of 7.6 (IQR 0-29.8), and impact score of 7.4 (IQR 0-17.1).
Conclusions:
IOS can be performed by one-half of preschool-aged children with bronchopulmonary dysplasia and reveals abnormal lung function characterized by elevated airway resistance and decreased reactance that is bronchodilator-responsive. IOS is a feasible technique to evaluate objectively the early, critical changes in respiratory health and response to medical therapy in a population in whom other methods are not available.
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