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Oscillometry for the diagnosis of asthma in children: a systematic review
Senali Y Seneviratne1,2, Saxon Law-Gleen1, Jonathan Broomfield1,3
1Department of Respiratory Sciences, Leicester NIHR Biomedical Research Centre (Respiratory theme), University of Leicester, Leicester, UK.
Insights
Diagnosing asthma in children using oscillometry is challenging. Current European Respiratory Society (ERS) thresholds for bronchodilator response (BDR) show low sensitivity, necessitating further research for accurate asthma diagnosis in young people.
Area of Science:
- Pediatric Pulmonology
- Respiratory Diagnostics
- Medical Technology Assessment
Background:
- Asthma diagnosis in children and young people (CYP) presents significant challenges.
- Oscillometry is a feasible respiratory assessment tool for children as young as 2 years old.
- Established European Respiratory Society (ERS) technical standards and bronchodilator response (BDR) thresholds exist, but their diagnostic accuracy in CYP is unproven.
Purpose of the Study:
- To systematically review studies comparing oscillometry and spirometry in CYP undergoing asthma investigation.
- To evaluate the sensitivity and specificity of current ERS oscillometry thresholds for diagnosing asthma.
- To identify optimal oscillometry threshold values for improved diagnostic accuracy.
Main Methods:
- Systematic review of 11 studies comparing oscillometry with spirometry in CYP.
- Reference standards included positive BDR or methacholine challenge tests (MCT).
- Analysis focused on sensitivity and specificity of ERS thresholds and explored alternative values.
Main Results:
- Eleven studies (1523 CYP) were included; meta-analysis was precluded by heterogeneity.
- Current ERS BDR thresholds demonstrated zero sensitivity and high specificity (>85%) in two studies.
- Weighted regression analyses suggested alternative thresholds: 17.0% decrease in R5 (71.6% sensitivity/specificity for BDR) and 20.2% increase in X5 (68.6% sensitivity/specificity for BDR).
- For MCT, a 27.7% increase in R5 showed 73.6% sensitivity and specificity.
Conclusions:
- The current ERS thresholds for oscillometry BDR exhibit low sensitivity in CYP.
- Proposed oscillometry thresholds for positive BDR and MCT require prospective validation.
- Standardization of oscillometry measurement and reporting is crucial for future diagnostic studies.
Background:
Diagnosing asthma in children and young people (CYP) remains challenging. Oscillometry is a promising tool and is feasible from 2 years of age. European Respiratory Society (ERS) technical standards and bronchodilator response (BDR) oscillometry thresholds have been published, but diagnostic accuracy is not established.
Methods:
We systematically reviewed studies comparing oscillometry and spirometry in CYP under investigation for asthma. Reference standards were positive BDR or positive methacholine challenge test (MCT). Primary aims were to investigate the sensitivity and specificity of current ERS oscillometry thresholds (>40% decrease in resistance at 5 Hz (R 5), >50% increase in reactance at 5 Hz (X 5) or >80% decrease in the area under the reactance curve); secondary aims were to identify oscillometry threshold values optimising both sensitivity and specificity.
Results:
11 studies were included; six (n=992 CYP) utilised BDR and five (n=531 CYP) MCT as reference standard. Meta-analysis was not possible due to heterogeneity of results reported. In two studies using current ERS BDR thresholds, zero sensitivity and high specificity (>85%) were observed. In weighted regression analyses of BDR studies, a 17.0% decrease in resistance at 5-6 Hz had sensitivity and specificity of 71.6% (95% CI 69.7-73.7%); a 20.2% increase in X 5 had sensitivity and specificity of 68.6% (95% CI 66.6-70.8%). Similarly, 27.7% increase in R 5 had sensitivity and specificity of 73.6% (95% CI 71.9-75.3%) for MCT.
Conclusion:
Currently recommended ERS thresholds for oscillometry BDR have low sensitivity. Proposed thresholds for defining positive BDR and MCT by oscillometry require prospective validation and adoption of standards for measuring and reporting oscillometry parameters in future diagnostic comparative studies.
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