Impulse oscillometry values calibrated against spirometric obstruction in children with suspected asthma

The impulse oscillation system (IOS) requires less cooperation than spirometry for assessing obstructive lung disease in children aged 6-18 years; however, diagnostic criteria for several IOS parameters remain controversial. This study compared IOS and spirometry to determine IOS parameter cutoff values for spirometry-detectable airway obstruction in children.

Spirometry was used as the reference standard. We enrolled 722 children with suspected asthma. Airway obstruction was defined as a ≥ 12% increase in FEV₁ after bronchodilator or any abnormal spirometric value (FEV₁ < 80% predicted, FEV₁/FVC <80%, or FEF parameters (MMEF, FEF₂₅-₇₅, etc.) < 56% predicted. IOS parameters (R5, X5, AX, Fres and R5-R20) were recorded.

Spirometry and IOS parameters were significantly correlated, R5-R20 correlated the strongest with FEV1 and MMEF. The suggestive AX and Fres cutoff values were 1.54 kPa·L⁻¹ and 20.41 Hz for 6-11-year olds and 0.54 kPa·L⁻¹ and 13.77 Hz for 12-18-year olds. After bronchodilator inhalation, Fres and AX decreased respectively by 20% and 40% in 6-11-year olds, predicting obstructive lung diseases with accuracies of 62.2% and 60.2%. In the 12-18-year group, a 20% decrease in Fres and a 40% decrease in AX predicted obstructive lung disease with accuracies of 73.2% and 75.7%, respectively.

Our study compared pre- and post-bronchodilator IOS and spirometry results and identified which IOS values correspond to spirometric obstruction.