Impulse oscillometry in the assessment of lung function in children with chronic nonspecific lung diseases

Introduction. The article proposes an approach to evaluating the main parameters of impulse oscillometry (IOS) in children with chronic nonspecific lung diseases (CNSLD) using multivariate statistical methods. Aim. To identify types of ventilatory disorders in children with CNSLD using cluster analysis based on impulse oscillometry data. Materials and methods. A total of 71 children were examined, including 10 conditionally healthy children and 61 patients with CNSLD. Lung function was evaluated using IOS. The analyzed parameters included: Z5Hz—total respiratory impedance at an oscillation frequency of 5 Hz; R5Hz—total resistance at 5 Hz; R20Hz—proximal airway resistance at 20 Hz; X5Hz—reactance at 5 Hz; frequency dependence of resistance—D(Rrs5–Rrs20); delta Xrs5; and resonance frequency (Fres). Results. Analysis of the IOS data allowed all subjects to be divided into three clusters. The first cluster included children with the highest values of the main parameters studied. The clinical course of the disease in this group was characterized by pronounced clinical symptoms. Median values of the main respiratory impedance parameters in children of the second cluster remained within normal ranges; however, 20% of the children in this group showed increased values of X5Hz, D(Rrs5–Rrs20), delta Xrs5, and Fres with slightly elevated or normal R20Hz and R5Hz values, indicating ventilatory disorders at the level of the distal airways. The health status of children in the third cluster was more favorable compared to patients in the first and second clusters, and their IOS parameters were 1.5–2 times lower than those of children in the first and second clusters, indicating the absence of airway dysfunction. Conclusion. The presented IOS parameters will enable the practicing physician to make informed decisions regarding individual patients for better assessment of disease progression and treatment efficacy.

1. Bogdanova A.V., Zandakov T.V., Titova O.N., Bojtsova E.V., Goloborod'ko M.M. [Epidemiological aspects of children bronchial tubes disease]. Vestnik Sovremennoy Klinicheskoy Meditsiny = The Bulletin of Contemporary Clinical Medicine 2015; 8(2):43–50 (in Russian).

2. Kozlov V.K., Pichugina S.V., Gandurov S.G., Evseeva G.P., Suprun S.V., Chaikа М.S., Lebed’ko O.A. [Clinical features of congenital stridor in children]. Bûlleten' fiziologii i patologii dyhaniâ = Bulletin Physiology and Pathology of Respiration 2023; (90):39–46 (in Russian). https://doi.org/10.36604/1998-5029-2023-90-39-46

3. Jordan B.K., McEvoy C.T. Trajectories of lung function in infants and children: setting a course for lifelong lung health. Pediatrics 2020; 146(4):e20200417. https://doi.org/10.1542/peds.2020-0417

4. Kiryukhina L.D., Kameneva M.Yu., Novikova L.N. [Possibilities of pulsed oscillometry in diagnostics of a restrictive version of ventilation]. Mezhdunarodnyy nauchno-issledovatel'skiy zhurnal 2017; 5(59):136–141 (in Russian). https://doi.org/10.23670/IRJ.2017.59.032/

5. Dyakova S.Е., Orlova E.A., Klyukhina Y.B., Kudinova T.V. [Modern functional diagnostics methods for the respiratory system in children (Part 1. Methods based on the study of tidal breathing in children)]. Meditsinskiy alfavit = Medical Alphabet 2022; 20:52–60 (in Russian). https://doi.org/10.33667/2078-5631-2022-20-52-60

6. Komarow H.D., Myles I.A., Uzzaman A., Metcalfe D.D. Impulse oscillometry in the evaluation of diseases of the airways in children. Ann. Allergy Asthma Immunol. 2011; 106(3):191–199. https://doi.org/10.1016/j.anai.2010.11.011

7. Savushkina O.I., Chernyak A.V. [Application of pulse oscillometry in clinical practice]. Prakticheskaya pul'monologiya 2015; 1:38–42 (in Russian).

8. Chernaya N.L., Fomina O.V., Ivanova I.V. [Impulse oscillometry as a method of diagnosis of early respiratory dysfunction in asthmatic children]. Pul'monologiya = Russian Pulmonology 2007; 4:62–68 (in Russian). https://doi.org/10.18093/0869-0189-2007-0-4-62-68

9. Kiryukhina L.D., Chernyak A.V. [Oscillometry: clinical significance and applications]. Pul'monologiya = Russian Pulmonology 2023; 33(6):798–808 (in Russian). https://doi.org/10.18093/0869-0189-2023-33-6-798-808

10. Brashier B., Salvi S. Measuring lung function using sound waves: role of the forced oscillation technique and impulse oscillometry system. Breathe (Sheff) 2015; 11(1):57–65. https://doi.org/10.1183/20734735.020514

11. Qvarnström B., Engström G., Frantz S., Zhou X., Zaigham S., Sundström J., Janson C., Wollmer P., Malinovschi A. Impulse oscillometry indices in relation to respiratory symptoms and spirometry in the Swedish Cardiopulmonary Bioimage Study. ERJ Open Res. 2023; 9(5):00736-2022. https://doi.org/10.1183/23120541.00736-2022

12. Kiryukhina L.D., Volodich O.S., Denisova N.V., Nefedova N.G., Kovaleva S.А., Аrchakova L.I. [Impulse oscillometry in the diagnosis of obstructive ventilation disorders in pulmonary tuberculosis patients]. Tuberkulёz i bolezni lёgkikh = Tuberculosis and Lung Diseases 2019; 97(11):34–40 (in Russian). http://doi.org/10.21292/2075-1230-2019-97-11-34-40

13. Li L.Y., Yan T.S., Yang J., Li Y.Q., Fu L.X., Lan L., Liang B.M., Wang M.Y., Luo F.M. Impulse oscillometry for detection of small airway dysfunction in subjects with chronic respiratory symptoms and preserved pulmonary function. Respir. Res. 2021; 22(1):68. http://doi.org/10.1186/s12931-021-01662-7

14. Kiryukhina L.D., Lavrushin A.A., Aganezova E.S. [Assessment of impulse oscillometry parameters]. Pul'monologiya = Russian Pulmonology 2004; 5:41–44 (in Russian).

15. Kalchiem-Dekel О., Hines S.E. Forty years of reference values for respiratory system impedance in adults: 1977– 2017. Respir. Med. 2018; 136:37–47. https://doi.org/10.1016/j.rmed.2018.01.015

16. Kiryukhina L.D., Antonova E.A., Zhelenina L.A. [The use of pulse oscillometry to assess respiratory function in respiratory pathology in children and adults]. Sankt Peterburg; 2003 (in Russian).

17. Borisov A.G. [Cluster analysis of types of immune disorders in infectious and inflammatory diseases]. Rossiyskiy immunologicheskiy zhurnal = Russian Journal of Immunology 2014; 8(17-4):1002–1011 (in Russian).

18. O’Regan A., Hannigan A., Glynn L., Bengoechea E.G., Donnelly A., Hayes G., Murphy A.W. , Clifford A.M., Gallagher S., Woods C.B. A cluster analysis of device-measured physical activity behaviours and the association with chronic conditions, multi-morbidity and healthcare utilisation in adults aged 45 years and older. Prev. Med. Rep. 2021; 24:101641. https://doi.org/10.1016/j.pmedr.2021.101641

19. Savushkina O.I., Chernyak A.V., Kryukov E.V., Zaytsev A.A., Naumenko Zh.K., Tatarsky A.R. [Impulse oscillometry in the diagnosis of moderately severe airway obstruction]. Klinicheskaya praktika = Journal of Clinical Practice 2018; 9(4):33–39 (in Russia). https://doi.org/10.17816/clinpract9433–39

20. Savushkina O.I., Chernyak A.V., Kameneva M.Yu., Kryukov E.V., Zaytsev A.A. [An informative value of impulse oscillonetry for detecting restrictive abnormalities in idiopathic pulmonary fibrosis]. Pul'monologiya = Russian Pulmonology 2018; 28(3):325–331 (in Russian). http://doi.org/10.18093/0869-0189-2018-28-3-325-331

21. Savushkina O.I., Chernyak A.V., Zaytsev A.A., Kulagina I.Ts. [An informative value of impulse oscillometry for diagnosis of ventilation abnormalities in patients with newly diagnosed pulmonary sarcoidosis]. Pul'monologiya = Russian Pulmonology 2017; 27(4):439–445 (in Russia). http://doi.org/10.18093/0869-0189-2017-27-4-439-445

22. Nesterova I.V., Kovaleva S.V., Chudilova G.A., Lomtatidze L.V., Shinkareva O.N., Malinovskaya V.V. [Tactics of rehabilitation of immunocompromised children with recurrent respiratory infections: differentiated approaches to interferono- and immunotherapy]. Farmateka 2016; 20(333):15–23 (in Russian).

23. Cherniak A.V., Savushkina O.I., Pashkova T.L., Kryukov E.V. [Diagnosis of small airway dysfunction in patients with chronic obstructive pulmonary disease]. Al'manakh klinicheskoy meditsiny = Almanac of Clinical Medicine 2020; 48(5):307–315. http://doi.org/10.18786/2072-0505-2020-48-019