Clinical Application of Forced Oscillation Technique (FOT) in Early Detection of Airway Changes in Smokers
Abstract
:1. Background
2. Clinically Relevant FOT Parameters for Detecting Early Changes in Smokers
Study/Year | Study Design/Frequency Used/Methods | Summary of Finding |
---|---|---|
Borrill, Z. L. et al., 2008 [47] | Compared inflammatory markers, spirometry, plethysmography, IOS with multiple frequency and in 18 smokers and 10 non-smokers | Resonate Frequency was significantly higher in smokers (compared to non-smokers while other parameters of IOS were not significant. IOS showed the detrimental effects of smoking while FEV1 was normal |
Faria, A. C. et al., 2010 [19] | FOT measurements using AOS (4–32 Hz in170 subjects divided into five groups according to the number of pack-years smoked as <20, 20–39, 40–59, and >60 pack-years and a control group | R0, RM and CRs, dyn values are more useful than spirometry in detecting early changes in smokers. R0 and Rm obtained AUC values considered adequate for clinical to detected change in <20 pack years group |
Crim, C. et al., 2011 [30] | Measured lung impedance with IOS (multi frequency) in healthy non-smokers (n = 233), healthy former smokers (n = 322) and patients with COPD (n = 2054) and compared it with spirometry and CT | No differences in IOS between smokers and non-smokers except for R20. IOS was not significantly correlated with smoking pack years. Weak association between IOS and MMEFs was seen. IOS appeared to be more variable than spirometry over the period of 3 months |
Shinke, H. et al., 2013 [38] | Intermittent hunning impulse of 4–36 Hz used for comparison of the impedance components in non-smokers, smokers, and COPD patients during inspiratory and expiratory phases | Difference between the maximum and minimum values of R5 and X5 i.e R5 Sub and X5 Sub were significantly different in smokers from non-smokers |
Silva, K. K. et al., 2015 [37] | Twenty healthy individuals, 20 smokers and 74 patients with stable COPD were evaluated for the mean respiratory impedance (Zm) and the respiratory cycle dependence in the impedance. Low pressure sinusoidal signal filtered at 5 Hz with analog filter was used | Non-significant changes along the respiratory cycle in healthy subjects and smokers, but significantly higher expiratory impedance values than the inspiratory values inCOPD patients |
Berger, K. I. et al., 2016 [31] | FOT with multiple frequency and inflammatory markers were measured in bronchioalveolar lavage from 7 controls and 16 smokers | Smokers had elevated R5 with abnormal R5–20 and X5. Abnormal FOT was associated with two-fold higher lymphocyte and neutrophil counts and with higher interleukin (IL)-8, eotaxin and fractalkine levels |
Contoli, M., 2016 [50] | Fifty asthmatic patients (25 current smokers and 25 non-smokers) performed single breath nitrogen wash out and IOS with multiple frequency | R5–R20 but not R5 was significantly higher in smokers compared to non-smoking asthmatic patients. R5–R20 comparable with dN2 in detecting airway changes in smoking asthmatic group |
Schivinski, C. I. S. et al., 2017 [48] | Spirometry and FOT using IOS (5–20 Hz) was performed in 6–14 years children divided as passive and non-passive smoker, (n = 78) | The passive smoker group had higher mean absolute values for reactance area (AX5) and significantly higher percentage of predicted values for R20, Fres, X5 and AX. IOS was able to identify the early changes in lung function in adolescent and children due to passive smoking |
Jetmalani, K. et al., 2018 [56] | Eighty smokers with normal spirometry completed a symptom questionnaire and went for MBNW and IOS using 5–35 Hz pulse of pressure waves | Forty-one (51%) subjects had at least one abnormal IOS parameter, predominantly in resistance. Sixty-one (76%) subjects had an abnormality in either MBNW or IOS. Abnormalities in MBNW and IOS parameters were unrelated to each other |
Ribeiro, C. O. et al., 2018 [36] | 40 healthy controls, 40 smokers (20.3 ± 9.3 pack-years) and 40 patients with mild COPD performed FOT (4–32 Hz). The contributions of the integer-order (InOr) and fractional-order (FrOr) models was evaluated | FOT parameters and InOr modelling may adequately identify early changes (–AUC > 0.8). The use of FrOr modelling significantly improved the process, allowing the early diagnosis of smokers and patients with mild COPD with high accuracy (AUC > 0.9) |
Thacher, J. D. et al., 2018 [52] | Investigated the influence of maternal smoking during pregnancy, second-hand smoke exposure and adolescent smoking on lung function. Participants performed spirometry and IOS (n = 2295) | Significant increases in R5, R5–20 and AX0 in adolescent exposed to maternal smoking during pregnancy. Effect of a smoking in adolescent was also shown by IOS parameters |
Soares, M. et al., 2019 [57] | Compared two commercially available FOT devices: Impulse Oscillometry (IOS) and TremoFlo FOT (AOS) in (a) healthy controls (n = 14), asymptomatic smokers (n = 17) and individuals with asthma (n = 73) and (b) a 3D printed CT-derived airway tree model | Both R5 and R20 of IOS were able to differentiate smokers from healthy controls but only R19 of AOS was able to do so. IOS consistently measured higher resistance values compared to AOS at both 5 Hz and 20 Hz in all patient group. The printed airway resistance and standardized volume reactance confirmed the observations seen in patients |
3. Methodological Variation in FOT for Detecting Early Changes in Smokers
4. Modified Approaches in Data Analysis and Interpretation to Increase the Sensitivity
5. Correlation of FOT and Biomarkers in Smokers
6. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Bhattarai, P.; Myers, S.; Chia, C.; Weber, H.C.; Young, S.; Williams, A.D.; Sohal, S.S. Clinical Application of Forced Oscillation Technique (FOT) in Early Detection of Airway Changes in Smokers. J. Clin. Med. 2020, 9, 2778. https://doi.org/10.3390/jcm9092778
Bhattarai P, Myers S, Chia C, Weber HC, Young S, Williams AD, Sohal SS. Clinical Application of Forced Oscillation Technique (FOT) in Early Detection of Airway Changes in Smokers. Journal of Clinical Medicine. 2020; 9(9):2778. https://doi.org/10.3390/jcm9092778
Chicago/Turabian StyleBhattarai, Prem, Stephen Myers, Collin Chia, Heinrich C. Weber, Sally Young, Andrew D. Williams, and Sukhwinder Singh Sohal. 2020. "Clinical Application of Forced Oscillation Technique (FOT) in Early Detection of Airway Changes in Smokers" Journal of Clinical Medicine 9, no. 9: 2778. https://doi.org/10.3390/jcm9092778