Masoud NAZEMIYAH, Khalil ANSARIN, Masoud NOURIVASKEH, Tohid SADEGI, Akbar SHARIFI

Comparison of spirometry and impulse oscillometry in methacholine challenge test for the detection of airway hyperresponsiveness in adults

Comparison of spirometry and impulse oscillometry in methacholine challenge test for the detection of airway hyperresponsiveness in adults Introduction: Airway hyper-responsiveness (AHR) is a characteristic feature of asthma. The aim of this study was to compare the impulse oscillometry (IOS) and spirometry to methacholine for AHR detection among individuals with clinically hyper-reactive airway disease suggestive of bronchial asthma and baseline spirometry were normal. Materials and Methods: Adults with symptoms suggestive of AHR and normal baseline spirometry test were selected. The short protocol of methacholine challenge test (MCT) was performed for all subjects using IOS and spirometry simultaneously. The primary endpoint was to compare the methacholine dosage causing a 20% drop in forced expiratory volume in one second (FEV1), with methacholine dosage that causing 40% increasing the baseline respiratory resistance at 5 hertz (R5), as measured by IOS. Results: A total of 235 participants were analyzed, 184 (78.2%) had positive test results with R5, while 81 (34.4%) had positive MCT results with FEV1.The sensitivity and specificity of MCT with R5were 87.3%, 64.6%, and MCT with FEV1 were 39.1%, 85.4%, respectively. The area under the receiver operating characteristic (ROC) curve was greater at lower doses of MCT at R5, (AUROC: 0.653; p= 0.01). Conclusion: The results showed higher sensitivity, negative predictive value, and earlier response of the short protocol of MCT with IOS, compared to MCT with spirometry. Our study suggested the utility of IOS in addition to conventional spirometry as a method of choice in MCT for detection of AHR.

Spirometri ve impuls karşılaştırması metakolin meydan okumasında osilometri hava yolu tespiti için test yetişkinlerde aşırı duyarlılık

Yetişkinlerde hava yolu aşırı duyarlılığının tespiti için metakolin provokasyon testinde spirometri ve impuls osilometrinin karşılaştırılması Giriş: Hava yolu hiperreaktivitesi (HHR) astımın karakteristik bir özelliğidir. Bu çalışmada amaç, bronşiyal astımı düşündüren klinik olarak HHR olan ve başlangıç spirometresi normal olan bireylerde, HHR tespiti için impuls osilometri (IOS) ve metakolin provokasyon testlerinin karşılaştırılmasıdır. Materyal ve Metod: Çalışmaya HHR'yi düşündüren semptomları olan ve normal başlangıç spirometri testi olan yetişkinler seçildi. Metakolin provokasyon testinin (MPT) kısa protokolü, eş zamanlı olarak IOS ve spirometri kullanılarak tüm hastalara uygulandı. Birincil son nokta, bir saniyede zorlu ekspiratuar hacimde %20'lik bir düşüşe (FEV1) neden olan metakolin dozunu, IOS ile ölçülen bazal solunum rezistansını gibi 5 hertz'de (R5) %40 artıran metakolin dozajıyla karşılaştırmaktı. Bulgular: Çalışmada toplam 235 hasta değerlendirildi. Hastaların 184'ü (%78,2) R5 ile pozitif test sonuçlarına sahipken, 81'i (%34,4) FEV1 ile pozitif MPT sonuçlarına sahipti. MPT'nin R5 ile duyarlılığı ve özgüllüğü sırasıyla %87,3,%64,6 ve FEV1 ile MPT %39,1, %85,4 idi. ROC analizinde eğri altında kalan alan, R5'te daha düşük MPT dozlarında daha büyüktü (AUROC: 0,653; p= 0,01). Sonuç: Sonuçlar, spirometri ile MPT'ye kıyasla, IOS ile MPT'nin kısa protokolünün daha yüksek duyarlılığı, daha yüksek negatif prediktif değeri ve daha erken yanıtı olduğunu gösterdi. Çalışmamızın, HHR'nin saptanması için MPT'de tercih edilen bir yöntem olarak geleneksel spirometriye ek olarak IOS'un kullanımını önermektedir.

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