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Respiratory Resistance in the Emergency Department : A Reproducible and Responsive Measure of Asthma Severity

Francine M. Ducharme; G. Michael Davis
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Affiliations: From the Division of Respiratory Medicine and the Department of Pediatrics, Montreal Children's Hospital, McGill University Faculty of Medicine, Montreal, Canada,  From the the Departments of Pediatrics and Epidemiology and Biostatistics, Montreal Children's Hospital, McGill University Faculty of Medicine, Montreal, Canada

Affiliations: From the Division of Respiratory Medicine and the Department of Pediatrics, Montreal Children's Hospital, McGill University Faculty of Medicine, Montreal, Canada,  From the the Departments of Pediatrics and Epidemiology and Biostatistics, Montreal Children's Hospital, McGill University Faculty of Medicine, Montreal, Canada


1998 by the American College of Chest Physicians


Chest. 1998;113(6):1566-1572. doi:10.1378/chest.113.6.1566
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Abstract

Objectives: To determine, in preschool children with an acute asthma exacerbation, the responsiveness to change of respiratory resistance measurements obtained by the forced oscillation (Rfo) technique, and to identify the magnitude of change indicative of airway obstruction reversibility.

Design/setting: A prospective observational study of 114 children, aged 3 to 17 years, untrained in the Rfo technique and treated for acute asthma in a tertiary-care pediatric emergency department (ED).

Measurements: A physical examination followed by three measurements of respiratory resistance by forced oscillation were obtained at 8 Hz (Rfo8) and at 16 Hz (Rfo16). In cooperative children, routine spirometry that included FEV1 was also performed on the Custo Vit R (Custo Med; Munich, Germany). All measurements were obtained twice during the course of the ED treatment, before and after treatment with nebulized bronchodilators.

Results: The Rfo8 and Rfo16 measurements were highly reproducible (reproducibility coefficients >0.85). Both the Rfo8 and Rfo16 were at least as responsive to change (responsiveness coefficients of 2.3 and 1.2, respectively) as was FEV1 (2.0) and the four clinical signs most sensitive to change (0.6 to 1.0). A 19% change in Rfo8 was suggestive of significant reversibility.

Conclusions: In the assessment of children aged ≥3 years with acute asthma exacerbation, the respiratory resistance measurements are highly reproducible and responsive to change, particularly when obtained at 8 Hz. A 19% change from baseline Rfo8 is suggestive of reversibility. This technique appears to be an attractive alternative in the evaluation of children who are too young or too sick to perform spirometry reproducibly.


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