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Original Research: Asthma |

Increased Day-to-Day Variability of Forced Oscillatory Resistance in Poorly Controlled or Persistent Pediatric AsthmaRespiratory System Impedance Variability in Asthma

Paul D. Robinson, MBChB, PhD; Nathan J. Brown, PhD; Martin Turner, PhD; Peter Van Asperen, MD; Hiran Selvadurai, PhD; Gregory G. King, MBChB, PhD
Author and Funding Information

From the Woolcock Institute of Medical Research (Drs Robinson, Brown, Turner, and King), Sydney; The University of Sydney (Drs Robinson, Brown, Turner, Van Asperen, Selvadurai, and King), Sydney; the Department of Respiratory Medicine (Drs Robinson, Van Asperen, and Selvadurai), The Children’s Hospital at Westmead, Westmead; the Cooperative Research Centre for Asthma and Airways (Drs Robinson, Brown, Turner, and King), Sydney; and the Department of Respiratory Medicine (Dr King), Royal North Shore Hospital, St. Leonards, NSW, Australia.

CORRESPONDENCE TO: Paul D. Robinson, MBChB, PhD, Department of Respiratory Medicine, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia; e-mail: dr.pdrobinson@gmail.com


FUNDING/SUPPORT: This study was supported by a National Health and Medical Research Council (NHMRC) Postgraduate Research Scholarship, an NHMRC Practitioner Fellowship, the Cooperative Research Centre for Asthma and Airways (Project 2.1), the Australian Research Council (UPTECH [Ultrafine Particles from Traffic Emissions and Children’s Health] study), and an NHMRC project grant [512387].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(4):974-981. doi:10.1378/chest.14-0288
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BACKGROUND:  Pediatric asthma lacks sensitive objective measures for asthma monitoring. The forced oscillation technique (FOT) offers strong feasibility across the pediatric age range, but relationships between FOT parameter day-to-day variability and pediatric asthma severity and control are unknown.

METHODS:  Day-to-day variability in FOT respiratory system resistance (Rrs) and respiratory system reactance (Xrs) compared with peak expiratory flow (PEF) were defined in 22 children with asthma (mean ± SD age, 10.4 ± 1.1 years) during a 5-day asthma camp. FOT was performed at 6 Hz in triplicate on each test occasion. Relationships between day-to-day FOT variability (expressed as within-subject SD [SDW] and asthma control and severity (defined according to GINA [Global Initiative for Asthma] recommendations) were explored. For comparison, normal baseline FOT values and variability, measured on two occasions, were defined in a separate cohort of 38 healthy children (age, 9.5 ± 1.0 years).

RESULTS:  Day-to-day Rrs variability was greater in persistent (n = 16) vs intermittent (n = 6) asthma (mean SDW, 0.69 cm H2O/L/s vs 0.39 cm H2O/L/s; P ≤ .01). Day-to-day Rrs variability was increased in uncontrolled (n = 13) vs partly controlled asthma (n = 9) (mean SDW, 0.75 cm H2O/L/s vs 0.42 cm H2O/L/s; P ≤ .05). PEF variability did not differentiate the groups. Day-to-day variability of Rrs and Xrs but not baseline values were increased in children with asthma vs control children (Rrs mean SDW, 0.61 cm H2O/L/s vs 0.33 cm H2O/L/s [P ≤ .05]; Xrs mean SDW, 0.24 cm H2O/L/s vs 0.15 cm H2O/L/s [P ≤ .05]).

CONCLUSIONS:  Increased day-to-day FOT variability exists in school-aged children with asthma. Day-to-day Rrs variability was associated with asthma severity and asthma control. FOT may be a useful objective monitoring tool in pediatric asthma and warrants further study.

TRIAL REGISTRY:  Australian and New Zealand Clinical Trials Registry; No.: ACTRN12614000885695; URL: www.anzctr.org.au

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