Total respiratory impedance measurement by forced oscillations: a noninvasive method to assess bronchial response in occupational medicine.

The forced oscillation technique is a noninvasive and effort-independent test to characterize the mechanical impedance of the respiratory system. By applying a complex signal, the frequency-dependent behavior of the respiratory system can be measured over an extended spectrum. For clinical practice, the input impedance is used most frequently; pressure and flow are measured at the same place. The impedance can be partitioned into a real part or resistance and an imaginary part or reactance. At low frequencies, reactance is determined by the capacitance of the system and at high frequencies by the inertial properties of the system. Equipment and impedance data in normal subjects and patients with chronic obstructive pulmonary disease are discussed. The frequency-dependent behavior of the respiratory system is described with the use of an electrical model characterized by partitioning of airway resistance and the presence of shunt compliance represented by the compliance of the intrathoracic airway walls. Influences of peripheral resistance, airway compliance, lung volumes, chest wall and pulmonary resistance, and resistance of the cheeks and upper airways are analyzed. Input impedance can be applied to the detection of bronchoconstriction and bronchodilation, but this technique is suitable for detecting early airway abnormalities caused by smoking or occupational hazards.