Jordon Louise H, Gore Robin B, Rusk Rosemary A, Knox-Brown Ben, Marciniak Stefan J
Department of Cardiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Department of Respiratory Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
J Asthma. 2022 Aug;59(8):1577-1583. doi: 10.1080/02770903.2021.1941088. Epub 2021 Jun 23.
The impulse oscillometry system (IOS) provides an alternative method of lung function testing for patients in whom forced expiratory manoeuvres are contraindicated, such as those with inherited vascular connective tissue disorders. Here we examine the role of IOS in the diagnosis and monitoring of asthma in such patients through a clinical case series and literature review. The clinical case series comprised of data from 12 patients with inherited connective tissue disorders representing 32 clinical encounters. Of these, 11 encounters were for asthma diagnosis and 21 were for asthma monitoring. Symptoms, exhaled nitric oxide (FeNO) and IOS were assessed at each encounter. In the clinical case series, 5 of 6 patients with likely asthma (as determined by physician review and exhaled nitric oxide testing) had abnormal IOS parameters compared with 0 of 5 of those with unlikely asthma. In the monitoring group, 11 encounters resulted in treatment escalation (demonstrating suboptimal control), and 8 resulted in no change to treatment (good control). Six of 11 of those with suboptimal control had abnormalities in ≥3 IOS parameters, with R5 and R5-20 most frequently affected. Only 1 of 8 of those with good control had abnormalities in ≥3 IOS parameters. IOS can be used as an alternative to conventional lung function testing to support the diagnosis and monitoring of asthma when forced expiratory manoeuvres are contraindicated. Larger studies are required to establish severity and treatment escalation thresholds and provide clearer comparisons with spirometry values.
脉冲振荡法系统（IOS）为用力呼气动作禁忌的患者提供了一种替代的肺功能测试方法，例如患有遗传性血管结缔组织疾病的患者。在此，我们通过一个临床病例系列和文献综述来研究IOS在这类患者哮喘诊断和监测中的作用。该临床病例系列包含来自12例遗传性结缔组织疾病患者的数据，共32次临床诊疗。其中，11次诊疗用于哮喘诊断，21次用于哮喘监测。每次诊疗时均评估症状、呼出一氧化氮（FeNO）和IOS。在该临床病例系列中，6例可能患有哮喘的患者（经医生评估和呼出一氧化氮检测确定）中有5例IOS参数异常，而5例不太可能患有哮喘的患者中无一例异常。在监测组中，11次诊疗导致治疗升级（表明控制不佳），8次诊疗治疗无变化（控制良好）。控制不佳的11例患者中有6例≥3项IOS参数异常，其中R5和R5-20受影响最频繁。控制良好的8例患者中只有1例≥3项IOS参数异常。当用力呼气动作禁忌时，IOS可作为传统肺功能测试的替代方法，以支持哮喘的诊断和监测。需要开展更大规模的研究来确定严重程度和治疗升级阈值，并与肺活量测定值进行更清晰的比较。
