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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 69  |  Issue : 1  |  Page : 64-71

Satisfaction and clinical application value of impulse oscillometry in geriatric patients with chronic obstructive pulmonary disease in comparison with non geriatric patients


Department of Chest, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Date of Submission02-Mar-2019
Date of Acceptance20-Jun-2019
Date of Web Publication31-Jan-2020

Correspondence Address:
MD Dina Ruby Sultan
Lecturer of Chest Medicine in Faculty of Medicine in Ain Shams University, Ramsis Street, Abbasseya, Beside El Nour Mosque, Cairo, 11759
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ejcdt.ejcdt_56_19

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  Abstract 


Context Chronic obstructive pulmonary disease (COPD) diagnosis depends on spirometry, which is an effort-dependent test and needs cooperative patients, whereas impulse oscillometry (IOS) requires less effort and cooperation, which are advantageous for geriatric patients. However, the clinical value of IOS in geriatric patients remains under study.
Aims To investigate the satisfaction and clinical value of IOS in geriatric patients with COPD in comparison with nongeriatric patients.
Patients and methods A total of 100 individuals were prospectively included in this study: 50 patients with COPD (25 nongeriatric and 25 geriatric) and 50 healthy (25 nongeriatric and 25 geriatric) as control. Both groups underwent IOS and spirometry examination, and a short questionnaire evaluated satisfaction of patients with COPD with spirometry and IOS.
Statistical analysis Statistical Package for the Social Science, version 20 was used to analyze the data.
Results (a) Geriatric patients with COPD had an increase in Fres and respiratory resistance (R5, R20, and R5–R20) and a decrease in respiratory reactance (X5) in comparison with healthy geriatric patients. (b) The IOS parameters, in particular R5–R20, correlated well with forced expiratory volume in 1 s (FEV1) in nonadvanced elderly patients with COPD. (c) The sensitivities of the spirometric measures [FEV1/force vital capacity ratio, force vital capacity (% predicted value), and FEV1 (% predicated value)] and that of IOS parameters (R5 and R20) are 100% in geriatric patients with COPD. (d) Better satisfaction score for IOS in comparison with spirometry was found in advanced elderly patients with COPD.
Conclusion IOS had a good clinical value in COPD diagnosis, mainly in elderly, who cannot undergo spirometry.

Keywords: chronic obstructive pulmonary disease, geriatric, impulse oscillometry, spirometry


How to cite this article:
Sultan DR. Satisfaction and clinical application value of impulse oscillometry in geriatric patients with chronic obstructive pulmonary disease in comparison with non geriatric patients. Egypt J Chest Dis Tuberc 2020;69:64-71

How to cite this URL:
Sultan DR. Satisfaction and clinical application value of impulse oscillometry in geriatric patients with chronic obstructive pulmonary disease in comparison with non geriatric patients. Egypt J Chest Dis Tuberc [serial online] 2020 [cited 2022 May 19];69:64-71. Available from: http://www.ejcdt.eg.net/text.asp?2020/69/1/64/277305




  Introduction Top


Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation, which is partly reversible [1], and nowadays, it the fourth leading cause of death, and it will become the third leading cause of death by 2030 as WHO predicts [2].

Currently, spirometry is the gold standard to diagnose airway limitations [3]. The Global Initiative for Chronic Obstructive Lung Disease states diagnosis of obstructive lung disease when the postbronchodilator ratio of forced expiratory volume in 1 s (FEV1) to force vital capacity (FVC) is 70% and use FEV1 percentage of the predicted value for classification of airflow limitation severity [2].

However, clinical application of pulmonary function tests has several limitations and are particularly challenging in elderly patients, those who have cognitive impairment, poor motor coordination, and breathing difficulties [4], as the forceful maneuvers in spirometry require good patient cooperation and the examinations take at least 30 min, which are not tolerated by elderly or critically ill patients, and they produce false-positive results owing to repeated forced breathing causing change in bronchomotor tone, especially in elderly [3]. Therefore, it is necessary to have other modalities to assess lung function in elderly patients with COPD, who cannot undergo spirometry, as 23% of global disease burden is associated with people aged more than or equal to60 years [5].

The advantages of impulse oscillometry (IOS) are that it is a noninvasive, effort-independent method that can be carried out easily in those who are unable to perform spirometry. It is also more sensitive than spirometry and can detect early changes in lung function and differentiate large airway obstruction from small airway obstruction [6].

The application value of IOS in geriatric patients, especially those with advanced aged has not been studied enough [3]. Thus, this study aimed to study IOS satisfaction and clinical application in geriatric patients with COPD in comparison with nongeriatric patients.


  Patients and methods Top


A total of 100 patients (50 patients with stable COPD and 50 healthy individuals as control) were prospectively included in this study during the period from September 2018 to February 2019 in Chest Department in El-Demerdash Hospital. After obtaining the ethical approval from the ethical committee of chest department of Ain Shams University and verbal informed consent was obtained from all participants.

According to the Global Initiative for Chronic Obstructive Lung Disease criteria, COPD was diagnosed depending on COPD risk factors, symptoms, and postbronchodilator FEV1/FVC less than or equal to 70%. Exclusion criteria were age less than 40 years; patients with other obvious respiratory diseases, severe comorbid diseases, and exacerbation in the past 3 months; and patients unable to undergo pulmonary function test. They were randomly selected from patients admitted to outpatient clinic or pulmonary function laboratory in El-Demerdash Hospital.

However, healthy geriatric and nongeriatric groups were randomly selected from among the visitors or companions of the patients in the same outpatient clinics or pulmonary function unit at the participating center. Individuals with abnormal pulmonary function, with chronic lung and heart diseases, and with recent respiratory tract infection were excluded from the control group.

Study design

The present study was conducted on 100 individuals who were classified into two groups:

(a) Group A included 50 nongeriatric individuals, defined as participants aged 40–65 years, and they were divided into 25 patients with stable COPD and 25 healthy volunteers as a control group.

(b) Group B included 50 geriatric individuals, defined as participants aged more than 65 years, and they were subdivided into two groups: (i) the nonadvanced elderly aged 65–80 years, and it included 15 patients with stable COPD and 15 healthy volunteers as a control group, and (ii) the advanced elderly group aged above 80 years, and it included 10 patients with stable COPD and ten healthy volunteers as a control group.

Data collection

Baseline demographic data were collected, including age, smoking status, and full medical history, and then both nongeriatric patients with COPD and geriatric patients with COPD were asked a simple questionnaire about their satisfaction regarding spirometry and IOS.

The questionnaire consisted of four items, with a Likert scale (question 1: this test was hard to do, question 2: this test made me cough, question 3: I had trouble breathing during this test, and question 4: I would have trouble doing this test again), and it was translated to Arabic and asked by a pulmonologist after doing each test. The score was assessed as follows (each question was answered on a five-degree scale): 5=strongly agree, 4=agree, 3=neutral, 2=disagree, and 1=strongly disagree. The lower score indicates higher satisfaction [7].

Both IOS and spirometry were done by Master Screen IOS with a built-in program (Masterscreen IOS 2011; Erich Jaeger GmbH, Strabheimer St. Friedberg (Hessen), Germany) present in pulmonary function Laboratory in El-Demerdash Hospital, Chest Department, according to the main principles of the European Respiratory Society Task Force recommendations [8], and oral informed consent was received from both groups included in the study.

Measurements

Spirometric measurements

The test was started 15 min after inhalation of salbutamol 400 mg following the European Respiratory Society/American Thoracic Society criteria [9]. The spirometry parameters measured were FVC, FEV1, and FEV1/FVC. Obstructive pattern is considered as FEV1/FVC ratio below 0.7, FEV1 below 80% predicted, and FVC can be normal or reduced [10]. Diagnosis of small airway flow limitation (airway resistance) by spirometry was as follows: forced expiratory flow 25–75 or forced expiratory flow 50 below 65% of predicted [11].

Impulse oscillometry measurements

The procedure was conducted with patients in sitting position with an airway clipped to the nose clip [12]. Participants were required to keep the airway open with their teeth clenched on the mouthpiece, the tongue positioned in the mouth of the device, and lips pursed around the device, so that the breathing channel remained patent and to prevent any air leak.

Both hands were used to suppress the cheek to minimize the vibration of the cheeks [13].

The actual values of respiratory resistance at R5 and R20 and distal capacitive reactance at X5 were recorded. Criteria for diagnosing ventilatory defect according to IOS were according to Al-Mutairi et al. [14].

Statistical analysis

Statistical Package for the Social Science (SPSS, version 20; IBM, Armonk, New York) was used to analyze the data. Suitable analysis was done according to the type of data obtained for each parameter. Description of quantitative variables as mean, SD, and range. Independent test was used to assess the statistical significance of the difference between two study group means. Unpaired t test was used to compare quantitative variables, in parametric data (SD<50% mean). χ2 test was used to examine the relationship between two qualitative variables between groups. Correlation analysis (using Pearson’s method) was used to assess the strength of association between two quantitative variables positively or inversely. The correlation coefficient, denoted symbolically as r, defines the strength and direction of the linear relationship between two variables. Sensitivity was the ability of the test to detect +ve cases. Specificity was ability of the test to exclude negative cases. The level of significance (P value) was set as follows: P value more than 0.05 was considered a nonsignificant statistical result (NS), P value less than 0.05 was considered a statistically significant result (S), and P value less than 0.01 was considered a highly statistically significant result (HS).


  Results Top


A total of 50 patients with COPD (25 nongeriatric and 25 geriatric) and 50 healthy controls (25 nongeriatric and 25 geriatric) were included in the study, and in ([Table 1],[Table 2],[Table 3]), their demographic data are mentioned.
Table 1 Comparison between nongeriatric patients with chronic obstructive pulmonary disease and healthy controls regarding demographic data

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Table 2 Comparison between nonadvanced elderly patients with chronic obstructive pulmonary disease and healthy controls regarding demographic data

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Table 3 Comparison between advanced elderly patients with chronic obstructive pulmonary disease and healthy controls regarding demographic data

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In ([Table 4],[Table 5],[Table 6]), there was a significant increase regarding spirometry parameters (FEV1/FVC%, FEV1, and FVC) in both nongeriatric patients with COPD and geriatric patients with COPD, in comparison with healthy controls.
Table 4 Comparison between nongeriatric patients with chronic obstructive pulmonary disease and healthy controls regarding spirometry

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Table 5 Comparison between nonadvanced elderly patients with chronic obstructive pulmonary disease and healthy controls regarding spirometry

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Table 6 Comparison between advanced elderly patients with chronic obstructive pulmonary disease and healthy controls regarding spirometry

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In ([Table 7],[Table 8],[Table 9]), there was a significant increase regarding IOS parameters (R5–R20, R5, R20, and Fres) and a decrease in X5 in both nongeriatric patients with COPD and geriatric patients with COPD in comparison with the healthy control.
Table 7 Comparison between nongeriatric patients with chronic obstructive pulmonary disease and healthy controls regarding impulse oscillometry

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Table 8 Comparison between non-advanced elderly patients with chronic obstructive pulmonary disease and healthy controls regarding impulse oscillometry

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Table 9 Comparison between advanced elderly patients with chronic obstructive pulmonary disease and healthy controls regarding impulse oscillometry

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In ([Table 10]), in nongeriatric patients with COPD, Fres was negatively correlated with FVC and FEV1, X5 was positively correlated with FEV1 and FEV1/FVC (%), R5 was negatively correlated with FEV1, and R5–R20 was negatively correlated with FEV1 and FEV1/FVC.
Table 10 Correlation between spirometry and impulse oscillometry in nongeriatric patients with chronic obstructive pulmonary disease

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However, in ([Table 11]), in nonadvanced elderly patients with COPD, Fres was negatively correlated with FVC, FEV1, and FEV1/FVC, and R5 and R5–R20 both were negatively correlated with FEV1 and FEV1/FVC.
Table 11 Correlation between spirometry and impulse oscillometry in nonadvanced elderly patients with chronic obstructive pulmonary disease

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In ([Table 12]), in advanced elderly patients with COPD, only X5 was positively correlated with FVC.
Table 12 Correlation between spirometry and impulse oscillometry in advanced elderly patients with chronic obstructive pulmonary disease

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In ([Table 13] and [Table 14]), the sensitivity of the spirometric measures [FEV1/FVC ratio, FVC (% predicted value), FEV1 (% predicated value), and that of IOS parameters (R5, R20) in patients with COPD is shown.
Table 13 Sensitivity and specificity of impulse oscillometry parameters and spirometry parameters in nongeriatric patients with chronic obstructive pulmonary disease

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Table 14 Sensitivity and specificity of impulse oscillometry parameters and spirometry parameters in geriatric patients with chronic obstructive pulmonary disease

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In ([Table 15]), there was better satisfaction for IOS as compared with spirometry (average mean score of 4 for IOS compared with 20 for spirometry in advanced elderly patients with COPD), indicating greater ease of performing test of IOS especially in advanced elderly patients with COPD.
Table 15 Comparison of satisfaction score for impulse oscillometry and spirometry between nongeriatric and geriatric patients with chronic obstructive pulmonary disease

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  Discussion Top


Pulmonary function tests are a group of laboratory tests used for the evaluation of the respiratory functions to assess the physical fitness and working ability of individuals. Spirometry measures how an individual inhales or exhales volumes of air as a function of time; it measures all lung volumes and capacities except total lung capacity (TLC), functional residual capacity (FRC), and residual volume (RV) [15].

However, IOS is a noninvasive and effort-independent test that characterizes the respiratory system’s mechanical impedance. The advantages of the IOS are being rapid and needs only passive cooperation, which makes it easy for children and for conditions in which quiet breathing is preferred instead of forced expiratory maneuvers [16].

Many studies have shown the application of IOS in COPD, including distinguishing asthma from COPD, monitoring efficacy of drug and airway resistance measurement [17]. This study compared the spirometry and IOS parameters to explore the value of IOS in COPD, in particular in elderly, and we also compared the patient satisfaction for spirometry and IOS.

In this study, FVC, FEV1, and FEV1/FVC decreased in patients with COPD (nongeriatric and geriatric groups) compared with healthy controls, which mean limitations of airflow. Among the IOS parameters, Fres, R5, R20, and R5–R20 increased significantly in both nongeriatric and geriatric groups, whereas X5 (the lung compliance index) was significantly decreased in this study, which was consistent with the decrease in lung compliance in patients with COPD, and all the previous findings were agreeable with other research results [3],[14],[18],[19].

There was a good correlation between IOS and spirometry in all patients with COPD. R5–R20 had a good correlation with FEV1 and FEV1/FVC (r=−0.599, −0.571) in nongeriatric patients with COPD and also in nonadvanced elderly group (r=−0.827, r=−0.784), but it did not correlate with advanced elderly group, and this may be because of the small sample size. Piorunek et al. [20] showed that FEV1% predicted correlates with IOS parameters, and their results are the same as the results of this study but that was not observed in advanced elderly, which may be owing to the small sample size.Gong et al. [21] also showed that the IOS parameters (Fres, R5, and X5) are most closely associated with the spirometry parameters in patients with COPD, and these results are agreeable with our results.

Some studies [22],[23] have shown that Fres strongly correlated with FEV1 and FEV1/FVC, and this was compatible with our results in geriatric (nonadvanced age elderly group), as there was correlation of Fres with FEV1 and FEV1/FVC (r=−0.843 and r=−0.714, respectively) and also in nongeriatric, as there was a correlation of Fres with FEV1 and FEV1/FVC (r=−0.564 and r=−0.329, respectively).

Our results showed that the sensitivity of FVC (% pred.) and FEV1(% pred.) in both nongeriatric and geriatric patients with COPD was 100% and sensitivity of FVC/FEV1 ratio was 95.65% in nongeriatric and 100% in geriatric, and the sensitivity of the IOS parameters R5 and R20 was 100% in both nongeriatric patients with COPD and geriatric patients with COPD. Guo et al. [24] showed that the IOS sensitivity to detect COPD in elderly patients was 76% for IOS and 78% for spirometry.

The satisfaction score was the best for IOS than spirometry in advanced elderly, then nonadvanced elderly, and then nongeriatric group, and this can be explained by that IOS is a simple, force-independent procedure for elderly group.

In summary, there was a well correlation between spirometry and IOS parameters in both nongeriatric patients with COPD and geriatric patients with COPD, but IOS is not widely used in clinical practice, although its simple and force independent; thus, IOS can be an alternative modality for spirometry in elderly patients who cannot perform spirometry.


  Conclusion Top


IOS had a good clinical value in COPD diagnosis, mainly in elderly, who cannot perform spirometry.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12], [Table 13], [Table 14], [Table 15]



 

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