A retrospective analysis of usefulness of impulse oscillometry system in the treatment of asthma

Hiroyuki Sugawara,Hirofumi Chiba,Kazunori Tsunematsu,Atsushi Saito,Saori Yokoyama,Hiroki Takahashi

doi:10.1186/s12931-020-01494-x

Abstract

BackgroundBronchial asthma (BA) has different phenotypes, and it requires a clinically effective subtype classification system. The impulse oscillometry system (IOS) is an emerging technique device used in respiratory functional tests. However, its efficacy has not been validated. Therefore, this study aimed to assess the relationship between BA and the IOS parameters, and the difference in the therapeutic effects of inhaled corticosteroids (ICSs) among the subtype classifications was evaluated using the IOS.MethodsOf the 245 patients with bronchial asthma who were screened, 108 were enrolled in this study. These patients were divided based on three subtypes according to the IOS result as follows: central predominant type (n = 34), peripheral predominant type (n = 58), and resistless type (n = 16). Then, the following ICSs were randomly prescribed in daily medical care: coarse-particle ICS (fluticasone propionate [FP]), fine-particle ICS (mometasone furoate [MF]), and moderate-particle ICS (budesonide [BUD]). The treatment effects were assessed using the Asthma Health Questionnaire (AHQ) and the Asthma Control Test (ACT) and were compared among the three subtypes.ResultsIn the central predominant type, the AHQ score of the MF group was significantly higher than that of the FP group (15.4 vs. 3.6, p < 0.01) and the BUD group (15.4 vs. 8.8, p < 0.05); the ACT score of the FP group was significantly higher than that of the MF and BUD groups (24.3 vs. 21.7, 22.3, respectively, p < 0.05) at 4 weeks after treatment. In the peripheral predominant type, the AHQ score of the FP group was significantly higher than that of the MF group (14.1 vs. 3.4, p < 0.05); the ACT score of the FP group was lower than that of the MF and BUD groups (22.8 vs. 24.6, 24.4, respectively, p < 0.01) at 4 weeks after treatment.ConclusionsAn association was observed between IOS subtype classification and ICS particle size in terms of therapeutic efficacy in BA. This result indicates that the IOS could be an effective tool in the selection of ICS and the evaluation of the BA phenotype.

Highlights

Bronchial asthma (BA) has different phenotypes, and it requires a clinically effective subtype classification system
We examined the effect of dry powder inhaler (DPI) and excluded pressurized metered dose inhaler device because pMDI and DPI are completely different in terms of the inhalation procedure
The current study showed that the differences in asthma phenotypes based on the impulse oscillometry system (IOS) parameters might be correlated to the efficacy of Inhaled corticosteroid (ICS)

Summary

Introduction

Bronchial asthma (BA) has different phenotypes, and it requires a clinically effective subtype classification system. The impulse oscillometry system (IOS) can be used to assess the parameters of large and small airway functions It is an emerging technique and noninvasive device used for the assessment of respiratory function using the forced oscillation technique, which was first described by Dubois et al [6,7,8]. This device uses sound waves to rapidly detect airway changes. Our recent study revealed that a relationship exists between the therapeutic effect based on the particle size of ICSs and the parameters of IOS in CVA patients [11]. Several studies have assessed the clinical application of the IOS for the treatment of BA [15, 16]

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