Evaluation of the interrupter technique for measuring change in airway resistance in 5‐year‐old asthmatic children

Abstract

The interrupter technique is a noninvasive method for measuring airway resistance during quiet breathing which requires minimal subject cooperation. It, therefore, has enormous potential for use in young children unable to cooperate with conventional lung function tests. We evaluated the interrupter technique during bronchial challenge with methacholine administered by the tidal breathing method in 10 5-year-old asthmatic children. The mouth pressure/time [P mo(t)] curve obtained following brief airflow interruption during the expiratory phase of quiet breathing was analyzed to determine the interrupter resistance (Rint) using four different methods: RintC, a smooth curve fit with back-extrapolation; RintEO, calculated from the pressure change after the postinterruption oscillations had decayed (end-oscillation); RintL, two-point linear fit with back-extrapolation; and RintEI, calculated from the pressure change at the end of the period of interruption. The four Rint methods were compared for repeatability and sensitivity with the direct measurement of resistance by the forced oscillation technique (Rrs), and with an independent method of measuring the response to challenge, utilizing the change in transcutaneous oxygen tension (PtcO2). The sensitivity of the methods was defined by a sensitivity index (SI), the change after challenge expressed in multiples of the baseline standard deviation. The PtcO2 method had the lowest variability and was by far the most sensitive method (geometric mean SI 18.9), at least 1 doubling concentration more sensitive than the other techniques in every subject (P < 0.05). RintL was more sensitive than the other interrupter methods (geometric mean SI: RintL 4.2; RintC 1.0; RintEO 2.7; RintEI 3.1; P < 0.05) and similar in sensitivity to Rrs (geometric mean SI 4.6) in 7 out of 10 children in which this could be measured. We conclude that the interrupter method provides a simpler method than the oscillation technique for assessing airway obstruction in this age group.