Abstract
Spirometry is considered the primary method to detect the air flow limitation associated with obstructive lung disease. However, air flow limitation is the end-result of many factors that contribute to obstructive lung disease. One of these factors is increased airway resistance. Airway resistance is traditionally measured by relating air flow and driving pressure using body plethysmography, thus deriving airway resistance (Raw), specific airway resistance (sRaw), and specific airway conductance (sGaw). Other methods to measure airway resistance include the forced oscillation technique (FOT), which allows calculation of respiratory system resistance (RRS) and reactance (XRS), and the interrupter technique, which allows calculation of interrupter resistance (Rint). An advantage of these other methods is that they may be easier to perform than spirometry, making them particularly suited to patients who cannot perform spirometry, such as young children, patients with neuromuscular disorders, or patients on mechanical ventilation. Since spirometry also requires a deep inhalation, which can alter airway resistance, these alternative methods may provide more sensitive measures of airway resistance. Furthermore, the FOT provides unique information about lung mechanics that is not available from analysis using spirometry, body plethysmography, or the interrupter technique. However, it is unclear whether any of these measures of airway resistance contribute clinically important information to the traditional measures derived from spirometry (FEV1, FVC, and FEV1/FVC). The purpose of this paper is to review the physiology and methodology of these measures of airway resistance, and then focus on their clinical utility in relation to each other and to spirometry.
Footnotes
- Correspondence: David A Kaminsky MD, Pulmonary Disease and Critical Care Medicine, University of Vermont College of Medicine, Given D-213, 89 Beaumont Avenue, Burlington VT 05405. E-mail: david.kaminsky{at}uvm.edu.
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Dr Kaminsky presented a version of this paper at the 48th Respiratory Care Journal Conference, “Pulmonary Function Testing,” held March 25–27, 2011, in Tampa, Florida.
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Dr Kaminsky has disclosed relationships with Medical Graphics and Merck.
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↵* Kenneth W Rundell PhD, Pharmaxis, Exton, Pennsylvania.
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↵† Dean R Hess PhD RRT FAARC, Respiratory Care Services, Massachusetts General Hospital, Boston, Massachusetts, and Editor in Chief, Respiratory Care.
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