Chest

Chest

Volume 128, Issue 3, September 2005, Pages 1266-1273
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Clinical Investigations
Impulse Oscillometry: Reference Values in Children 100 to 150 cm in Height and 3 to 10 Years of Age

https://doi.org/10.1378/chest.128.3.1266Get rights and content

Objectives

To generate reference equations in North American children to be used for assessing respiratory function through the forced oscillation (Rfo) technique, and to determine the changes in oscillatory resistance, reactance, and resonant frequency (Fres) in relation to age, body height, and weight.

Design/setting

A prospective cross-sectional study performed on healthy children selected according to strict criteria of American Thoracic Society and European Respiratory Society recommendations.

Measurements

Triplicate measures were obtained of resistance and reactance at 5, 10, 15, 20, 25, and 35 Hz as well as Fres through the impulse oscillometer (MasterScreen IOS; Jaeger/Toennies; Höchberg, Germany). Two hundred twenty-two white children—normally distributed within the 3-to 10-year age range and 100 to 150 cm in height—were recruited in Montreal, Canada. We used regression analysis to generate multiple predictive equations separately per gender and frequency on age, height, and body weight.

Results

Stepwise multiple regression in both natural and logarithmic forms for height, weight, age, and gender showed that standing height was the only significant predictor for all variables. Minimal variability was noted in each subject among the triplicate measurements (p = 0.68 to 0.96). Coherence was > 0.9 at all oscillating frequencies except 5 Hz (< 0.72), with tendencies to lower values in young children.

Conclusions

Resistance and Fres decrease by height, but also by age; and reactance increases. As opposed to our past experience with spirometry in compatible age groups, the Rfo technique was well accepted by preschool children.

Section snippets

Materials and Methods

We conducted a cross-sectional study of patients and/or accompanying siblings, aged 3 to 10 years, who presented at the Ophthalmology or General Surgery Clinics of the Montreal Children Hospital. Patients were accrued over two consecutive summers, at a time when viral infections were minimal. The protocol was reviewed and approved by the Institutional Review Board, and informed consent for participation was obtained for each subject from parents or guardians.

Study Subjects

In accordance with the ATS and ERS recommendations for the selection of healthy subjects,14, 15 exclusions occurred for the following reasons: (1) personal or family history (including parents and siblings) of wheezing or asthma18, 19; (2) personal history of allergic rhinitis20, 21 or eczema22, 23; (3) low birth weight (< 1,500 g)24, 25; premature birth (< 37 weeks), neonatal mechanical ventilation, or bronchopulmonary dysplasia26, 27; (4) passive smoking in the house28, 29; (5) obesity

Procedures

Assessment of respiratory function through the Rfo technique is used on a daily basis in our clinic. In 2003 only, of a total of 3,997 children evaluated for pulmonary function, the Rfo technique was employed in 761 children, the majority of whom were of preschool age. However, for the purposes of the current study, potentially eligible subjects visiting the Ophthalmology or General Surgery Clinics were approached and initially screened by questionnaire. The 12-item questionnaire, extracted

Statistical Analysis

Stepwise multiple regressions were carried out to identify the best predictors of respiratory resistance parameters using height, weight, gender, age, and ethnicity as potential determinants. Log-transformation of variables were also tested for the best-fitting function using the method of least squares. The fifth and ninety-fifth percentiles were calculated using parametric methods. Analysis of variance was used to test the difference of triplicate trials recorded in each subject. Pearson R

Results

During the study period, 1,127 children were approached for the study. Of these, 247 children (22%) were not involved in the study because of parental refusal, and another 65 children (5.5%) were excluded because parents were not available, or because of language barrier. Of the remaining 715 children, 72 children (6.3%) were not evaluated because of concurrent enrolment of another candidate or they were ready to be seen by the treating physician for their clinical disease. Thus, 643 children

Discussion

In this group of 222 healthy children, oscillatory resistance (Rfo) was closely related to height, with 56 to 66% of the variance explained solely by the measurement of stature. Log-transformation of height and resistance did not improve this relationship. Furthermore, standing height correlated at least as well as age with resistance (Table 2). Moreover, consideration of gender or race as individual classification factors did not improve prediction in multiple regression analysis. This study

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    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

    Dr. Hatzakis was supported by a Chercheur Boursier Career Award from the Fonds de la Recherche en Santé du Québec.

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    Copyright © 2005 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.