Glottal aperture and buccal airflow leaks critically affect forced oscillometry measurements

Andras Bikov, Neil B. Pride, Michael D. Goldman, James H. Hull, I. Horváth, Peter J. Barnes, Omar S. Usmani, Paolo Paredi

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: The forced oscillation technique (FOT) measures respiratory resistance and reactance; however, the upper airways may affect the results. We quantified the impact of glottal aperture and buccal air leaks. METHODS: In the glottal aperture study (1) 10 healthy subjects (aged 34 ± 2 years) performed a total lung capacity maneuver followed by 10-s breath-hold with and without total glottal closure and (2) the effects of humming (incomplete glottal narrowing) on FOT measurements were studied in six healthy subjects. Glottal narrowing was confirmed by direct rhinolaryngoscopy. In the air leak study, holes of increasing diameter (3.5, 6.0, and 8.5 mm) were made to the breathing filters. Eleven healthy subjects (aged 33 ± 2 years) and five patients with COPD (aged 69 ± 3 years) performed baseline FOT measurements with the three modified filters. RESULTS: Narrow glottal apertures and humming generated whole-breath resistance at 5 Hz (R5) peaks, increased R5 (1.49 ± 0.37 kPa/L/s vs 0.34 ± 0.01 kPa/L/s, P <.001), and decreased whole-breath reactance at 5 Hz (X5) values (-2.10 ± 0.51 kPa/L/s vs-0.09 ± 0.01 kPa/L/s, P <.001). The frequency dependency of resistance was increased. Holes in the breathing filters produced indentations on the breathing trace. Even the smaller holes reduced R5 in healthy subjects (0.33 ± 0.02 to 0.24 ± 0.02 kPa/L/s, P <.01) and patients with COPD (0.50 ± 0.04 to 0.41 ± 0.04 kPa/L/s, P <.05), whereas X5 became less negative (from-0.09 ± 0.01 to-0.05 ± 0.01 in healthy subjects, P <.01; from -0.22 ± 0.06 to - 0.11 ± 0.03 kPa/L/s in patients with COPD, P <.05). CONCLUSIONS: Visual inspection of the data is required to exclude glottal narrowing and buccal air leaks identified as R5 peaks and volume indentations, respectively, because these significantly affect FOT measurements.

Original languageEnglish
Pages (from-to)731-738
Number of pages8
JournalChest
Volume148
Issue number3
DOIs
Publication statusPublished - Sep 1 2015

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Oscillometry
Cheek
Healthy Volunteers
Chronic Obstructive Pulmonary Disease
Respiration
Air
Total Lung Capacity

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Bikov, A., Pride, N. B., Goldman, M. D., Hull, J. H., Horváth, I., Barnes, P. J., ... Paredi, P. (2015). Glottal aperture and buccal airflow leaks critically affect forced oscillometry measurements. Chest, 148(3), 731-738. https://doi.org/10.1378/chest.14-2644

Glottal aperture and buccal airflow leaks critically affect forced oscillometry measurements. / Bikov, Andras; Pride, Neil B.; Goldman, Michael D.; Hull, James H.; Horváth, I.; Barnes, Peter J.; Usmani, Omar S.; Paredi, Paolo.

In: Chest, Vol. 148, No. 3, 01.09.2015, p. 731-738.

Research output: Contribution to journalArticle

Bikov, A, Pride, NB, Goldman, MD, Hull, JH, Horváth, I, Barnes, PJ, Usmani, OS & Paredi, P 2015, 'Glottal aperture and buccal airflow leaks critically affect forced oscillometry measurements', Chest, vol. 148, no. 3, pp. 731-738. https://doi.org/10.1378/chest.14-2644
Bikov, Andras ; Pride, Neil B. ; Goldman, Michael D. ; Hull, James H. ; Horváth, I. ; Barnes, Peter J. ; Usmani, Omar S. ; Paredi, Paolo. / Glottal aperture and buccal airflow leaks critically affect forced oscillometry measurements. In: Chest. 2015 ; Vol. 148, No. 3. pp. 731-738.
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title = "Glottal aperture and buccal airflow leaks critically affect forced oscillometry measurements",
abstract = "BACKGROUND: The forced oscillation technique (FOT) measures respiratory resistance and reactance; however, the upper airways may affect the results. We quantified the impact of glottal aperture and buccal air leaks. METHODS: In the glottal aperture study (1) 10 healthy subjects (aged 34 ± 2 years) performed a total lung capacity maneuver followed by 10-s breath-hold with and without total glottal closure and (2) the effects of humming (incomplete glottal narrowing) on FOT measurements were studied in six healthy subjects. Glottal narrowing was confirmed by direct rhinolaryngoscopy. In the air leak study, holes of increasing diameter (3.5, 6.0, and 8.5 mm) were made to the breathing filters. Eleven healthy subjects (aged 33 ± 2 years) and five patients with COPD (aged 69 ± 3 years) performed baseline FOT measurements with the three modified filters. RESULTS: Narrow glottal apertures and humming generated whole-breath resistance at 5 Hz (R5) peaks, increased R5 (1.49 ± 0.37 kPa/L/s vs 0.34 ± 0.01 kPa/L/s, P <.001), and decreased whole-breath reactance at 5 Hz (X5) values (-2.10 ± 0.51 kPa/L/s vs-0.09 ± 0.01 kPa/L/s, P <.001). The frequency dependency of resistance was increased. Holes in the breathing filters produced indentations on the breathing trace. Even the smaller holes reduced R5 in healthy subjects (0.33 ± 0.02 to 0.24 ± 0.02 kPa/L/s, P <.01) and patients with COPD (0.50 ± 0.04 to 0.41 ± 0.04 kPa/L/s, P <.05), whereas X5 became less negative (from-0.09 ± 0.01 to-0.05 ± 0.01 in healthy subjects, P <.01; from -0.22 ± 0.06 to - 0.11 ± 0.03 kPa/L/s in patients with COPD, P <.05). CONCLUSIONS: Visual inspection of the data is required to exclude glottal narrowing and buccal air leaks identified as R5 peaks and volume indentations, respectively, because these significantly affect FOT measurements.",
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AU - Pride, Neil B.

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AU - Horváth, I.

AU - Barnes, Peter J.

AU - Usmani, Omar S.

AU - Paredi, Paolo

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N2 - BACKGROUND: The forced oscillation technique (FOT) measures respiratory resistance and reactance; however, the upper airways may affect the results. We quantified the impact of glottal aperture and buccal air leaks. METHODS: In the glottal aperture study (1) 10 healthy subjects (aged 34 ± 2 years) performed a total lung capacity maneuver followed by 10-s breath-hold with and without total glottal closure and (2) the effects of humming (incomplete glottal narrowing) on FOT measurements were studied in six healthy subjects. Glottal narrowing was confirmed by direct rhinolaryngoscopy. In the air leak study, holes of increasing diameter (3.5, 6.0, and 8.5 mm) were made to the breathing filters. Eleven healthy subjects (aged 33 ± 2 years) and five patients with COPD (aged 69 ± 3 years) performed baseline FOT measurements with the three modified filters. RESULTS: Narrow glottal apertures and humming generated whole-breath resistance at 5 Hz (R5) peaks, increased R5 (1.49 ± 0.37 kPa/L/s vs 0.34 ± 0.01 kPa/L/s, P <.001), and decreased whole-breath reactance at 5 Hz (X5) values (-2.10 ± 0.51 kPa/L/s vs-0.09 ± 0.01 kPa/L/s, P <.001). The frequency dependency of resistance was increased. Holes in the breathing filters produced indentations on the breathing trace. Even the smaller holes reduced R5 in healthy subjects (0.33 ± 0.02 to 0.24 ± 0.02 kPa/L/s, P <.01) and patients with COPD (0.50 ± 0.04 to 0.41 ± 0.04 kPa/L/s, P <.05), whereas X5 became less negative (from-0.09 ± 0.01 to-0.05 ± 0.01 in healthy subjects, P <.01; from -0.22 ± 0.06 to - 0.11 ± 0.03 kPa/L/s in patients with COPD, P <.05). CONCLUSIONS: Visual inspection of the data is required to exclude glottal narrowing and buccal air leaks identified as R5 peaks and volume indentations, respectively, because these significantly affect FOT measurements.

AB - BACKGROUND: The forced oscillation technique (FOT) measures respiratory resistance and reactance; however, the upper airways may affect the results. We quantified the impact of glottal aperture and buccal air leaks. METHODS: In the glottal aperture study (1) 10 healthy subjects (aged 34 ± 2 years) performed a total lung capacity maneuver followed by 10-s breath-hold with and without total glottal closure and (2) the effects of humming (incomplete glottal narrowing) on FOT measurements were studied in six healthy subjects. Glottal narrowing was confirmed by direct rhinolaryngoscopy. In the air leak study, holes of increasing diameter (3.5, 6.0, and 8.5 mm) were made to the breathing filters. Eleven healthy subjects (aged 33 ± 2 years) and five patients with COPD (aged 69 ± 3 years) performed baseline FOT measurements with the three modified filters. RESULTS: Narrow glottal apertures and humming generated whole-breath resistance at 5 Hz (R5) peaks, increased R5 (1.49 ± 0.37 kPa/L/s vs 0.34 ± 0.01 kPa/L/s, P <.001), and decreased whole-breath reactance at 5 Hz (X5) values (-2.10 ± 0.51 kPa/L/s vs-0.09 ± 0.01 kPa/L/s, P <.001). The frequency dependency of resistance was increased. Holes in the breathing filters produced indentations on the breathing trace. Even the smaller holes reduced R5 in healthy subjects (0.33 ± 0.02 to 0.24 ± 0.02 kPa/L/s, P <.01) and patients with COPD (0.50 ± 0.04 to 0.41 ± 0.04 kPa/L/s, P <.05), whereas X5 became less negative (from-0.09 ± 0.01 to-0.05 ± 0.01 in healthy subjects, P <.01; from -0.22 ± 0.06 to - 0.11 ± 0.03 kPa/L/s in patients with COPD, P <.05). CONCLUSIONS: Visual inspection of the data is required to exclude glottal narrowing and buccal air leaks identified as R5 peaks and volume indentations, respectively, because these significantly affect FOT measurements.

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