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Henry C, Boucher M, Boulay M, Côté A, Bossé Y. Oscillometry with or without spirometry for methacholine testing. Physiol Rep 2025; 13:e70387. [PMID: 40405531 PMCID: PMC12098963 DOI: 10.14814/phy2.70387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2025] [Revised: 05/13/2025] [Accepted: 05/13/2025] [Indexed: 05/24/2025] Open
Abstract
Oscillometry is proposed as a complementary technique to spirometry for methacholine testing. Yet, before being prescribed in conjunction with spirometry, the extent by which the oscillometric readouts are influenced by spirometric maneuvers, especially the deep inspirations, will need to be determined. Herein, 16 very mild-to-mild asthmatics underwent two methacholine challenges on separate visits. On visit 1, the response was tracked by both oscillometry and spirometry, and the challenge was stopped at the provocative concentration causing a decline in forced expiratory volume in 1 s of at least 20%. The same concentration regimen was used on visit 2, but the response was tracked by oscillometry only. The results demonstrated that, except for resistance at 19 Hz, the changes in all oscillometric readouts were greater in the challenge without spirometry (p ≤ 0.02). The maximal change in reactance at 5 Hz (Xrs5), for example, was on average 75.8% greater in the challenge without than with spirometry (p = 0.025). The number of doubling concentrations of methacholine that was needed to reach an equivalent change in Xrs5 was also lower without concomitant spirometry (p = 0.0078). It is concluded that the deep inspirations that are required in spirometry to monitor the response to methacholine decrease the oscillometric response.
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Affiliation(s)
- Cyndi Henry
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ)Université LavalQuébec CityQuébecCanada
| | - Magali Boucher
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ)Université LavalQuébec CityQuébecCanada
| | - Marie‐Ève Boulay
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ)Université LavalQuébec CityQuébecCanada
| | - Andréanne Côté
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ)Université LavalQuébec CityQuébecCanada
| | - Ynuk Bossé
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ)Université LavalQuébec CityQuébecCanada
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Kim I, Shin HW, Galant S. Baseline Impulse Oscillometry Metrics Differentiate Asthmatic Children From Non-Asthmatic Children Across Ethnicity/Race: A Meta-Analysis. Pediatr Pulmonol 2025; 60:e27389. [PMID: 39503171 DOI: 10.1002/ppul.27389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 10/22/2024] [Accepted: 10/27/2024] [Indexed: 01/25/2025]
Abstract
INTRODUCTION Identifying the asthmatic early to prevent permanent airway remodeling and the progression of the disease is desirable. In children, baseline impulse oscillometry has been found effective in identifying asthma in some studies but not others. OBJECTIVE The purpose of our study was to utilize a meta-analysis to determine whether there were significant peripheral airway differences between asthmatic and non-asthmatic children across ethnicity/race, utilizing baseline impulse oscillometry (IOS) to establish its usefulness as a diagnostic tool in this age group. METHODS This was a comprehensive search of published literature on pediatric oscillometric studies evaluating younger children (mean age ranging from 4.3 to 6 years) and older children (mean age ranging from 8.7 to 11.4 years) from the United States, Europe, Asia, and Middle East. Inclusion criteria required the primary variable resistance at 5 Hertz (R5) (kPa/L/s) or (cmH2O/L/s) for both control and asthmatic subjects, and excluded studies if asthmatics had uncontrolled disease. RESULTS Our data show that there are significantly higher R5 and area of reactance (AX) and lower reactance at 5 Hertz (X5) in both younger and older asthmatic children compared to healthy controls from various countries. CONCLUSIONS This meta-analysis firmly establishes that baseline oscillometry metrics, resistance and reactance, are effective in identifying the asthmatic child across age and the ethnicities/races evaluated.
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Affiliation(s)
- Iris Kim
- Division of Basic and Clinical Immunology, Department of Medicine, University of California, Irvine, California, USA
| | - Hye-Won Shin
- UCI Institute for Memory Impairments and Neurological Disorders (UCI MIND), University of California, Irvine, California, USA
| | - Stanley Galant
- Department of Pediatrics, Children's Hospital of Orange County, Orange, California, USA
- Department of Pediatrics, University of California, Irvine, California, USA
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Meoli A, Trischler J, Hutter M, Dressler M, Esposito S, Blümchen K, Zielen S, Schulze J. Impulse oscillometry bronchodilator response in preschool children. Pediatr Pulmonol 2024; 59:1321-1329. [PMID: 38353391 DOI: 10.1002/ppul.26909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 01/03/2024] [Accepted: 01/31/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND In preschoolers, performing an acceptable spirometry and measuring bronchodilator response (BDR) is challenging; in this context, impulse oscillometry (IOS) represents a valid alternative. However, more studies on the standardization of BDR for IOS in young children are required. OBJECTIVE The objective of the study was to identify optimal thresholds to define a positive BDR test with IOS in preschoolers with suspected asthma. METHODS Children aged 3-6 years with suspected asthma and their lung function investigated with both IOS and spirometry pre- and post-BDR were retrospectively analyzed. The spirometric BDR was defined as positive when the change of FEV1 was ≥12% or ≥200 mL. The oscillometric BDR was defined as positive in case of change of at least -40% in R5, +50% in X5, and -80% in AX. RESULTS Among 72 patients, 36 (age 5.2 ± 1 years; 64% boys) were selected for the subsequent analysis according to ATS/ERS quality criteria of measurements; specifically, 19 patients did not meet IOS and 36 did not meet spirometry criteria. The spirometric BDR was found positive in seven subjects (19.4%); conversely, a positive oscillometric BDR was identified in four patients (11.1%). No patient presented a positive BDR response with both methods. In IOS, the mean decrease in R5 and AX was 19.9% ± 10% and 44% ± 22.1%, and the mean increase in X5 was 23.3% ± 17.8%, respectively. A decrease in R5 of 25.7% (AUC 0.77, p = .03) and an increase in X5 of 25.7% (AUC 0.75, p = .04) showed the best combination of sensitivity and specificity to detect an increase of FEV1 ≥ 12% and/or ≥200 mL. CONCLUSION The IOS represents a valid alternative to spirometry to measure BDR in preschool children and should be the gold standard in this age group. We are considering a decrease of 26% in R5 and an increase of 26% in X5 as diagnostic threshold for BDR.
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Affiliation(s)
- Aniello Meoli
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Frankfurt am Main, Germany
- Department of Medicine and Surgery, Pediatric Clinic, University Hospital of Parma, Parma, Italy
| | - Jordis Trischler
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Frankfurt am Main, Germany
| | - Martin Hutter
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Frankfurt am Main, Germany
| | - Melanie Dressler
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Frankfurt am Main, Germany
| | - Susanna Esposito
- Department of Medicine and Surgery, Pediatric Clinic, University Hospital of Parma, Parma, Italy
| | - Katharina Blümchen
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Frankfurt am Main, Germany
| | - Stefan Zielen
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Frankfurt am Main, Germany
| | - Johannes Schulze
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Frankfurt am Main, Germany
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Díaz Palacios MÁ, Hervás Marín D, Giner Valero A, Colomer Hernández N, Torán Barona C, Hernández Fernández de Rojas D. Correlation between impulse oscillometry parameters and asthma control in an adult population. J Asthma Allergy 2019; 12:195-203. [PMID: 31410030 PMCID: PMC6643487 DOI: 10.2147/jaa.s193744] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/01/2019] [Indexed: 01/27/2023] Open
Abstract
Purpose: Impulse oscillometry (IOS) has been proposed as an alternative test to evaluate the obstruction of small airways and to detect changes in airways earlier than spirometry. In this study, we sought to determine the utility and association of IOS parameters with spirometry and asthma control in an adult population. Patients and methods: Adults 14-82 years of age with asthma were classified into uncontrolled asthma (n=48), partially controlled asthma (n=45), and controlled asthma (n=49) groups, and characterized with fractional exhaled nitric oxide (FENO), IOS, and spirometry in a transversal analysis planned as a one-visit study. The basic parameters evaluated in IOS are resistance at 5 Hz (R5), an index affected by the large and small airway; resistance at 20 Hz (R20), an index of the resistance of large airways; difference between R5 and R20 (R5-R20), indicative of the function of the small peripheral airways; reactance at 5 Hz (X5), indicative of the capacitive reactance in the small peripheral airways; resonance frequency (Fres), the intermediate frequency at which the reactance is null, and reactance area (XA), which represents the total reactance (area under the curve) at all frequencies between 5 Hz to Fres. Results: There were statistical differences between groups in standard spirometry and IOS parameters reflecting small peripheral airways (R5, R10, R5-R20, Fres, XA and X5) (P<0.001). Accuracy of IOS and/or spirometry to discriminate between controlled asthma vs partially controlled asthma and uncontrolled asthma was low (AUC=0.61). Using linear regression models, we found a good association between spirometry and IOS. In order to evaluate IOS as an alternative or supplementary method for spirometry, we designed a predictive model for spirometry from IOS applying a penalized regression model (Lasso). Then, we compared the original spirometry values with the values obtained from the predictive model using Bland-Altman plots, and the models showed an acceptable bias in the case of FEV1/FVC, FEV1%, and FVC%. Conclusion: IOS did not show a discriminative capacity to correctly classify patients according to the degree of asthma control. However, values of IOS showed good association with values of spirometry. IOS could be considered as an alternative and accurate complement to spirometry in adults. In a predictive model, spirometry values estimated from IOS tended to overestimate in low values of "real" spirometry and underestimate in high values.
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Affiliation(s)
| | - David Hervás Marín
- Department of Biostatistics, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Ana Giner Valero
- Department of Allergy, Hospital Universitari La Fe, Valencia, Spain
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Song JY, Ha EK, Sheen YH, Kim MA, Lee SW, Yoon JW, Lee SJ, Jung YH, Lee KS, Ahn JC, Jee HM, Han MY. The association of nasal patency with small airway resistance in children with allergic and nonallergic rhinitis. CLINICAL RESPIRATORY JOURNAL 2018; 12:2264-2270. [PMID: 29660251 DOI: 10.1111/crj.12902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 03/18/2018] [Accepted: 04/08/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Allergic rhinitis (AR) is immunologically and morphologically related to disorders in the lower airway. We investigated the relationship between the anatomy of the intranasal cavity and small airway resistance in subjects with nonallergic rhinitis (NAR). METHODS We enrolled 226 children who were 7 years old and participated in the Seongnam Atopy Project 2016. We evaluated nasal patency using acoustic rhinometry to measure the volume of the nasal cavity at 0-5 cm, and measured lung function of the lower airway using an impulse oscillometry system (IOS) and spirometry. We also performed skin prick tests for 18 aero-allergens, and measured blood total eosinophil counts (TEC) and rhinitis symptom scores for the previous month using a visual analog scale (VAS, range: 0-10). RESULTS We examined 226 children, 71 (31.7%) with AR, and 62 (27.7%) with NAR. Nasal patency in children with AR (median: 8.28 mm3 , IQR: 7.07-9.83) was lower than that of healthy children (median: 9.3 mm3 , IQR: 7.69-10.64, P = 0.011). Multivariate regression analysis showed that nasal patency was inversely associated with IOS resistance at 5 Hz after adjustment for compounding factors (B = -0.005, SE = 0.0032, P = 0.041). Analysis of NAR subjects, according to quartiles of nasal patency and quartiles of small airway resistance (Rrs5), indicated that nasal patency decreased as Rrs5 increased (linear trend: P = 0.020). CONCLUSION Nasal symptoms and TEC negatively correlated with nasal patency. Children with AR and NAR who had poor nasal patency had increased small airway resistance.
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Affiliation(s)
- Joo Young Song
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Eun Kyo Ha
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Yoon Ho Sheen
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University, Seoul, South Korea
| | - Mi-Ae Kim
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Seung Won Lee
- CHA University School of Medicine, Seongnam, South Korea
| | - Jung Won Yoon
- Department of Pediatrics, Myongji Hospital, Seonam University, Goyang, South Korea
| | - Seung Jin Lee
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Young-Ho Jung
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Kyung Suk Lee
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Jae-Cheul Ahn
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Hye Mi Jee
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
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Sheen YH, Jee HM, Ha EK, Jang HM, Lee SJ, Lee S, Lee KS, Jung YH, Choi SH, Sohn MH, Han MY. Impulse oscillometry and spirometry exhibit different features of lung function in bronchodilation. J Asthma 2018; 55:1343-1351. [PMID: 29300537 DOI: 10.1080/02770903.2017.1418884] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Bronchodilator responses (BDRs) from impulse oscillometry (IOS) are not interchangeable with those from spirometry. We aimed to identify the characteristics of children with small airway hyperresponsiveness and to determine whether BDR from IOS provides an important supplement to BDR from spirometry. METHODS The records of 592 children with asthma or suspected asthma who underwent spirometric and oscillometric BDRs were retrospectively reviewed. Oscillometric BDR was defined as positive when relative or absolute changes of Rrs5 or Xrs5 were beyond two standard deviations and spirometric BDR as positive when absolute change of forced expiratory volume in one second (FEV1) was ≥12%. Subjects were classified as positive for spirometric BDR only, positive for oscillometric BDR only, positive for both BDRs, or negative for both BDRs. RESULTS The results indicated that 101 (17.6%) subjects were positive for spirometric BDR only, 49 (8.5%) positive for oscillometric BDR only, 48 (8.3%) positive for both BDRs, and 377 (65.6%) negative for both BDRs. The agreement between spirometric and oscillometric BDRs was poor. Baseline FEV1, Rrs5, and Xrs5 values strongly influenced the BDRs. Subjects positive for oscillometric BDR only were found to be younger than those positive for spirometric BDR only (P < 0.001). Subjects positive for both BDRs were more likely to have asthma, atopic dermatitis, wheezing apart from cold, or decreased baseline lung function relative to those positive in either test (P < 0.001). CONCLUSIONS There was a low concordance between spirometric and oscillometric BDRs. Use of IOS to detect small airway hyperresponsiveness may add more information about a clinical profile of subjects with asthma.
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Affiliation(s)
- Youn Ho Sheen
- a Department of Pediatrics, CHA Gangnam Medical Center , CHA University , Seoul , South Korea
| | - Hye Mi Jee
- b Department of Pediatrics, CHA Bundang Medical Center , CHA University , Seongnam , South Korea.,c Department of Pediatrics, Graduate School , Yonsei University College of Medicine , Seoul , South Korea
| | - Eun Kyo Ha
- b Department of Pediatrics, CHA Bundang Medical Center , CHA University , Seongnam , South Korea
| | - Ho Min Jang
- b Department of Pediatrics, CHA Bundang Medical Center , CHA University , Seongnam , South Korea
| | - Seung Jin Lee
- b Department of Pediatrics, CHA Bundang Medical Center , CHA University , Seongnam , South Korea
| | - Shinhae Lee
- b Department of Pediatrics, CHA Bundang Medical Center , CHA University , Seongnam , South Korea
| | - Kyung Suk Lee
- b Department of Pediatrics, CHA Bundang Medical Center , CHA University , Seongnam , South Korea
| | - Young-Ho Jung
- b Department of Pediatrics, CHA Bundang Medical Center , CHA University , Seongnam , South Korea
| | - Sun Hee Choi
- d Department of Pediatrics , Kyung Hee University College of Medicine , Seoul , South Korea
| | - Myung Hyun Sohn
- e Department of Pediatrics , Yonsei University College of Medicine , Seoul , South Korea
| | - Man Yong Han
- b Department of Pediatrics, CHA Bundang Medical Center , CHA University , Seongnam , South Korea
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Alblooshi A, Alkalbani A, Albadi G, Narchi H, Hall G. Is forced oscillation technique the next respiratory function test of choice in childhood asthma. World J Methodol 2017; 7:129-138. [PMID: 29354485 PMCID: PMC5746666 DOI: 10.5662/wjm.v7.i4.129] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 10/08/2017] [Accepted: 11/02/2017] [Indexed: 02/06/2023] Open
Abstract
Respiratory diseases, especially asthma, are common in children. While spirometry contributes to asthma diagnosis and management in older children, it has a limited role in younger children whom are often unable to perform forced expiratory manoeuvre. The development of novel diagnostic methods which require minimal effort, such as forced oscillation technique (FOT) is, therefore, a welcome and promising addition. FOT involves applying external, small amplitude oscillations to the respiratory system during tidal breathing. Therefore, it requires minimal effort and cooperation. The FOT has the potential to facilitate asthma diagnosis and management in pre-school children by faciliting the objective measurement of baseline lung function and airway reactivity in children unable to successfully perform spirometry. Traditionally the use of FOT was limited to specialised centres. However, the availability of commercial equipment resulted in its use both in research and in clinical practice. In this article, we review the available literature on the use of FOT in childhood asthma. The technical aspects of FOT are described followed by a discussion of its practical aspects in the clinical field including the measurement of baseline lung function and associated reference ranges, bronchodilator responsiveness and bronchial hyper-responsiveness. We also highlight the difficulties and limitations that might be encountered and future research directions.
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Affiliation(s)
- Afaf Alblooshi
- Department of Pediatrics, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Alia Alkalbani
- Department of Pediatrics, Tawam Hospital, Al-Ain, United Arab Emirates
| | - Ghaya Albadi
- Department of Pediatrics, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Hassib Narchi
- Department of Pediatrics, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Graham Hall
- Department of Children’s Lung Health, Telethon Kids Institute, Perth 6000, Australia
- School of Physiotherapy and Exercise Science, Curtin University and Centre of Child Health Research, University of Western Australia, Perth 6000, Australia
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Galant SP, Komarow HD, Shin HW, Siddiqui S, Lipworth BJ. The case for impulse oscillometry in the management of asthma in children and adults. Ann Allergy Asthma Immunol 2017; 118:664-671. [PMID: 28583260 DOI: 10.1016/j.anai.2017.04.009] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/16/2017] [Accepted: 04/11/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To provide a clinical rationale for including impulse oscillometry (IOS) as a part of standard office-based asthma assessment. DATA SOURCES PubMed and Google search, limited to English language and human disease, with the keywords IOS and asthma. STUDY SELECTIONS Articles included in this review were based on the expert opinion and previous publications by the authors. RESULTS In children, IOS was more useful than spirometry in identifying asthma and uncontrolled asthma and predicting loss of control and exacerbations. IOS predicts young children at risk for loss of lung function with age and the potential for early intervention to prevent further sequelae. In adults, peripheral airway impairment detected by IOS or spirometry (ie, forced expiratory flow between 25% and 75%) commonly occurs across severity, and each measure may be complementary in predicting loss of control even with normal forced expiratory volume in 1 second. Extrafine inhaled corticosteroids with or without long-acting β-agonists proved superior to standard particle aerosols in improving IOS-detected peripheral airway obstruction. Our data also suggest that currently available commercial reference values for lung resistance at 5 Hz and lung reactance at 5 Hz are applicable across diverse populations, but further studies are needed. CONCLUSION The findings of this review suggest that IOS can add value to traditional clinical and spirometric assessment and thus improve management of asthma in children and adults, as well as have the potential to detect early dysfunction of the peripheral airways, which may result in better outcomes.
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Affiliation(s)
| | - Hirsh D Komarow
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Hye-Won Shin
- Pediatrics and Pediatrics Exercise and Genomics Research Center, University of California, Irvine, Irvine, California
| | - Salman Siddiqui
- Department of Infection, Immunity and Inflammation, Respiratory Biomedical Research Unit, Glenfield Hospital, Leicester, England
| | - Brian J Lipworth
- Scottish Centre for Respiratory Research Ninewells Hospital, Dundee, Scotland
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Clinical Implications of Oscillatory Lung Function during Methacholine Bronchoprovocation Testing of Preschool Children. BIOMED RESEARCH INTERNATIONAL 2017; 2017:9460190. [PMID: 28740854 PMCID: PMC5504923 DOI: 10.1155/2017/9460190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 04/21/2017] [Accepted: 05/07/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To investigate the repeatability and safety of measuring impulse oscillation system (IOS) parameters and the point of wheezing during bronchoprovocation testing of preschool children. METHODS Two sets of methacholine challenge were conducted in 36 asthma children. The test was discontinued if there was a significant change in reactance (Xrs5) and resistance (Rrs5) at 5 Hz (Condition 1) or respiratory distress due to airway obstruction (Condition 2). The repeatability of PC80_Xrs5, PC30_Rrs5, and wheezing (PCw) was assessed. The changes in Z-scores and SD-indexes from prebaseline (before testing) to postbaseline (after bronchodilator) were determined. RESULTS For PC30_Rrs5, PC80_Xrs5, and PCw for subjects, PC80_Xrs5 showed the highest repeatability. Fifteen of 70 tests met Condition 2. The changes from pre- and postbaseline values varied significantly for Rrs5 and Xrs5. Excluding subjects with Z-scores higher than 2SD, we were able to detect 97.1% of bronchial hyperresponsiveness during methacholine challenge based on the change in Rrs5 or Xrs5. A change in IOS parameters was associated with wheezing at all frequencies. CONCLUSION Xrs5 and Rrs5 have repeatability comparable with FEV1, and Xrs5 is more reliable than Rrs5. Clinicians can safely perform a challenge test by measuring the changes in Rrs5, Xrs5, and Z-scores from the prebaseline values.
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Saadeh C, Saadeh C, Cross B, Gaylor M, Griffith M. Advantage of impulse oscillometry over spirometry to diagnose chronic obstructive pulmonary disease and monitor pulmonary responses to bronchodilators: An observational study. SAGE Open Med 2015; 3:2050312115578957. [PMID: 26770777 PMCID: PMC4679284 DOI: 10.1177/2050312115578957] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 03/03/2015] [Indexed: 11/29/2022] Open
Abstract
Objectives: This retrospective study was a comparative analysis of sensitivity of impulse oscillometry and spirometry techniques for use in a mixed chronic obstructive pulmonary disease group for assessing disease severity and inhalation therapy. Methods: A total of 30 patients with mild-to-moderate chronic obstructive pulmonary disease were monitored by impulse oscillometry, followed by spirometry. Lung function was measured at baseline after bronchodilation and at follow-up (3–18 months). The impulse oscillometry parameters were resistance in the small and large airways at 5 Hz (R5), resistance in the large airways at 15 Hz (R15), and lung reactance (area under the curve X; AX). Results: After the bronchodilator therapy, forced expiratory volume in 1 second (FEV1) readings evaluated by spirometry were unaffected at baseline and at follow-up, while impulse oscillometry detected an immediate improvement in lung function, in terms of AX (p = 0.043). All impulse oscillometry parameters significantly improved at follow-up, with a decrease in AX by 37% (p = 0.0008), R5 by 20% (p = 0.0011), and R15 by 12% (p = 0.0097). Discussion: Impulse oscillometry parameters demonstrated greater sensitivity compared with spirometry for monitoring reversibility of airway obstruction and the effect of maintenance therapy. Impulse oscillometry may facilitate early treatment dose optimization and personalized medicine for chronic obstructive pulmonary disease patients.
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Affiliation(s)
- Constantine Saadeh
- Texas Tech University Health Sciences Center, Lubbock, TX, USA; Amarillo Center for Clinical Research (ACCR), Allergy A.R.T.S. (Asthma, Rheumatology Treatment Specialists), Amarillo, TX, USA
| | - Charles Saadeh
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Blake Cross
- Texas College of Osteopathic Medicine, University of North Texas, Denton, TX, USA
| | - Michael Gaylor
- Amarillo Center for Clinical Research (ACCR), Allergy A.R.T.S. (Asthma, Rheumatology Treatment Specialists), Amarillo, TX, USA
| | - Melissa Griffith
- Amarillo Center for Clinical Research (ACCR), Allergy A.R.T.S. (Asthma, Rheumatology Treatment Specialists), Amarillo, TX, USA
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Yoon JW, Shin YH, Jee HM, Chang SJ, Baek JH, Choi SH, Kim HY, Han MY. Useful marker of oscillatory lung function in methacholine challenge test-comparison of reactance and resistance with dose-response slope. Pediatr Pulmonol 2014; 49:521-8. [PMID: 24039248 DOI: 10.1002/ppul.22866] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 06/08/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND There are few studies focusing on the comparison of resistance (Rrs) and reactance (Xrs) in impulse oscillometry system (IOS) in the bronchial challenge test using dose-response slope (DRS), a quantitative index of bronchial hyperresponsiveness. MATERIAL AND METHODS We conducted a case-control study of 144 asthmatic and 218 non-asthmatic children to compare the diagnostic accuracy of two-point linear DRS for FEV1 , Rrs5 , and Xrs5 (DRS_FEV1 , DRS_Rrs5 , and DRS_Xrs5 ) and assessed various diagnostic cut-off points of provocation concentrations (PC) using receiver operating characteristic (ROC) curves. RESULTS DRS_FEV1 had a stronger correlation with DRS_Xrs5 (r = 0.739, P < 0.001) than with DRS_Rrs5 (r = 0.652, P < 0.001) and the area under the ROC curves of DRS_Xrs5 (0.737) was similar to that of DRS_FEV1 (0.732) and higher than that of DRS_Rrs5 (0.668). The area under the ROC curves in order of greater value was as follows: absolute change of Xrs5 (Abs_Xrs5 ) (0.759) > percent change of FEV1 (Pch_FEV1 ) (0.735) > Pch_Xrs5 (0.727) > Abs_Rrs5 (0.690) > Pch_Rrs5 (0.630). PC78 _Xrs5 and PC0.17 _Xrs5 of IOS showed considerably good sensitivity and specificity comparable to those of PC20 _FEV1 by spirometry. Additional 18 (13%) children who showed normal spirometric measures were identified as asthmatics with the use of IOS. CONCLUSION The utility of the DRS_Xrs5 to differentiate asthmatics from controls was comparable to that of the DRS_FEV1 and better than that of the DRS_Rrs5 . In addition, IOS could detect additional asthmatic patients who did not show positive responses in spirometry.
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Affiliation(s)
- Jung Won Yoon
- Department of Pediatrics, CHA University School of Medicine, Seongnam, Korea
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Retrospective observations on the ability to diagnose and manage patients with asthma through the use of impulse oscillometry: comparison with spirometry and overview of the literature. Pulm Med 2014; 2014:376890. [PMID: 24665365 PMCID: PMC3934316 DOI: 10.1155/2014/376890] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 10/31/2013] [Accepted: 11/26/2013] [Indexed: 11/20/2022] Open
Abstract
Objective. Impulse oscillometry (IOS) is an evolving technology for the diagnosis and followup of patients with asthma. Our objective is to review the findings on patients who underwent both spirometry and IOS during clinical evaluations of their asthma. The goal was to retrospectively evaluate IOS during the initial diagnosis and followup of patients with asthma in comparison with spirometry. Methods. We routinely perform IOS and spirometry evaluation in patients with suspected asthma during baseline visits and at followup. We reviewed the data on 39 patients over the age of 13 with asthma at baseline and following treatment with inhaled corticosteroids. IOS and spirometry were both done at baseline, following short acting bronchodilator administration, and at followup after at least three months of inhaled corticosteroid treatment. Results. IOS showed improvement in airway function both initially, following short acting bronchodilator introduction, and later after initiation of long term inhaled corticosteroid treatment, even when the spirometry did not reveal improvement. We noted the IOS improvement in the reactance or AX as well as the resistance in smaller airways or R5. Conclusion. IOS may provide a useful measure towards identifying an asthma diagnosis and followup without inducing the extra respiratory effort spirometry requires.
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Jee HM, Shin YH, Han MY. Evaluation of lung function in children. ALLERGY ASTHMA & RESPIRATORY DISEASE 2014. [DOI: 10.4168/aard.2014.2.1.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Hye Mi Jee
- Department of Pediatrics, CHA University School of Medicine, Seongnam, Korea
| | - Youn Ho Shin
- Department of Pediatrics, CHA University School of Medicine, Seongnam, Korea
| | - Man Yong Han
- Department of Pediatrics, CHA University School of Medicine, Seongnam, Korea
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Shin YH, Yoon JW, Choi SH, Baek JH, Kim HY, Jee HM, Yum HY, Han MY. Use of impulse oscillometry system in assessment of asthma severity for preschool children. J Asthma 2013; 50:198-203. [PMID: 23294170 DOI: 10.3109/02770903.2012.751996] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The National Asthma Education and Prevention Program/Expert Panel Report (NAEPP/EPR)-3 Guidelines for asthma treatment categorize asthma severity based on impairment and risks and on medications administered. The objective of this study was to determine whether impulse oscillometry system (IOS) measures in preschool children are consistent with asthma severity as defined by NAEPP/EPR-3 Guidelines. METHODS Asthma severity of the 162 subjects (aged 2-5 years) was classified by impairment and risks for exacerbations requiring oral systemic corticosteroids, by medication usage, and by combination classification (higher severity of impairment and risks or medication usage). An experienced pediatrician determined the appropriate medications for each child and parents completed structured questionnaires regarding day and night symptoms and interference with normal activity over the preceding 4 weeks. All children were tested by IOS. RESULTS The mean age was 3.7 ± 0.9 years and 91 (56%) of the total patients were males. When asthma severity was based on (1) impairment and risks and (2) medication usage, asthma was "intermittent" in 17.9% and 11.1% of the total patients, "mild persistent" in 42.0% and 50.6% of total patients, and "moderate-severe persistent" in 40.1% and 38.3% of total patients, respectively. The agreement between severity based on impairment and risks and medication usage was not significant. Xrs(5) z-scores differed between intermittent asthma and mild/moderate-severe persistent asthma, as determined by medication usage and combination classification, but not by impairment and risks. As asthma severity (assessed by medication usage) increased, the duration of asthma increased. CONCLUSIONS Xrs(5) can be used to discriminate intermittent and persistent asthma in preschool children. Further studies with larger sample sizes are warranted to confirm this finding and to determine the underlying mechanism.
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Affiliation(s)
- Youn Ho Shin
- Department of Pediatrics, CHA University School of Medicine, Seongnam, Republic of Korea
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Yoon JW, Hur HY, Jee HM, Baek JH, Kim HY, Shin YH, Han MY. Comparison of bronchial responsiveness assessing dose-response slope between cough-variant asthma and classic asthma in young children. ALLERGY ASTHMA & RESPIRATORY DISEASE 2013. [DOI: 10.4168/aard.2013.1.4.309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jung Won Yoon
- Department of Pediatrics, Myongji Hospital, Goyang, Korea
| | - Hye Young Hur
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Hye Mi Jee
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Ji Hyeon Baek
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Hyeong Yoon Kim
- Department of Pediatrics, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Youn Ho Shin
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
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Qi GS, Zhou ZC, Gu WC, Xi F, Wu H, Yang WL, Liu JM. Detection of the airway obstruction stage in asthma using impulse oscillometry system. J Asthma 2012. [PMID: 23189951 DOI: 10.3109/02770903.2012.743154] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Although spirometry is the most common method for evaluating the airway obstruction stage in asthma patients, it is difficult to perform in some patients. The aim of this study was to evaluate whether impulse oscillometry, an easy-to-perform technique, can detect asthmatic airway obstruction stage. METHODS A total of 80 subjects, including healthy volunteers and patients with asthma, were enrolled in this study. The asthma patients were classified into three groups according to American Thoracic Society (ATS)/European Respiratory Society (ERS)-2005: the mild group (forced expiratory volume in 1 second (FEV(1)) ≥ 70% predicted (Pred), n = 20), the moderate group (50% Pred ≤ FEV(1) <70% Pred, n = 20), and the severe group (FEV(1) < 50% Pred, n = 20). Spirometry and impulse oscillometry (IOS) parameters were obtained from every subject. Correlation analysis was used to compare spirometry measurements and IOS parameters. One-way analysis of variance (ANOVA) was performed to compare IOS parameters among different groups. The potential of using all individual IOS parameters to detect the different stages of asthmatic airway obstruction was evaluated by the receiver operating characteristic (ROC) curve analysis. RESULTS The correlation analysis showed that IOS parameters, such as respiratory resistance at 5 Hz (R(5)), respiratory resistance at 10 Hz (R(10)), respiratory resistance at 20 Hz (R(20)), difference in resistance between 5 Hz and 20 Hz (R(5-20)), impedance at 5 Hz (Z(5)), resonant frequency (Fres), and area of reactance (AX) were negatively correlated with FEV(1) and peak expiratory flow (PEF), while reactance at 5 Hz (X(5)) was positively correlated with FEV(1) and PEF. The increase in R(5), R(10), R(20), Z(5), R(5-20), Fres, (-X(5)), and AX parameters corresponded significantly with an increase in the airway obstruction stage, as determined by one-way ANOVA . ROC curve analysis revealed that all the IOS parameters studied, except for Fres, were capable of classifying asthmatic airway obstruction. R(5), R(5-20), and Z(5) were the most accurate parameters. CONCLUSION IOS provides an accurate, reliable, and patient-friendly technique for classifying asthmatic airway obstruction.
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Affiliation(s)
- Guang-Sheng Qi
- Department of Respiratory Medicine, Shanghai Pudong New Area People's Hospital, Shanghai, China
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Relating small airways to asthma control by using impulse oscillometry in children. J Allergy Clin Immunol 2011; 129:671-8. [PMID: 22178635 DOI: 10.1016/j.jaci.2011.11.002] [Citation(s) in RCA: 169] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 11/02/2011] [Accepted: 11/07/2011] [Indexed: 01/12/2023]
Abstract
BACKGROUND Previous reports suggest that the peripheral airways are associated with asthma control. Patient history, although subjective, is used largely to assess asthma control in children because spirometric results are many times normal values. Impulse oscillometry (IOS) is an objective and noninvasive measurement of lung function that has the potential to examine independently both small- and large-airway obstruction. OBJECTIVE We sought to determine the utility of IOS in assessing asthma control in children. METHODS Asthmatic and healthy children (6-17 years) were enrolled in the study. Spirometric and IOS (resistance of the respiratory system at 5 Hz [R5] and 20 Hz [R20], reactance of the respiratory system at 5 Hz [X5], resonant frequency of reactance [Fres], and area under the reactance curve between 5 Hz and Fres [reactance area {AX}]) values were collected in triplicate before and after a bronchodilator was administered. The physicians were blinded to the IOS measurements and assessed asthma control using American Thoracic Society guidelines. RESULTS Small-airway IOS measurements, including the difference of R5 and R20 [R5-20], X5, Fres, and AX, of children with uncontrolled asthma (n = 44) were significantly different from those of children with controlled asthma (n = 57) and healthy children (n = 14), especially before the administration of a bronchodilator. However, there was no difference in large-airway IOS values (R20). No differences were found between children with controlled asthma and healthy children in any of the end points. Receiver operating characteristic analysis showed cut points for baseline R5-20 (1.5 cm H(2)O · L(-1) · s) and AX (9.5 cm H(2)O · L(-1)) that effectively discriminated controlled versus uncontrolled asthma (area under the curve, 0.86 and 0.84) and correctly classified more than 80% of the population. CONCLUSION Uncontrolled asthma is associated with small-airways dysfunction, and IOS might be a reliable and noninvasive method to assess asthma control in children.
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Current World Literature. Curr Opin Otolaryngol Head Neck Surg 2011; 19:229-30. [DOI: 10.1097/moo.0b013e328347afd0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Meraz EG, Nazeran H, Ramos CD, Nava P, Diong B, Goldman MD. Analysis of impulse oscillometric measures of lung function and respiratory system model parameters in small airway-impaired and healthy children over a 2-year period. Biomed Eng Online 2011; 10:21. [PMID: 21439045 PMCID: PMC3071336 DOI: 10.1186/1475-925x-10-21] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 03/25/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Is Impulse Oscillometry System (IOS) a valuable tool to measure respiratory system function in Children? Asthma (A) is the most prevalent chronic respiratory disease in children. Therefore, early and accurate assessment of respiratory function is of tremendous clinical interest in diagnosis, monitoring and treatment of respiratory conditions in this subpopulation. IOS has been successfully used to measure lung function in children with a high degree of sensitivity and specificity to small airway impairments (SAI) and asthma. IOS measures of airway function and equivalent electrical circuit models of the human respiratory system have been developed to quantify the severity of these conditions. Previously, we have evaluated several known respiratory models based on the Mead's model and more parsimonious versions based on fitting IOS data known as extended RIC (eRIC) and augmented RIC (aRIC) models have emerged, which offer advantages over earlier models. METHODS IOS data from twenty-six children were collected and compared during pre-bronchodilation (pre-B) and post- bronchodilation (post-B) conditions over a period of 2 years. RESULTS AND DISCUSSION Are the IOS and model parameters capable of differentiating between healthy children and children with respiratory system distress? Children were classified into two main categories: Healthy (H) and Small Airway-Impaired (SAI). The IOS measures and respiratory model parameters analyzed differed consistently between H and SAI children. SAI children showed smaller trend of "growth" and larger trend of bronchodilator responses than H children.The two model parameters: peripheral compliance (Cp) and peripheral resistance (Rp) tracked IOS indices of small airway function well. Cp was a more sensitive index than Rp. Both eRIC and aRIC Cps and the IOS Reactance Area, AX, (also known as the "Goldman Triangle") showed good correlations. CONCLUSIONS What are the most useful IOS and model parameters? In this work we demonstrate that IOS parameters such as resistance at 5 Hz (R5), frequency-dependence of resistance (fdR: R5-R20), reactance area (AX), and parameter estimates of respiratory system such as Cp and Rp provide sensitive indicators of lung function and have the capacity to differentiate between obstructed and non-obstructed airway conditions. They are also capable of demonstrating airway growth-related changes over a two-year period. We conclude that the IOS parameters AX and the eRIC model derived parameter Cp are the most reliable parameters to track lung function in children before and after bronchodilator and over a time period (2 years). Which model is more suitable for interpreting IOS data? IOS data are equally well-modelled by eRIC and aRIC models, based on the close correlations of their corresponding parameters - excluding upper airway shunt compliance. The eRIC model is a more parsimonious and equally powerful model in capturing the differences in IOS indices between SAI and H children. Therefore, it may be considered a clinically-preferred model of lung function.
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Affiliation(s)
- Erika G Meraz
- Department of Electrical and Computer Engineering, The University of Texas at El Paso, El Paso, Texas, USA
- Universidad Autónoma de Ciudad Juárez, Chihuahua, México
| | - Homer Nazeran
- Department of Electrical and Computer Engineering, The University of Texas at El Paso, El Paso, Texas, USA
| | - Carlos D Ramos
- Department of Electrical and Computer Engineering, The University of Texas at El Paso, El Paso, Texas, USA
| | - Pat Nava
- Department of Electrical and Computer Engineering, The University of Texas at El Paso, El Paso, Texas, USA
| | - Bill Diong
- Department of Engineering, Texas Christian University, Fort Worth, Texas, USA
| | - Michael D Goldman
- Department of Electrical and Computer Engineering, The University of Texas at El Paso, El Paso, Texas, USA
- Geffen School of Medicine, University of California at Los Angeles, California, USA
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