A Rapid, Handheld Device to Assess Respiratory Resistance: Clinical and Normative Evidence

Aaron B. Holley, Wesley D. Boose, Michael Perkins, Karen L. Sheikh, Nancy P. Solomon, Angela M. Dietsch, Jafar Vossoughi, Arthur T. Johnson, Jacob F. Collen

Research output: Contribution to journalArticle

Abstract

INTRODUCTION: Following reports of respiratory symptoms among service members returning from deployment to South West Asia (SWA), an expert panel recommended pre-deployment spirometry be used to assess disease burden. Unfortunately, testing with spirometry is high cost and time-consuming. The airflow perturbation device (APD) is a handheld monitor that rapidly measures respiratory resistance (APD-Rr) and has promising but limited clinical data. Its speed and portability make it ideally suited for large volume pre-deployment screening. We conducted a pilot study to assess APD performance characteristics and develop normative values. MATERIALS AND METHODS: We prospectively enrolled subjects and derived reference equations for the APD from those without respiratory symptoms, pulmonary disease, or tobacco exposure. APD testing was conducted by medical technicians who received a 10-min in-service on its use. A subset of subjects performed spirometry and impulse oscillometry (iOS), administered by trained respiratory therapists. APD measures were compared with spirometry and iOS. RESULTS: The total study population included 199 subjects (55.8% males, body mass index 27.7 ± 6.0 kg/m2, age 49.9 ± 18.7 yr). Across the three APD trials, mean inspiratory (APD-Ri), expiratory (APD-Re), and average (APD-Ravg) resistances were 3.30 ± 1.0, 3.69 ± 1.2, and 3.50 ± 1.1 cm H2O/L/s. Reference equations were derived from 142 clinically normal volunteers. Height, weight, and body mass index were independently associated with APD-Ri, APD-Re, and APD-Ravg and were combined with age and gender in linear regression models. APD-Ri, APD-Re, and APD-Ravg were significantly inversely correlated with FEV1 (r = -0.39 to -0.42), FVC (r = -0.37 to -0.40), and FEF25-75 (r = -0.31 to -0.35) and positively correlated with R5 (r = 0.61-0.62), R20 (r = 0.50-0.52), X5 (r = -0.57 to -0.59), and FRES (r = 0.42-0.43). Bland-Altman plots showed that the APD-Rr closely approximates iOS when resistance is normal. CONCLUSION: Rapid testing was achieved with minimal training required, and reference equations were constructed. APD-Rr correlated moderately with iOS and weakly with spirometry. More testing is required to determine whether the APD has value for pre- and post-deployment respiratory assessment.

Original languageEnglish (US)
Pages (from-to)e370-e377
JournalMilitary medicine
Volume183
Issue number9-10
DOIs
StatePublished - Sep 1 2018

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Equipment and Supplies
Oscillometry
Spirometry
Linear Models
Body Mass Index
Pulmonary Ventilation
Lung Diseases
Tobacco
Healthy Volunteers
Weights and Measures
Costs and Cost Analysis

Keywords

  • asthma
  • dyspnea
  • impulse oscillometry
  • occupational lung disease
  • respiratory resistance
  • spirometry

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Holley, A. B., Boose, W. D., Perkins, M., Sheikh, K. L., Solomon, N. P., Dietsch, A. M., ... Collen, J. F. (2018). A Rapid, Handheld Device to Assess Respiratory Resistance: Clinical and Normative Evidence. Military medicine, 183(9-10), e370-e377. https://doi.org/10.1093/milmed/usx224

A Rapid, Handheld Device to Assess Respiratory Resistance : Clinical and Normative Evidence. / Holley, Aaron B.; Boose, Wesley D.; Perkins, Michael; Sheikh, Karen L.; Solomon, Nancy P.; Dietsch, Angela M.; Vossoughi, Jafar; Johnson, Arthur T.; Collen, Jacob F.

In: Military medicine, Vol. 183, No. 9-10, 01.09.2018, p. e370-e377.

Research output: Contribution to journalArticle

Holley, AB, Boose, WD, Perkins, M, Sheikh, KL, Solomon, NP, Dietsch, AM, Vossoughi, J, Johnson, AT & Collen, JF 2018, 'A Rapid, Handheld Device to Assess Respiratory Resistance: Clinical and Normative Evidence', Military medicine, vol. 183, no. 9-10, pp. e370-e377. https://doi.org/10.1093/milmed/usx224
Holley, Aaron B. ; Boose, Wesley D. ; Perkins, Michael ; Sheikh, Karen L. ; Solomon, Nancy P. ; Dietsch, Angela M. ; Vossoughi, Jafar ; Johnson, Arthur T. ; Collen, Jacob F. / A Rapid, Handheld Device to Assess Respiratory Resistance : Clinical and Normative Evidence. In: Military medicine. 2018 ; Vol. 183, No. 9-10. pp. e370-e377.
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T2 - Clinical and Normative Evidence

AU - Holley, Aaron B.

AU - Boose, Wesley D.

AU - Perkins, Michael

AU - Sheikh, Karen L.

AU - Solomon, Nancy P.

AU - Dietsch, Angela M.

AU - Vossoughi, Jafar

AU - Johnson, Arthur T.

AU - Collen, Jacob F.

PY - 2018/9/1

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N2 - INTRODUCTION: Following reports of respiratory symptoms among service members returning from deployment to South West Asia (SWA), an expert panel recommended pre-deployment spirometry be used to assess disease burden. Unfortunately, testing with spirometry is high cost and time-consuming. The airflow perturbation device (APD) is a handheld monitor that rapidly measures respiratory resistance (APD-Rr) and has promising but limited clinical data. Its speed and portability make it ideally suited for large volume pre-deployment screening. We conducted a pilot study to assess APD performance characteristics and develop normative values. MATERIALS AND METHODS: We prospectively enrolled subjects and derived reference equations for the APD from those without respiratory symptoms, pulmonary disease, or tobacco exposure. APD testing was conducted by medical technicians who received a 10-min in-service on its use. A subset of subjects performed spirometry and impulse oscillometry (iOS), administered by trained respiratory therapists. APD measures were compared with spirometry and iOS. RESULTS: The total study population included 199 subjects (55.8% males, body mass index 27.7 ± 6.0 kg/m2, age 49.9 ± 18.7 yr). Across the three APD trials, mean inspiratory (APD-Ri), expiratory (APD-Re), and average (APD-Ravg) resistances were 3.30 ± 1.0, 3.69 ± 1.2, and 3.50 ± 1.1 cm H2O/L/s. Reference equations were derived from 142 clinically normal volunteers. Height, weight, and body mass index were independently associated with APD-Ri, APD-Re, and APD-Ravg and were combined with age and gender in linear regression models. APD-Ri, APD-Re, and APD-Ravg were significantly inversely correlated with FEV1 (r = -0.39 to -0.42), FVC (r = -0.37 to -0.40), and FEF25-75 (r = -0.31 to -0.35) and positively correlated with R5 (r = 0.61-0.62), R20 (r = 0.50-0.52), X5 (r = -0.57 to -0.59), and FRES (r = 0.42-0.43). Bland-Altman plots showed that the APD-Rr closely approximates iOS when resistance is normal. CONCLUSION: Rapid testing was achieved with minimal training required, and reference equations were constructed. APD-Rr correlated moderately with iOS and weakly with spirometry. More testing is required to determine whether the APD has value for pre- and post-deployment respiratory assessment.

AB - INTRODUCTION: Following reports of respiratory symptoms among service members returning from deployment to South West Asia (SWA), an expert panel recommended pre-deployment spirometry be used to assess disease burden. Unfortunately, testing with spirometry is high cost and time-consuming. The airflow perturbation device (APD) is a handheld monitor that rapidly measures respiratory resistance (APD-Rr) and has promising but limited clinical data. Its speed and portability make it ideally suited for large volume pre-deployment screening. We conducted a pilot study to assess APD performance characteristics and develop normative values. MATERIALS AND METHODS: We prospectively enrolled subjects and derived reference equations for the APD from those without respiratory symptoms, pulmonary disease, or tobacco exposure. APD testing was conducted by medical technicians who received a 10-min in-service on its use. A subset of subjects performed spirometry and impulse oscillometry (iOS), administered by trained respiratory therapists. APD measures were compared with spirometry and iOS. RESULTS: The total study population included 199 subjects (55.8% males, body mass index 27.7 ± 6.0 kg/m2, age 49.9 ± 18.7 yr). Across the three APD trials, mean inspiratory (APD-Ri), expiratory (APD-Re), and average (APD-Ravg) resistances were 3.30 ± 1.0, 3.69 ± 1.2, and 3.50 ± 1.1 cm H2O/L/s. Reference equations were derived from 142 clinically normal volunteers. Height, weight, and body mass index were independently associated with APD-Ri, APD-Re, and APD-Ravg and were combined with age and gender in linear regression models. APD-Ri, APD-Re, and APD-Ravg were significantly inversely correlated with FEV1 (r = -0.39 to -0.42), FVC (r = -0.37 to -0.40), and FEF25-75 (r = -0.31 to -0.35) and positively correlated with R5 (r = 0.61-0.62), R20 (r = 0.50-0.52), X5 (r = -0.57 to -0.59), and FRES (r = 0.42-0.43). Bland-Altman plots showed that the APD-Rr closely approximates iOS when resistance is normal. CONCLUSION: Rapid testing was achieved with minimal training required, and reference equations were constructed. APD-Rr correlated moderately with iOS and weakly with spirometry. More testing is required to determine whether the APD has value for pre- and post-deployment respiratory assessment.

KW - asthma

KW - dyspnea

KW - impulse oscillometry

KW - occupational lung disease

KW - respiratory resistance

KW - spirometry

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