J ALLERGY CLIN IMMUNOL

FEBRUARY 2014

AB242 Abstracts

TUESDAY

835 The Evaluation Of Airway Obstruction By Lung SoundAnalysis In The Patients With Asthma

Dr. Terufumi Shimoda, MD1, Dr. Yukio Nagasaka, MD2, Dr. Yasushi

Obase, MD3, Dr. Michiyoshi Imaoka, MD1, Dr. Tomoaki

Iwanaga, MD1, Dr. Reiko T. Kishikawa, MD1; 1Fukuoka National Hospi-

tal, Fukuoka, Japan, 2Kyoto Respiratory Center, Otowa Hospital, Kyoto,

Japan, 3Kawasaki Medical School, Kurashiki, Japan.

RATIONALE: A relationship between various indices of computer-aided

lung sound analysis (LSA) and respiratory function has been reported. We

investigated whether LSA can be used to evaluate peripheral airway

obstruction in asthmatic patients.

METHODS: A total of 49 inhaled corticosteroid naive bronchial asthma

patients underwent LSA, spirometry, impulse oscillometry and airway

hyperresponsiveness testing with inhaled acetylcholine. Lung sounds were

recorded and analyzed using a bio-sound sensor and a sound

spectrometer(BSS-01 and LSA-2008; Kenz Medico, Saitama, Japan).

The data were analyzed to assess correlations between the expiration:ins-

piration lung sound power ratio (dB) at low frequencies between 100 and

195 Hz (E/I LF) and various parameters.

RESULTS: E/I LF showed a statistically significant positive correlation

with R5, R20, AX and Fres(r50.34, p50.017; r50.34, p50.018, r5 0.40,

p5 0.005; r 5 0.32, p5 0.024, respectively). A negative correlation was

found between E/I LF and X5 (r 5 -0.47, p 5 0.0006). E/I LF showed a

negative correlation with FEV1.0/FVC(%), FEV1.0,%pred, V50,%pred, and

V25,%pred (r 5 -0.41, p 5 0.003; r 5 -0.44, p 5 0.002; r 5 -0.49, p 50.0004; r 5 -0.30, p 5 0.024, respectively). E/I LF was negatively corre-

lated with logPC20 (r 5 -0.30, p 5 0.024).

CONCLUSIONS: E/I LF of lung sound analysis can be an indicator of

central and peripheral airway obstruction in bronchial asthma patients.

836 IOS Is Useful In Younger Children Who Cannot PerformSpirometry

Dr. Shintaro Okazaki, MD, Hiroki Murai, MD, PhD, Hisako

Hayashi, MD, Akiko Kawakita, MD, Motoko Yasutomi, MD, PhD, Mitsu-

fumi Mayumi, MD, PhD, Yusei Ohshima, MD, PhD; University of Fukui,

Fukui, Japan.

RATIONALE: Spirometry is a common and reliable pulmonary function

test to evaluate the airway obstruction. However it is challenging for

younger children to be carried out. Recently, impulse oscillation

system(IOS) has been shown to evaluate the localization of airway

obstruction without forced breathing. Although IOS has a potential to be

applied for younger children, few data are available in asthmatic children.

METHODS: 40 asthmatic children were recruited to the study. After

obtaining guardians’ informed consent, airway resistance, reactance, and

flow-volume curve were measured by an IOS, Mostgraph TM(Chest Co.

Japan) and a spirometer. Correlations between each parameter were

analyzed using Spearman’s correlation tests. Reveresibility of airway

obstruction and responsiveness to short acting beta stimulant(SABA) were

evaluated by measuring before and SABA inhalation.

RESULTS: 39 patients(3-14 years old) successfully performed IOS. The

younger the patient is, the variance of parameter will be larger. R5, R20,

and R5-R20 have negative correlations with patients’ weight, height, body

surface area, and age, whereas X5 has a positive correlationwith them. The

patients with large R20 values(central airway obstruction) tends to exhibit

more responsiveness to SABA, wheres the patients with large R20-R5

values(peripheral airway obstruction) did not.

CONCLUSIONS: IOS can be an alternative to spirometry in younger

children. Peripheral obstruction dominant asthmatic patients may be less

effective in using beta stimulant.

837 The Association Of Spirometry With Asthma Control andAsthma Morbidity In Inner City Schoolchildren With Asthma

Dr. Watcharoot Kanchongkittiphon, MD, PhD1,2, Dr. Jonathan M.

Gaffin, MD, MMSc1,3, Dr. Lianne S. Kopel, MD1,3, Dr. William J.

Sheehan, MD1,3, Dr. Sachin N. Baxi, MD1,3, Dr. Perdita

Permaul, MD3,4, Dr. Diane R. Gold, MD, MPH3,5, Dr. Wanda

Phipatanakul, MD, MS, FAAAAI1,3; 1Boston Children’s Hospital, Boston,

MA, 2Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,3Harvard Medical School, Boston, MA, 4Division of Pediatric Allergy/

Immunology, Massachusetts General Hospital, Boston, MA, 5Channing

Laboratory, Brigham and Women’s Hospital, Boston, MA.

RATIONALE: Forced expiratory volume in 1 second (FEV1) percent pre-

dicted is recommended for the assessment for asthma control. Previous re-

ports demonstrated 46% of children have normal FEV1 alone, but have low

forced expiratory flow from 25% to 75% of vital capacity (FEF25-75). It has

been suggested that low FEF25-75 may be more relevant to clinical impair-

ment. In addition, bronchodilator reversibility (BDR) has been related to

airway inflammation and exacerbations.

METHODS: The School Inner-City Asthma Study (SICAS) is an ongoing

study evaluating the role of classroom and school allergens and mold on

asthma morbidity for inner city schoolchildren with asthma. Baseline

FEV1, FEF25-75 and BDR from subjects enrolled in SICAS was analyzed

for morbidity outcomes.

RESULTS: Of 259 subjects, 27 (10.4%) had an isolated low FEF25-75.These subjects with a low FEF25-75 had more than double the odds of

nocturnal wheezing in the past 2 weeks (OR 2.5, 95%CI 1.1–5.6) and dys-

pnea in the past 4 weeks (OR 2.9, 95%CI 1.0–8.0) compared with those

with normal spirometry. From 175 subjects with both pre- and post-bron-

chodilator spirometry, 38 (22%) subjects with positive BDR (>_12% change

in FEV1) had significantly greater risk for activity limitation (OR 2.9, 95%

CI 1.2-6.8), nocturnal wheezing (OR 2.4, 95%CI 1.2–5.1), and school

absence (OR 4.1, 95%CI 1.2–13.5) in the past 4 weeks.

CONCLUSIONS: In inner city school children with asthma, an isolated

low FEF25-75, and bronchodilator reversibility were associated with

increased asthma symptoms. FEF25-75 and BDR should be considered a

tool for assessing asthma severity, morbidity, and control.

838 Impulse Oscillometry (IOS) Is Easier Than Spirometry ForOlder Asthmatic and Non-Asthmatic Subjects

Dr. Michael C. Balduzzi, MD1, Dr. Adam Updegraff, DO1, Dr. Kerri

Rawson, PhD, MS2, Dr. Brice Taylor, MD3, Dr. Monroe J. King, DO,

FAAAAI4, Dr. Richard F. Lockey, MD5; 1University of South Florida,

Tampa, FL, 2Washington University School of Medicine of Medicine,

St. Louis, MO, 3Morsani College of Medicine, University of South FLor-

ida, Tampa, FL, 4University of South Florida, Largo, FL, 5Division of Al-

lergy and Immunology, Department of Internal Medicine, University of

South Florida Morsani College of Medicine and James A. Haley Veterans’

Affairs Hospital, Tampa, FL.

RATIONALE: Asthma is underdiagnosed in the elderly and some older

persons find spirometry difficult. Therefore, a feasibility study comparing

IOS and spirometry was performed in older asthmatics and non-asthmatics

to determine patient acceptance and their ability to meet American

Thoracic Society (ATS) and European Respiratory Society (ERS)

standards.

METHODS: Older subjects (age >_ 65) with physician diagnosed asthma

and controls without asthma were asked to perform IOS and spirometry

until they met ATS/ERS standards. They performed up to 8 trials of each

unless they were unable to continue or required a rescue bronchodilator.

They were asked to rate the ease of IOS and spirometry on a scale of 1-5

(easy-hard).

RESULTS: Nineteen subjects meeting ATS/ERS standards completed

IOS and spirometry. Ages ranged from 65-82 (M574.05, SD55.27) and

58% were female. No significant differences in age or gender were found

between asthma (n513) and control (n56) groups. IOS ratings ranged

from 1 to 3 (M51.26, SD5.56) and spirometry ratings ranged from 1 to 5

(M52.95, SD51.39). Using Wilcoxon Signed Ranks Test, the IOS was

rated significantly easier to perform than spirometry, z 5 -3.37, p5 .001,

r 5 -.55.

CONCLUSIONS: IOS was easier to perform than spirometry for older

subjects with and without asthma and is a valuable option when patients

can’t perform spirometry.