Sensitivity Study Of Impulse Oscillomety Pulmonary Function In Evaluating The Control Level Of Bronchial Asthma In Children

Objective:To explore the sensitivity of impulse oscillometry and pulmonary function test in the assessment of children’s asthma control level.Methods:A total of 300 children with bronchial asthma who were admitted to the pediatric clinic and ward of Shandong Provincial Hospital from March 2020 to December 2020 were divided into complete control group,partial control group and uncontrolled group according to C-ACT score.Pulmonary function test(FEV₁,FEV₁/FVC,PEF,FEF₅₀,FEF₇₅,MMEF)and impulse oscillometry（Z5,R5,R20,X5,Fres,AX）were tested in the three groups.Perform impulse oscillometry testing first,and then perform pulmonary function testing,to avoid forced exhalation to cause airway and emotional tensionand and respiratory muscle fatigue in children and affect the measurement results of impulse oscillometry.The data obtained was analyzed statistically using SPSS 25.0 software.Results:（1）Comparison of pulmonary function test indexes among the three groups:complete control group（106.02±11.94,100.55（95.73,103.83）,102.82±14.53,87.60（72.60,97.90）,68.25（57.50,82.58）,83.75（70.03,97.13））and some control groups（102.46±15.56,97.45（92.28,103.00）,98.17±15.95,78.40（66.93,93.63）,62.50（46.38,80.28）,75.50（61.48,93.63））FEV₁,FEV₁/FVC,PEF,FEF₅₀,FEF₇₅,and MMEF levels were higher than those in the uncontrolled group（95.33±16.95,93.45（87.88,99.18）,88.22±19.45,64.10（53.30,79.85）,51.25（36.43,70.05）,60.85（51.20,77.68））The difference was statistically significant（all P<0.05）,but there was no significant difference between the complete control group and part of the control group（all P>0.05）.（2）Comparison of impulse oscillometry indexes among the three group:complete control group（66.11（61.96,72.64）,66.45（62.07,73.70）,74.76（66.45,82.92）,66.17（59.17,76.34）,1.02（0.66,1.43））,18.11（15.77,19.22）)Z5,R5,R20,X5,AX,Fres levels are lower than some control groups（76.56（68.35,85.07）,76.37（67.11,84.42）,80.72（68.85,92.09）,78.74（66.67,91.55）,1.59（1.22,2.31）,19.69（17.78,21.47））,the difference was statistically significant（all P<0.05）;the levels of Z5,R5,R20,X5,AX,and Fres in some control groups were lower than those of uncontrolled Group（86.79（76.92,104.55）,86.24（76.38,103.28）,89.06（78.58,100.35）,95.79（78.45,120.60）,2.55（1.92,3.46）,22.21（19.66,25.60））,the difference was statistically significant（all P<0.05）.（3）The orderly logistic regression analysis results of two lung function test indexes and asthma control level:impulse oscillometry index AX（OR=4.208,95%CI:1.826～9.699,P=0.001）and asthma control level are significant There was a negative correlation,PEF（OR=0.977,95%CI:0.958～0.997,P=0.027）,an index of pulmonary function test,was significantly positively correlated with the level of asthma control.（4）ROC analysis of pulmonary function test index for predicting complete control of asthma:the areas under the curve of FEV₁,FEV₁/FVC,PEF,FEF_50,FEF₇₅and MMEF for predicting complete control of asthma were 0.628,0.645,0.670,0.666,0.653 and0.667,respectively.The area under the curve of PEF was the largest,and the sensitivity and specificity for predicting complete control of asthma were 78.0%and52.0%,respectively.（5）Impulse oscillometry index predicted asthma not completely controlled by ROC analysis:the areas under the curve predicted by Z5,R5,R20,X5,AX and Fres were 0.805,0.782,0.668,0.782,0.839,0.787 respectively,all of which had certain predictive value.AX had the highest predictive value for incomplete control of asthma（AUC was the highest）,and the sensitivity was 78.5%.The specificity is 73.0%.（6）Correlation analysis of two pulmonary function test:Z5,R5,AX,X5,Fres and FEV_1,FEV₁/FVC,PEF,FEF₅₀,FEF₇₅,MMEF are all negatively correlated（all P<0.05）.Conclusion:（1）Impulse oscillometry has good sensitivity in assessing the level of asthma control in children,and it is more sensitive to distinguish between complete control and partial control of asthma in children than pulmonary function test.（2）The predictive value of pulse oscillatory pulmonary function indexes（Z5,R5,AX,X5,Fres）for incomplete control of asthma was higher than that of pulmonary function test(FEV₁,FEV₁/FVC,PEF,FEF₅₀,FEF₇₅,MMEF),among which AX had the highest predictive value（AUC was 0.839,sensitivity was 78.5%,specificity was 73.0%）.（3）Impulse oscillometry function indexes（Z5,R5,AX,X5,Fres）were negatively correlated with pulmonary function test indexes(FEV₁,FEV₁/FVC,PEF,FEF₅₀,FEF₇₅,MMEF).